Iowa Medicaid denying gender-affirming, medically necessary surgery to someone simply because they are transgender is discriminatory. And now it's also clearly against the law.
That's what the Iowa Supreme Court unanimously ruled today, establishing that Iowa’s Medicaid program may not categorically discriminate against transgender people seeking gender-affirming, medically necessary care. It's the first Iowa Supreme Court case recognizing the right that transgender Iowans have to nondiscrimination under the Iowa Civil Rights Act in Medicaid — or by any other public accommodation.
We brought the lawsuit on behalf of two brave clients, EerieAnna Good of southwest Iowa and Carol Ann Beal of northwest Iowa, that were denied Medicaid coverage for gender-affirming medical care by the Iowa Department of Human Services because they were transgender.
One of the clients, Carol Ann Beal, said, “This has been a long journey since we first started fighting for this gender-affirming health care which some transgender people so desperately need. I’m so glad we finally won. I’m still processing this. But I’m extremely happy for those people who will come after me, that we’ve made a path for them so that they can get the medical care and surgery they need. That’s one reason I fought so hard for this. It’s opened a door.”
The other client, EerieAnna Good, said “I’m super happy about this decision. It’s been a long time coming. I’m honored and thankful that I’ve been able to see this victory and that the ACLU had my back. It’s hard to believe that it’s taken so many years for Iowa laws to catch up with the reality of transgender Iowans. I’ve been living this reality for many years.
“I’m honored to have the opportunity to do what I have to help the hundreds and thousands of other transgender people out there who definitely need this type of medical care,” EerieAnna said. “So many people still don’t understand that this is not something we need for trivial or cosmetic reasons. It’s medical care a doctor is recommending for someone who has a medical need for it. And it can save lives. Transgender people are at such risk for suicide, and I’ve lost transgender friends to suicide. I hope this decision helps change that.”
The Iowa Supreme Court rejected arguments made by the Iowa Department of Human Services, which administers Medicaid, that such medical care was primarily for psychological or cosmetic reasons. The unrebutted evidence in this case demonstrated that the care Carol and EerieAnna seek is not cosmetic but is medically necessary for them.
In the ruling, the Iowa Supreme Court recognized that the Iowa Civil Rights Act specifically prohibits discrimination based on gender identity and has done so since 2007. It also affirmed the lower court's decision on this case, which found, “Gender Dysphoria has a biological component and the current medical consensus no longer supports the conclusion that gender affirming surgery is not therapeutic. Medical thinking and Iowa law has changed."
Until today, as a result of Iowa Medicaid's sweeping discriminatory exclusion, all surgical treatments for gender dysphoria were excluded from coverage, even though the same or substantially equivalent treatments are provided to cisgender Iowans. For example, Iowans who are not transgender routinely receive coverage for a medically necessary mastectomy — but a transgender Iowan would be banned from coverage for the same care to treat gender dysphoria regardless of medical need. That's a violation of the Iowa Civil Rights Act.
The availability of transition-related medical care, including surgeries for those who need it, is recommended by the American Medical Association, American Psychological Association, the American Psychiatric Association, the American Academy of Family Physicians, the National Association of Social Workers, and many other professional associations.