Advertisement

Iowa Supreme Court strikes down state’s ban on Medicaid paying for gender affirmation procedures


Carol Ann Beal — photo courtesy of the ACLU of Iowa

In a unanimous decision issued on Friday, the Iowa Supreme Court ruled the state’s prohibition on the use of Medicaid funds to pay for sex reassignment procedures deemed medically necessary by doctors violates the Iowa Civil Rights Act. The decision confirms a district court judge’s ruling in June 2018, striking down the Iowa Department of Human Services (DHS) rule against paying for such procedures.

The decision came in a lawsuit brought by two transgender Iowans, Carol Ann Beal and EerieAnna Good, who sued DHS after the agency decided to deny Medicaid coverage for transition-related procedures ordered by their doctors.

“This has been a long journey since we first started fighting for this gender-affirming health care which some transgender people so desperately need,” Beal said in a statement following the court’s decsion. “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 state’s civil rights act was amended in 2007 to prohibit discrimination based on actual or perceived sexual orientation or gender identity, but the DHS based its decision to deny Medicaid funds to pay for Beal and Good’s treatments on an older section of Iowa’s administrative code that banned the use of Medicaid funds for “procedures related to transsexualism, hermaphroditism, gender identity disorders or body dysmorphic disorders.”

“The Regulation clearly discriminates against transgender Medicaid recipients on the basis of gender identity,” District Court Judge Arthur Gamble wrote in his decision last year.

“DHS failed [in its obligation to keep up with medical science] when it denied coverage to Good and Beal for medically necessary gender affirming surgery,” Gamble found. “This decision was made without regard to the law and facts. The agency acted in the face of evidence upon which there is no room for difference of opinion among reasonable minds.”

In its appeal of the district court’s ruling, DHS argued its rule “does not discriminate based on gender identity because transgender Medicaid beneficiaries and nontransgender Medicaid beneficiaries in Iowa alike are not entitled to gender-affirming surgical procedures,” because the rule bans all providing funds for cosmetic, reconstructive or plastic surgery performed “primarily for psychological purpose.”

Writing for the court, Justice Susan Christensen rejected that argument.

The record does not support the DHS’s position that [it’s rule] against is nondiscriminatory because its exclusion of coverage for gender-affirming surgical procedures encompasses the broader category of ‘cosmetic, reconstructive, or plastic surgery’ that is ‘performed primarily for psychological purposes.’

In a statement released on Friday morning, ACLU of Iowa Legal Director Rita Bettis Austen said, “Today’s decision is historic for civil rights in Iowa, because it is the first Iowa Supreme Court case to recognize the right that transgender Iowans have to nondiscrimination under the Iowa Civil Rights Act in Medicaid — or by any other public accommodation.”

This is the second notable legal victory for transgender Iowans this year.

Last month, a Polk County jury ruled in favor of the plaintiff in the first discrimination lawsuit filed in Iowa by a transgender plaintiff since the Iowa Civil Rights Act was amended to include protection for gender identity. In addition to finding the state illegally discriminated against Jesse Vroegh, a transgender man and former Iowa Department of Corrections employee, the jury awarded him $120,000 in damages.


[gravityform id="17" title="false" description="false" ajax="true"]
<div class='gf_browser_unknown gform_wrapper your-village-form_wrapper' id='gform_wrapper_17' ><a id='gf_17' class='gform_anchor' ></a><form method='post' enctype='multipart/form-data' target='gform_ajax_frame_17' id='gform_17' class='your-village-form' action='/iowa-supreme-court-strikes-down-states-ban-on-medicaid-paying-for-gender-affirmation-procedures/#gf_17'> <div class='gform_body'><ul id='gform_fields_17' class='gform_fields top_label form_sublabel_below description_below'><li id='field_17_7' class='gfield gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible' ><h3 style="font-weight:800; font-size:34px;">Let's get started</h3> <p style="font-size:18px;">Fill out this form and we'll contact you with information about marketing with Little Village!</p></li><li id='field_17_4' class='gfield field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label gfield_label_before_complex' for='input_17_4_3' ></label><div class='ginput_complex ginput_container no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gfield_trigger_change' id='input_17_4'> <span id='input_17_4_3_container' class='name_first' > <input type='text' name='input_4.3' id='input_17_4_3' value='' aria-label='First name' tabindex='2' aria-invalid="false" placeholder='First name'/> <label for='input_17_4_3' >First</label> </span> <span id='input_17_4_6_container' class='name_last' > <input type='text' name='input_4.6' id='input_17_4_6' value='' aria-label='Last name' tabindex='4' aria-invalid="false" placeholder='Last name'/> <label for='input_17_4_6' >Last</label> </span> </div></li><li id='field_17_5' class='gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_17_5' ><span class='gfield_required'>*</span></label><div class='ginput_container ginput_container_text'><input name='input_5' id='input_17_5' type='text' value='' class='large' tabindex='6' placeholder='Company name' aria-required="true" aria-invalid="false" /></div></li><li id='field_17_3' class='gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_17_3' ><span class='gfield_required'>*</span></label><div class='ginput_container ginput_container_email'> <input name='input_3' id='input_17_3' type='text' value='' class='large' tabindex='7' placeholder='Your email address' aria-required="true" aria-invalid="false"/> </div></li><li id='field_17_8' class='gfield gform_validation_container field_sublabel_below field_description_below gfield_visibility_' ><label class='gfield_label' for='input_17_8' >Phone</label><div class='ginput_container'><input name='input_8' id='input_17_8' type='text' value='' /></div><div class='gfield_description'>This field is for validation purposes and should be left unchanged.</div></li> </ul></div> <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_17' class='gform_button button' value='SUBMIT' tabindex='8' onclick='if(window["gf_submitting_17"]){return false;} window["gf_submitting_17"]=true; ' onkeypress='if( event.keyCode == 13 ){ if(window["gf_submitting_17"]){return false;} window["gf_submitting_17"]=true; jQuery("#gform_17").trigger("submit",[true]); }' /> <input type='hidden' name='gform_ajax' value='form_id=17&amp;title=&amp;description=&amp;tabindex=1' /> <input type='hidden' class='gform_hidden' name='is_submit_17' value='1' /> <input type='hidden' class='gform_hidden' name='gform_submit' value='17' /> <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' /> <input type='hidden' class='gform_hidden' name='state_17' value='WyJbXSIsIjlmNzc1YTEyZmZjNmYyODk5Mzk0NDM3ZjRlOGYyZDNmIl0=' /> <input type='hidden' class='gform_hidden' name='gform_target_page_number_17' id='gform_target_page_number_17' value='0' /> <input type='hidden' class='gform_hidden' name='gform_source_page_number_17' id='gform_source_page_number_17' value='1' /> <input type='hidden' name='gform_field_values' value='' /> </div> <p style="display: none !important;"><label>&#916;<textarea name="ak_hp_textarea" cols="45" rows="8" maxlength="100"></textarea></label><input type="hidden" id="ak_js_1" name="ak_js" value="154"/><script>document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() );</script></p></form> </div> <iframe style='display:none;width:0px;height:0px;' src='about:blank' name='gform_ajax_frame_17' id='gform_ajax_frame_17'>This iframe contains the logic required to handle Ajax powered Gravity Forms.</iframe> <script type='text/javascript'>jQuery(document).ready(function($){gformInitSpinner( 17, 'https://littlevillagemag.com/wp-content/plugins/gravityforms-asdf111aasdfffs-nope/images/spinner.gif' );jQuery('#gform_ajax_frame_17').load( function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_17');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_17').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;if(is_form){jQuery('#gform_wrapper_17').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_17').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_17').removeClass('gform_validation_error');}setTimeout( function() { /* delay the scroll by 50 milliseconds to fix a bug in chrome */ jQuery(document).scrollTop(jQuery('#gform_wrapper_17').offset().top); }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_17').val();gformInitSpinner( 17, 'https://littlevillagemag.com/wp-content/plugins/gravityforms-asdf111aasdfffs-nope/images/spinner.gif' );jQuery(document).trigger('gform_page_loaded', [17, current_page]);window['gf_submitting_17'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}setTimeout(function(){jQuery('#gform_wrapper_17').replaceWith(confirmation_content);jQuery(document).scrollTop(jQuery('#gf_17').offset().top);jQuery(document).trigger('gform_confirmation_loaded', [17]);window['gf_submitting_17'] = false;}, 50);}else{jQuery('#gform_17').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger('gform_post_render', [17, current_page]);} );} );</script><script type='text/javascript'> if(typeof gf_global == 'undefined') var gf_global = {"gf_currency_config":{"name":"U.S. Dollar","symbol_left":"$","symbol_right":"","symbol_padding":"","thousand_separator":",","decimal_separator":".","decimals":2},"base_url":"https:\/\/littlevillagemag.com\/wp-content\/plugins\/gravityforms-asdf111aasdfffs-nope","number_formats":[],"spinnerUrl":"https:\/\/littlevillagemag.com\/wp-content\/plugins\/gravityforms-asdf111aasdfffs-nope\/images\/spinner.gif"};jQuery(document).bind('gform_post_render', function(event, formId, currentPage){if(formId == 17) {if(typeof Placeholders != 'undefined'){ Placeholders.enable(); }} } );jQuery(document).bind('gform_post_conditional_logic', function(event, formId, fields, isInit){} );</script><script type='text/javascript'> jQuery(document).ready(function(){jQuery(document).trigger('gform_post_render', [17, 1]) } ); </script>