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Judge rules Iowa’s prohibition on Medicaid coverage for gender-reassignment procedures is unconstitutional


Carol Ann Beal — photo courtesy of the ACLU of Iowa

On Wednesday, Polk County Chief District Judge Arthur Gamble ruled a provision in Iowa law prohibiting the use of Medicaid funds for gender-reassignment procedures deemed medically necessary by doctors “violates the ICRA [Iowa Civil Rights Act] and the Iowa Constitution.”

Gamble issued his ruling in a lawsuit brought by two transgender Iowans, Carol Ann Beal and EerieAnna Good, who sued the Iowa Department of Human Services (DHS) after the agency decided to deny Medicaid coverage for transition-related procedures ordered by the plaintiffs’ doctors.

“It’s like any other surgery that a doctor would recommend for you or a family member,” Good said, in a written statement released by the ACLU of Iowa, which represented both Good and Beal in the case. “Public or private insurance would pay for it, and you’d just do it and move ahead with your life. I look forward to the day when someone fighting to get the transition-related medical care they need isn’t in the news because they had to go to court to fight for it.”

In 2007, the ICRA was amended to prohibit discrimination based on actual or perceived sexual orientation or gender identity, but the DHS based its decision 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,” Gamble wrote in his decision.

While the Court understands that the DHS is in some respects obligated to enforce the administrative rules as previously adopted, it also has an obligation to ensure those rules conform to the statutes like the ICRA and the Constitution which trump any prior administrative rule.

DHS had also contended that gender-reassignment surgery was basically no different the elective cosmetic surgeries, a position medical experts reject.

“DHS also has an obligation to keep up with medical science,” Gamble wrote. “DHS failed to do so when it denied coverage to Good and Beal for medically necessary gender affirming surgery. 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.”

Gamble ordered DHS to provide Medicaid coverage for Good and Beal’s transition-related procedures, and rejected a request by the agency to allow to delay approving coverage until after it creates new criteria for assessing claims for gender-reassignment procedures.

“New criteria based upon gender identity would be equally suspect,” Gamble wrote.

DHS has declined to comment on the decision, and the Iowa Attorney General’s office, which represented the DHS in the case, issued a statement saying it is reviewing the decision.

In its press release following the decision, the ACLU of Iowa noted the precedent-setting nature of the judge’s opinion: “It’s a historic moment for civil rights in Iowa, because it’s the first time that a court decision has recognized what we’ve long known: transgender Iowans are protected by the Iowa Constitution’s guarantee of equal protection, as well as by the Iowa Civil Rights Act.”


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