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Transgender Women Win Polk County Lawsuit Over Sex Change Surgeries

ACLU of Iowa
Carol Ann Beal, plaintiff in lawsuit challenging ban on Medicaid funding for gender reassignment surgery

A Polk County District Court judge this week ordered the Iowa Department of Human Services to cover the costs of sex reassignment surgery for two transgender women.  

The ACLU of Iowa says it’s the first court ruling recognizing the rights of transgender Iowans under the Iowa Constitution and the Iowa Civil Rights Act.    

In his ruling Chief District Judge Arthur Gamble ordered DHS to approve Medicaid coverage for what’s known as gender-affirming surgery for Carol Ann Beal of northwest Iowa and EerieAnna Good of the Quad Cities.   

"DHS offers no persuasive justification for this disparate treatment." -Judge Arthur Gamble

A  DHS regulation dating back to 1995 had denied Medicaid coverage for such surgeries.  

“At the time the Regulation was adopted more than two decades ago, the Iowa Civil Rights Act did not prohibit discrimination on the basis of gender identity,” Judge Gamble wrote.  “It does now.”

The Judge wrote that the DHS rule has not “kept pace with law and medicine.”

“Gender Dysphoria has a biological component and the current medical consensus no longer supports the conclusion that gender affirming surgery is not therapeutic,” Gamble wrote.

Further, the court held that the challenged ban violates the Iowa Constitution's equal protection guarantee. 

"DHS offers no persuasive justification for this disparate treatment,"  Gamble wrote.

The ACLU of Iowa brought the case on behalf of Beal and Good.

“We are so relieved for our brave clients that they can finally get the gender confirming surgical care that all their doctors agree is medically necessary for them,” said ACLU of Iowa attorney Rita Bettis.

"We are so relieved for our brave clients." -ACLU Atty Rita Bettis

The two women were first denied Medicaid coverage by one of the private managed care organizations in charge of the program even though their doctors deemed the surgeries to be medically necessary.  They lost two additional appeals to DHS before they turned to the district court.

The DHS had urged the court to allow a delay so they could come up with standards for the procedures, and so they could rehear each woman’s case.  However the judge ordered the agency to approve payment.    

“The ruling is clear it should not be delayed,” Bettis said.

A spokesman for the DHS would not comment on the likelihood of an appeal.

“DHS will not be commenting as this is related to ongoing litigation,” spokesman Matt Highland wrote in a statement.

According to the ACLU, the availability of transition-related medical care, including surgeries for those who need it, is recommended by leading medical groups including the American Medical Association, the American Psychological Association, the American Psychiatric Association, the American Academy of Family Physicians, and the National Association of Social Workers.

The federal government in 2014 invalided its ban on Medicare coverage for surgery and other transition-related care.   Since then, the ACLU says more and more states have also eliminated their Medicaid bans for transgender people.