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Iowa Supreme Court Rules Transgender People Can Use Medicaid For Sex Reassignment Surgeries

ACLU of Iowa
Carol Anne Beal, one of the plaintiffs in a 2017 lawsuit against the Iowa Department of Human Services.

The Iowa Supreme Court on Friday struck down the state’s policy excluding transgender people from using Medicaid coverage for transition-related surgical care.
Under the ruling, transgender people can now use Medicaid for gender-affirming surgeries. Iowa Department of Human Services policy dating back to 1995 denied Medicaid coverage for those surgeries. The Iowa Supreme Court supported Chief District Judge Arthur Gamble’s ruling in June that this violates gender identity protections under the state’s 2007 Civil Rights Act.

ACLU of Iowa Legal Director Rita Bettis Austen said Friday that coverage for this kind of care is “literally lifesaving” for some transgender people.

“And denying them care puts the people who need it at real risk of self-harm and even suicide in addition to other types of increased medical risks,” Austen said.

LGBTQ advocacy group One Iowa applauded the ruling. Keenan Crow, the group’s policy and advocacy director, said Medicaid was “created with the promise” to help low-income people get access to care.

“And today the court has kept that promise,” Crow said. “We at One Iowa have seen firsthand how powerful, life-changing and necessary these surgeries are. Make no mistake, today’s ruling will save lives.”

In 2017, transgender women Carol Ann Beal and EerieAnna Good sued the DHS after they were denied Medicaid coverage for surgeries, even though their doctors said these surgeries were medically necessary.

The ACLU says an appeal of the ruling in federal court is not possible because they fought for the change under the state’s constitution and the state's civil rights act. Austen said she hopes the ruling sets the stage for other states getting rid of "discriminatory exclusions" in their own laws.

DHS declined to comment on the ruling.

Katie Peikes was a reporter for Iowa Public Radio from 2018 to 2023. She joined IPR as its first-ever Western Iowa reporter, and then served as the agricultural reporter.