Iowa Supreme Court unanimously rules Medicaid must cover gender transition surgeries

The Iowa Supreme Court unanimously ruled Friday that the state could no longer ban Medicaid recipients from receiving taxpayer-funded sex change operations, ruling that transition surgeries are medically necessary.

What are the details?

Transgender women Eerieanna Good and Carol Beal had sued the Iowa Department of Human Services for discrimination over its administrative code classifying transition-related surgeries as "cosmetic, reconstructive or plastic surgery." The code explicitly bans "surgeries for the purpose of sex reassignment."

The plaintiffs insist "gender-affirming" surgeries are "medically necessary" for them in order to treat their gender dysphoria, and a district court ruled in their favor. DHS appealed, with Assistant Attorney General Matthew Gillespie arguing that the case was not about the discrimination of transgender Iowans, but whether the state had appropriately denied coverage for surgeries intended to treat psychological conditions, the Washington Examiner reported.

The Supreme Court upheld the lower court's decision, with Justice Susan Christensen writing that the state's "bar on Medicaid coverage for gender-affirming surgical procedures discriminates against transgender Medicaid recipients in Iowa" under Iowa civil rights laws. The justice pointed to the fact that the state amended the Iowa Civil Rights Act in 2007 to add "gender identity" to the list of protected groups.

Justice Christensen also noted in the decision that Medicaid already covers the costs of some cosmetic or reconstructive procedures, such as "'[r]evision of disfiguring and extensive scars resulting from neoplastic surgery' and '[c]orrection of a congenital anomaly.' Yet, it prohibits coverage for this same procedure if a transgender individual."

Anything else?

According to the Des Moines Register, transgender surgeries can range in cost from $20,000 to $100,000, "putting it out of reach of individuals who qualify for the assistance." Now, those out-of-reach costs must be covered by taxpayers.

John Knight of the American Civil Liberties Union — who represented the plaintiffs — hailed the court's decision, saying in a statement: "The ruling means that many transgender Iowans will be able to obtain life-saving medical care that they were unable to get in the past. We are thrilled that the Iowa Supreme Court rejected the Department's effort to minimize the importance of this surgery by labeling it as cosmetic and unanimously struck down this harmful ban on necessary health care."