Iowa Supreme Court Ruling Paves Way for Medicaid Coverage of Gender-Affirming Surgery

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DES MOINES, Iowa – The Iowa Supreme Court has affirmed a lower court’s decision that struck down an Iowa code prohibiting Medicaid coverage for gender-affirming surgery after determining it violates the Iowa Civil Rights Act.

In a ruling published Friday, the court affirmed a district court’s decision after the Iowa Department of Human Services appealed the case.

Two transgender women, Eerieanna Good and Carol Beal, sought judicial review after being denied Medicaid coverage for surgeries to correct their gender dysphoria, which were deemed medically necessary by their doctors. They had exhausted all intra-agency appeals within Medicare and its managed care providers before taking the action in 2018.

The district court ruled Iowa Administrative Code Rule 441—78.1(4) prohibiting Iowa Medicaid coverage of surgical procedures related to “gender identity disorders” violated a 2007 amendment to the Iowa Civil Rights Act, adding “gender identity” to the list of protected characteristics.

The Iowa Supreme Court agreed, saying “On our review, we affirm the judgment of the district court because the rule violates the ICRA’s prohibition against gender-identity discrimination.”

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