[Courtney Crowder, Luke Nozicka | Des Moines Register] Transgender Iowans can use Medicaid funds to pay for transition-related care, including surgeries, according to a unanimous Iowa Supreme Court ruling Friday.
The court’s decision strikes down the administrative code governing Medicaid in Iowa that classifies transition-related surgeries as “cosmetic, reconstructive or plastic surgery” and explicitly bans “surgeries for the purpose of sex reassignment.” The justices agreed with a district judge’s ruling that the rules contradicted protections in the Iowa Civil Rights Act.
That law’s “gender identity classification encompasses transgender individuals — especially those who have gender dysphoria — because discrimination against these individuals is based on the nonconformity between their gender identity and biological sex,” Justice Susan Christensen wrote for the court.
This decision is thought to be the first by a state’s highest court holding that transgender people have the right to use public money for transition-related surgeries. As issues of LGBT rights swirl nationally, the decision could help open the door for challenges to bans in other states, about half of which have language similar to Iowa’s in their administrative code.
“As the ruling showed, this case presented a difficult question involving individual rights and the state’s interests,” said Lynn Hicks, spokesman for the Attorney General’s Office. “This issue was a first for Iowa’s courts, and we thank the court for its guidance and for resolving this issue.”
For next steps, Hicks directed the Register to the Department of Human Services. That department’s spokesman, Matt Highland, said DHS would not be commenting.
The verdict ended an almost two-year legal battle that hinged on whether transition-related surgery was “medically necessary” or a procedure provided solely psychological purposes.
After years of dealing with denials and headaches regarding their health coverage, Carol Ann Beal, 42, of northwest Iowa, and EerieAnna Good, 28, of the Quad Cities, sued the Department of Human Services in 2017. They alleged that the state’s blanket ban denying their use of public funds for doctor-prescribed surgery violated the equal protection clauses in both the Iowa Civil Rights Act and the state constitution.
“The record evidence shows that this surgery is medically necessary,” John Knight, an attorney with the ACLU representing Beal and Good, told justices when the case was argued. “It’s really lifesaving treatment for a number of individuals.”
In his June decision, Polk County Chief District Judge Arthur Gamble concurred, saying the decades-old regulation “has not kept up with law and medicine.” He ordered the department to approve the women’s request for coverage.
But the state appealed, arguing the ban is not discriminatory because the department denies all surgeries performed primarily for psychological reasons — which is how it has characterized transition-related surgeries.
“We are covering these surgeries in the same instances when the primary purpose is to address a non-psychological purpose,” Assistant Attorney General Matthew Gillespie said during oral arguments. “And we don’t cover surgeries in the same instance, regardless of gender identity, when the surgery is performed primarily for a psychological purpose.”
Gender identity — or the deeply held sense of who one is that may differ from the sex organs with which one was born — and sexual orientation were added to the Iowa Civil Rights Act as protected classes in 2007.
Under that statute, transgender Iowans have legal protections against discrimination in education, employment, housing and public accommodations. Medicaid, a state and federally funded program, is considered a public accommodation.
[Editor’s Note: This article was written by Courtney Crowder and Luke Nozicka and originally published at the Des Moines Register. Title changed by P&P.]
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