Iowa judge overturns state’s ban on Medicaid covering transgender medical procedures

The ban “has not kept up with law and medicine.”

Carol Ann Beal. CREDIT: WHOTV/Screenshot
Carol Ann Beal. CREDIT: WHOTV/Screenshot

An Iowa judge has overturned the state’s ban on allowing Medicaid to cover the costs of surgical procedures for transgender people. In his ruling Thursday, Chief District Judge Arthur Gamble ordered the Iowa Department of Human Services (DHS) to immediately approve Medicaid coverage for the two petitioners, Carol Ann Beal and EerieAnna Good.

Both Beal and Good had already changed all of their documentation to reflect their identities, but were denied coverage for medically necessary procedures related to their transition that had been prescribed by their physicians. Iowa state administrative code classified transition-related surgeries as “cosmetic, reconstructive or plastic surgery” and prohibited any “surgeries for the purpose of sex reassignment.”


Gamble noted that the procedures that trans people require would be covered for other patients if they weren’t part of a transition. For example, Medicaid would cover a mastectomy for a woman fighting breast cancer, but not for a transitioning transgender man. Thus, the ban was discriminatory against transgender people according to the Iowa Civil Rights Act and Iowa state constitution:

DHS does not explain why the medical necessity of requests for sex reassignment surgeries could not simply be evaluated under the same criteria as other requested surgeries or treatment of non-transgender individuals… Petitioners have provided clear medical documentation outlining the medical necessity of their requested procedures. Thus, the Court sees no reason why DHS and the MCOs need an additional and indefinite period of time to develop new and separate criteria for evaluating requests by transgender individuals as opposed to simply applying the existing criteria.

The ban “has not kept up with law and medicine,” he wrote. “Gender Dysphoria has a biological component and the current medical consensus no longer supports the conclusion that gender affirming surgery is not therapeutic. Medical thinking and Iowa law has changed.”

Beal praised the ruling in a statement. “I look forward to the day when someone fighting to get the transition-related medical care they need isn’t in the news because they had to go to court to fight for it,” she said. “But I’m doing it because someone needs to be the trailblazer here. I want to make it easier for the younger people who need this surgery, so they don’t have to go through the struggles I have had to go through.”