Transgender people have long struggled for equal treatment, and today, in a historic moment, they moved one step closer toward equal access to medical services.
Two ACLU clients, Carol Ann Beal and EerieAnna Good, today won a lawsuit that successfully challenged an Iowa Department of Human Services (DHS) ban on Medicaid coverage for medically necessary surgical care for transgender Iowans.
The court found that the ban violates the Iowa Civil Rights Act and Iowa’s state constitution. It ordered that DHS should act right away to approve the clients’ physicians requests for pre-approval of coverage under Medicaid.
That means transgender Iowans covered by Medicaid can now get the medically necessary care they need and no longer face Medicaid’s sweeping, discriminatory, and categorical exclusion of all transition-related care. That care had been denied in the past, even though it was determined to be medically necessary by an individual’s doctor.
Medicaid otherwise provides coverage for virtually every other type of medical care deemed necessary by a doctor.
Carol Ann, shown in the photo here, said, “This has been a long time coming. I’m so glad I can get the care I need, and I’m glad that other Iowans can now get the same care. Transition-related care is a medical issue, plain and simple."
"It’s like any other surgery that a doctor would recommend for you or a family member," she said. "Public or private insurance would pay for it, and you’d just do it and move ahead with your life. 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. 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."
It's a historic moment for civil rights in Iowa, because it's the first time that a court decision has recognized what we've long known: transgender Iowans are protected by the Iowa Constitution's guarantee of equal protection, as well as by the Iowa Civil Rights Act. We are so relieved for our brave clients that they can finally, after years of trying, get the gender-confirming surgical care that all their doctors agree is medically necessary for them.
The availability of transition-related medical care, including surgeries for those who need it, is recommended by the American Medical Association, American Psychological Association, the American Psychiatric Association, the American Academy of Family Physicians, the National Association of Social Workers, and many other professional associations.
Until today, as a result of Iowa Medicaid's sweeping exclusion, all surgical treatments for gender dysphoria are excluded from coverage, even though the same or substantially equivalent treatments are provided to cisgender Iowans. For example, Iowans who are not transgender routinely receive coverage for a medically necessary mastectomy----but a transgender Iowan would be banned from coverage for the same care to treat gender dysphoria regardless of medical need. That's a violation of the Iowa Civil Rights Act and equal protection under the Iowa Constitution.
Despite clear medical standards and legal obligations, Iowa’s Medicaid program refused to cover transition-related medical care for our Carol Ann and EerieAnna. Excluding Iowa Medicaid coverage for transgender people who need it is a violation of the Iowa Civil Rights Act—which specifically prohibits discrimination based on gender identity—and the Iowa Constitution—which assures equal protection for all Iowans.
As the court's decision states, “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."
In 2014, the U.S. Department of Health and Human Services invalidated its ban on Medicare coverage for surgery and other transition-related care. Since then, more and more states have also eliminated their outdated bans on Medicaid coverage for healthcare for transgender people in those states.