Health

Should Medicaid cover gender-reassignment surgery? Transgender case argued before Iowa Supreme Court

The courtroom for the Iowa Supreme Court at the Iowa Judicial Building in Des Moines on Wednesday, January 15, 2014. (Stephen Mally/The Gazette)
The courtroom for the Iowa Supreme Court at the Iowa Judicial Building in Des Moines on Wednesday, January 15, 2014. (Stephen Mally/The Gazette)

DES MOINES — The Iowa Supreme Court heard oral arguments Thursday in a lawsuit challenging the state’s ban on using Medicaid funds for sex reassignment surgery, a procedure that is not medically necessary, the state argues.

Attorneys challenging the ban argued the law is discriminatory toward transgender individuals and violates civil rights protections.

“Unfortunately, transgender people in Iowa and elsewhere face all kinds of discrimination, but this is a form of discrimination that is common and really harmful,” John Knight, an American Civil Liberties Union lawyer, told the justices.

“It makes it difficult for people to move on with their lives and function fully in their lives.”

The justices are expected to rule on the case by June.

In June, 5th Judicial District Chief Judge Arthur Gamble ruled in favor of those challenging the ban, saying the ban violated the Iowa Civil Rights Act and the equal protection clause in the state’s Constitution.

Attorneys representing the Iowa Department of Human Services appealed that decision.

In Iowa, DHS rules determine which cosmetic surgical procedures must be covered by managed-care organizations, the insurers of those on Medicaid.

According to those rules, surgeries for the purpose of sex reassignment “are not considered as restoring bodily function” and are therefore excluded from coverage.

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Because of that rule, managed care insurers denied gender-affirming surgeries to treat gender dysphoria for two transgender women — EerieAnna Good of the Quad Cities and Carol Ann Beal of northwest Iowa.

The women, represented by the ACLU of Iowa, challenged that decision in a 2017 lawsuit.

Gender dysphoria is a condition in which an individual experiences distress because the gender they were assigned at birth does not match his or her gender identity.

“You can’t bar or take away an important benefit like health insurance coverage because of who they are, and that’s effectively what’s being done here,” ACLU’s Knight said in a news conference Thursday. “When you exclude coverage for a particular medical condition, which is now called gender dysphoria, you’re basically telling transgender people that they — unlike other people — are unable to get necessary medical care. That is not something the state should allow.”

DHS attorneys argued in court the law is not discriminatory because both non-transgender and transgender individuals are denied coverage for procedures performed for psychological purposes.

“Transgender Medicaid beneficiaries are given the same access to services, benefits, advantages and obligations under Iowa Medicaid as non-transgender Medicaid beneficiaries to whom they are similarly situated,” they argued in court documents.

They also noted not all medically necessary services are paid by Medicaid because the program has a limited capacity to fund procedures.

DHS declined to comment due to pending litigations.

l Comments: (319) 368-8536; michaela.ramm@thegazette.com

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