Metro Weekly

Two trans women challenging Iowa’s ban on Medicaid coverage for surgery

Lawyers for the two women claim the ban is discriminatory and violates Iowa's Civil Rights Act

Carol Ann Beal and EerieAnna Good – Photos: ACLU of Iowa.

The ACLU of Iowa is suing on behalf of two transgender women who contend that the state’s ban on Medicaid coverage for medically necessary surgical care is discriminatory and unconstitutional.

Carol Ann Beal, of northwest Iowa, and EerieAnna Good, of the Quad Cities, both brought their cases to the attention of the ACLU after being denied coverage for transition-related surgery that their doctors had deemed medically necessary.

Beal is currently appealing the refusal of coverage internally within the Department of Human Services, but will appeal to the district court once her appeal is exhausted.

Iowa’s Medicaid program, which provides coverage for the state’s low-income residents, provides coverage for virtually every type of care, so long as it is deemed medically necessary.

However, it continues to enforce a self-imposed ban on using Medicaid dollars to cover transition-related surgical expenses for transgender people.

The ban is derived from outdated medical science as it relates to the treatment of transgender patients.

In the past, such procedures were considered “cosmetic” and were regularly denied. But new insights from the medical community have revealed that gender confirmation surgery is often an important and medically necessary step to treating the gender dysphoria that many transgender individuals experience.

Indeed, many associations for medical professionals, such as the American Medical Association, American Psychological Association, American Psychiatric Association, the American Academy of Family Physicians, and the National Association of Social Workers, recommend surgery as a way to help treat gender dysphoria.

Therefore, the ACLU argues, Iowa’s Medicaid program has no right to deny coverage to Beal and Good, who lack the resources to pay for surgery out-of-pocket.

“As the result of this sweeping exclusion, all surgical treatments for gender dysphoria are excluded from coverage, even though the same or substantially equivalent treatments are provided to non-transgender Iowans,” Rita Bettis, the legal director of the ACLU of Iowa, said in a statement. “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.”

Iowa is one of 20 states with a nondiscrimination law that explicitly prohibits discrimination based on a person’s sexual orientation or gender identity.

“Through our work with transgender Iowans, we have seen firsthand how powerful, life-changing, and absolutely essential gender-affirming sugery can be for transgender people grappling with gender dysphoria,” Daniel Hoffman-Zinnel, the executive director of One Iowa, said in a statement. “We cannot sit idly by while this critical treatment is illegally denied to many in our state’s transgender community.”

In 2014, the U.S. Department of Health and Human Services invalidated its old ban on Medicare coverage for surgery and other transition-related care. Medicaid, on the other hand, is administered by the states.

Since HHS got rid of its ban, other states have moved to eliminate their bans on Medicaid coverage for transition-related treatments.

Last year, a judge in Minnesota ruled that state’s ban on using Medicaid dollars for transition-related care was unconstitutional.

In November, Amerigroup, one of Iowa’s private Medicaid providers, agreed to cover a transgender man’s gender confirmation surgery after it failed to issue its planned denial of coverage in a timely manner. But the state’s ban on surgery remained in effect for other transgender Medicaid recipients.

Both Beal and Good hope that they will be able to receive coverage for their medical needs.

“This surgery is not just something that I want,” Good said in a statement. “It’s something that I very much need to resolve the depression and anxiety I face because my outside fails to match who I know I am: a woman….I’ve faced a lot of challenges in my life that have made it difficult for me to do these things, but my inability to get the medical care I need has been one of the major roadblocks. This is so important for my health, well-being, and my life.”

“Transition-related care is a medical issue, plain and simple,” Beal said. “It’s like any other surgery that a doctor would recommend for you or a family member. 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 this,” she added. “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 all the struggles I have had to go through.”

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John Riley is the local news reporter for Metro Weekly. He can be reached at jriley@metroweekly.com

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