The Iowa Supreme Court has ruled that the state Medicaid plan must pay for sex reassignment surgery. Depending on what procedure is necessary, the cost can run from 20k to 100k. It is yet unclear whether state taxpayers or federal ones will actually foot the bill.
The program could be stopped before it gets started if the state legislature writes a law that does not grant transgenders the protections necessary for coverage. There is no indication as of yet, whether lawmakers will act on that or not. It was a unanimous ruling by the court.
The court’s unanimous decision struck 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.”
Transgender surgeries can range from $20,000 to $100,000, putting it out of reach of individuals who qualify for the assistance.
In affirming a district judge’s decision, Justice Susan Christensen wrote that the “express ban on Medicaid coverage for gender-affirming surgical procedures” contradicted the gender-identity protections in the Iowa Civil Rights Act.
Or, as Rita Bettis Austen, the ACLU of Iowa’s legal director, put it: “Any discriminatory ban on care — whether that’s from a medical provider, which is less likely, or it’s from an insurance provider, which is more likely — is illegal in Iowa.”
Advocates believe the decision is the first by a state’s highest court to hold 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 like Iowa’s in their administrative codes.