Judge Rules Iowa Cannot Deny Medicaid Coverage for Gender Dysphoria-Related Surgeries

DES MOINES, Iowa — A state judge has ruled that the Iowa Department of Human Services (DHS) cannot exclude gender dysphoria-related operations from Medicaid coverage, asserting that “medical thinking and Iowa law have changed,” and that the state regulation that prohibited coverage for such operations “has not kept pace with law and medicine.”

“The outdated medical evidence that formed the basis for the adoption of the regulation does not permanently validate it,” opined Chief District Judge Arthur Gamble.

“As petitioners proved, the medical consensus now holds that sex reassignment surgery is sometimes medically necessary and addresses far more than just the psychological aspects of gender dysphoria. It is the standard of care for the treatment of the biological components of gender dysphoria. Therefore, the court does not find DHS’ argument persuasive,” he wrote.

Two men, who go by the names Carol Ann Beal and EerieAnna Good, had sued the Iowa DHS in September after their doctors were informed that Medicaid would not cover procedures to remove their male reproductive organs. Under the Iowa Administrative Code, DHS prohibits coverage of cosmetic, reconstructive or plastic surgeries “primarily for psychological reasons or as a result of the aging process” or “for the purpose of sex reassignment.”

Read the rule in full here.

Beal and Good, with the aid of the American Civil Liberties Union (ACLU) and the testimony of their doctors, argued that their surgeries were “medically necessary,” advising the court that they struggle with depression and anxiety due to their gender dysphoria.

“This surgery is not just something that I want. 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,” Good said in a statement at the time.

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The ACLU also argued that the denial violated the Iowa Civil Rights Act and the Iowa Constitution, because “the same or substantially equivalent treatments” would be allowed for those who don’t have gender dysphoria. It cited the example of a mastectomy.

On Wednesday, Gamble sided with the plaintiffs, stating that the DHS did not prove that its exclusion served a substantial government interest. He also denied a request from DHS to create criteria to determine whether or not to approve coverage for gender dysphoria-related surgeries in the future.

“The court is … perplexed by this request,” Gamble stated. “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.”

He therefore ordered the reversal of DHS’ denial of coverage for Beal and Good’s operations, and declared the state regulation to be in violation of the Iowa Constitution.

“[T]he language of Iowa Administrative Code rule 441-78.1(4) pertaining to the exclusion of coverage for sex reassignment surgery in connection to the treatment of transsexualism should be and is hereby held to violate the Iowa Civil Rights Act and the Equal Protection Clause of the Iowa Constitution,” Good wrote.

“The language of the regulation excluding coverage for sex reassignment surgery for transsexualism shall be stricken from the regulation and the remaining language must be interpreted and applied in a manner allowing transgender individuals coverage under Iowa Medicaid for medically necessary gender affirming surgery for the treatment of Gender Dysphoria,” he ordered.

Read the ruling in full here.

However, as previously reported, Walt Heyer, a man who identified as a woman for eight years until he became regenerated by the Spirit of God, wrote an article in 2017 remarking that allowing those with gender dysphoria to conform their bodies to their psychology does not solve the underlying problem.

“Too many U.S. medical practitioners direct all gender-distressed people toward the extreme measures of conforming the body to the mind, rather than exploring the psychological issues that lie beneath the feelings,” he stated. “Giving powerful hormones and recommending radical surgeries without screening for psychological issues first causes great harm to the patients and their families.”

“Many people who are regretful and suicidal followed to the letter the generally accepted treatment protocol of doctor-prescribed hormone therapy and genital surgery,” Heyer, who now helps those with sex-change regret, outlined. “It is not homophobic, transphobic, or bigoted to look at the causes of dissatisfaction and suicide among the transgender population. Rather, it is a caring, heartfelt way to prevent dissatisfaction and suicides.”

Scripture also states that those who turn God’s creation “upside down” are like the clay telling the potter that he doesn’t know what he’s doing.

Romans 9:20 says, “Nay but, O man, who art thou that repliest against God? Shall the thing formed say to Him that formed it, ‘Why hast thou made me thus?’”

Isaiah 29:16 declares, “Surely your turning of things upside down shall be esteemed as the potter’s clay, for shall the work say of Him that made it, ‘He made me not?’ Or shall the thing framed say of Him that framed it, ‘He had no understanding?’”


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  • Seems I read somewhere that they were trying to do away with the Hippocratic Oath.
    So doctors would feel free to…do what’s best for der society…

  • Good for Judge Arthur Gamble! Evangelicals seem to prefer a person commit suicide than ease his mind and give him a chance at happiness than to have such surgery done. Faith over science (no empathy for others) is the very worst thing about religion.

    • Amos Moses – He>i

      ,blockquote>A group including former gays who benefited from reparative therapy is fighting a California bill that would label such therapy a fraudulent business practice and ban counseling aimed at helping people who are unhappy with their same-sex attraction.
      More than 350 people rallied at the state Capitol this week to oppose the proposal, claiming that the legislation unfairly limits people’s options to seek psychological help. The protesters included 30 former gay and transgendered people who spoke at a podium outside the California statehouse against the proposed law.

      “I did not want to be gay,” said Christian pastor Jim Domen, who said the therapy helped him to marry his wife and have children. “Please do not take away professional help programs that have helped people like me.”

      “This legislation actually takes away rights from those who are questioning their sexuality,” said Ken Williams, co-founder of Equipped to Love. “We don’t want to see an America where the government is controlling how people identify sexually.”

      Another demonstrator, pro golfer Kris Olsen denounced the bill for making it illegal for former homosexuals like her to freely seek counseling.

      “AB2943 violates my right to choose,” she said. “It is a blatant violation of my first amendment rights and I believe there’s a reason why our Founding Father chose to put these rights in the very first amendment.”

      The new legislation would ban “advertising, offering for sale, or selling services constituting sexual orientation change efforts to an individual,” which it would include in its list of “unfair or deceptive acts or practices.”

      Dr. Joseph Nicolosi is a licensed clinical psychologist who runs the largest reparative therapy clinic in the world. He told Breitbart News that his clinic uses evidence-based treatment interventions, the same interventions used by other clinics throughout the world, to treat trauma and sexual addictions.

    • Amos Moses – He>i

      BODILY MUTILATION of an otherwise HEALTHY body …… is EMPATHETIC ………. and the FACT is …. EVEN AFTER surgery …. they will continue to commit suicide at the SAME or even HIGHER levels ……… “EMPATHY” ….. ……