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“The outdated medical evidence that formed the basis for the adoption of the regulation does not permanently validate it,” opined Chief District Judge Arthur Gamble.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