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Neighbors Growing Together | Sep 20, 2018

ACLU files suit for transgender coverage

DHS considers Medicaid coverage for such surgical care as cosmetic
By Chelsea Keenan, The Gazette | Sep 22, 2017

The ACLU of Iowa on Thursday filed a lawsuit to challenge the Iowa Department of Human Services’s ban on Medicaid coverage for surgical care for transgender Iowans.

Under current Medicaid rules, sex reassignment surgery is considered a cosmetic treatment and is not included in the government-sponsored insurance program that covers nearly 600,000 low-income and needy Iowans.

“Although a federal appellate court ruled in 1980 that Iowa could not ‘arbitrarily’ deny coverage for surgery when it was medically necessary as treatment for an individual undergoing gender transition, the same court in 2001 held that the Iowa Medicaid regulation excluding gender reassignment surgery was valid because the court felt the state demonstrated that the rule was based on sound medical research,” ACLU legal director Rita Bettis said.

However, now the availability of transition-related medical care, including surgeries, for those who need it is recommended by the American Medical Association, American Psychological Association, American Psychiatric Association, American Academy of Family Physicians and National Association of Social Workers, the ACLU said.

Amy McCoy, DHS spokeswoman, said that agency is reviewing the suit and does not comment on pending litigation.

The ACLU of Iowa filed the lawsuit on behalf of EerieAnna Good, who lives in the Quad Cities, and Carol Ann Beal of northwest Iowa. The organization argues that excluding Iowa Medicaid coverage for the medical care sought by transgender people is a violation of the Iowa Civil Rights Act — which specifically prohibits discrimination based on gender identity — and the Iowa Constitution — which assures equal protection for all Iowans.

“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. I’m only 27 and I have my whole life stretching in front of me,” Good said in a news release.

“I want to have a career. I want to be married and raise kids. 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 and my life.”

Beal’s case still is before DHS, where she is appealing the denial of coverage. Once her appeal is exhausted at the agency level, the ACLU will take her case to the District Court along with Good’s, the agency said.

Last year, the ACLU was able to obtain Medicaid approval for a surgery for its client Andrew Evens. The approval, however, was a fluke — the ACLU appealed the original denial by the Medicaid insurer and the insurer did not respond to the appeal in a designated amount of time, the ACLU’s Bettis said.

“Transgender Iowans, like all Iowans, should have adequate health care based on medicine,” Bettis added. “Iowa’s Medicaid regulation is nothing more than an outdated relic.”

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