The Iowa Supreme Court ruled Friday that Iowa’s Medicaid program cannot categorically discriminate against transgender individuals seeking gender-affirming, medically necessary care.

According to The World Professional Association for Transgender Health, medically necessary care is defined as “health care services that a physician, exercising prudent clinical judgment, would provide to a patient for the purpose of preventing, evaluating, diagnosing or treating an illness, injury, disease or its symptoms, and […] not primarily for the convenience of the patient, physician, or other health care provider, and not more costly than an alternative service or sequence of services.”

On behalf of EerieAnna Good and Carol Ann Beal, the ACLU of Iowa carried out the lawsuit against The Iowa Department of Human Services.

Both women were previously denied coverage even though their doctors had deemed their surgeries “medically necessary” to treat their gender dysphoria. Because both qualify for Medicaid, meaning they do not make enough money to pay for the surgery out-of-pocket, both women were forced to forego the treatment.

“The Iowa Department of Human Services had in place a sweeping, categorical ban on Medicaid coverage for gender-affirming medical care for transgender Iowans, even when deemed necessary by their doctors,” according to the ACLU Iowa website when explaining why they took on this case.

The Iowa Supreme Court decision was unanimous. The Court rejected the arguments made by the Iowa Department of Human Services, which administers Medicaid, that such medical care was primarily for psychological or cosmetic reasons. The evidence, in this case, demonstrated that the care Carol and EerieAnna seek is not cosmetic but is medically necessary for them.

The Iowa Supreme Court recognized that the Iowa Civil Rights Act specifically prohibits discrimination based on gender identity and has done so since 2007.

“This has been a long journey since we first started fighting for this gender-affirming health care which some transgender people so desperately need,” Beal said, according to the ACLU of Iowa. “I’m so glad we finally won. I’m still processing this. But I’m extremely happy for those people who will come after me, that we’ve made a path for them so that they can get the medical care and surgery they need. That’s one reason I fought so hard for this. It’s opened a door.”

Good also agreed with Beal about this ruling being a long time coming.

“I’m honored to have the opportunity to do what I have to help the hundreds and thousands of other transgender people out there who definitely need this type of medical care,” Good said, according to the ACLU of Iowa. “So many people still don’t understand that this is not something we need for trivial or cosmetic reasons. It’s medical care a doctor is recommending for someone who has a medical need for it. And it can save lives. Transgender people are at such risk for suicide, and I’ve lost transgender friends to suicide. I hope this decision helps change that.”

The availability of transition-related medical care, including surgeries for those who need it, is recommended and supported by the American Medical Association, the American Psychological Association, the American Psychiatric Association, the American Academy of Family Physicians, the National Association of Social Workers, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American Public Health Association, the Endocrine Society and the World Professional Association for Transgender Health.

“[This ruling] defines Medicaid as a public accommodation for analysis under the Iowa Civil Rights Act,” said Keenan Crow, director of policy and advocacy for OneIowa. “That’s an important component because that is going to allow folks to file claims against Medicaid under the Iowa Civil Rights Act. That is surely LGBTQ folks but also folks with disabilities and other things like that. So I think that’s an important component of the ruling.”

nicci port, project director for diversity and inclusion and LGBTQ+ initiatives at Iowa State, said this ruling is fantastic for transgender Iowans and it’s especially great because of how big of an insurer Medicaid is.

“The Department of Human Services has had this broad sweeping categorical ban on Medicaid coverage for gender-confirming surgeries and our point was you can’t just eliminate and a whole category all protected class of people from a procedure,” said Veronica Fowler, communications director for the ACLU of Iowa. “You need to look at if it’s medically necessary what those the best medical research show. It needs to be on a case by case basis and not just wiping out everyone because they’re specifically transgender.”