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Rally to Resist outside the State Capitol building, Des Moines, Iowa, 2023
The law prevents Medicaid from paying for hormone therapy or gender-affirming surgeries for trans people, but not for cis people.
It's not just youth — Iowa's Medicaid program is now banned from covering gender-affirming care for adults, too.
House File 1049 prevents Medicaid from paying for hormone therapies or gender-affirming surgeries, though it does not prohibit coverage of mental health services for gender dysphoria. Signed into law without comment by Republican Gov. Kim Reynolds on Wednesday, the ban is set to go into effect on July 1.
"Yesterday the Governor signed into law an obviously discriminatory bill that limits healthcare simply because someone is transgender," Keenan Crow, Director of Policy and Advocacy at One Iowa, told The Advocate. "The bill provides these same medications and procedures for non-transgender Iowans without issue. It is unconscionable to restrict access to healthcare because of who someone is."
Iowa is now one of eleven states where Medicaid policy explicitly excludes transgender-related health care for all ages, according to the Movement Advancement Project. The other states are Arizona, Florida, Idaho, Kentucky, Missouri, Nebraska, Ohio, South Carolina, Tennessee, and Texas. Additionally, Arkansas, Kansas, and Mississippi prevent Medicaid from covering gender-affirming care for minors.
The American Medical Association, the American Psychiatric Association, the American Academy of Pediatrics, the American Academy of Child & Adolescent Psychiatry, the World Medical Association, and the World Health Organization all agree that gender-affirming care is evidence-based and medically necessary not just for adults, but minors as well.
Iowa has previously attempted to prevent gender-affirming care from being covered under Medicaid. After agencies implemented a rule banning the coverage in 2019, the Iowa Supreme Court determined that the policy was unlawful. In response, Iowa Republicans then passed a law that allowed the coverage to be denied.
That law was struck down in 2021 after a judge ruled that denial of such coverage violates both the Iowa Civil Rights Act and the guarantee of equal protection under the state's constitution. The state appealed, but the Iowa Supreme Court declined to hear the case in 2023, leaving the law blocked.
"Iowa courts have long noted that this is discriminatory and a violation of equal protection under the law," Crow continued. "We will continue working toward an Iowa where everyone gets the healthcare they need regardless of who they are or who they love.”
