Iowa’s Outdated Medicaid Ban Fails Transgender Iowans

Thanks to One Iowa executive director Donna Red Wing for explaining a little-known problem for transgender Iowans. -promoted by desmoinesdem

Amerigroup, one of Iowa’s private Medicaid providers, agreed last month to cover gender-affirming surgery for Andrew Evans, a transgender Iowa man and client of the American Civil Liberties Union (ACLU).

While we are happy Evans will receive the surgery he needs, we realize that it means only one thing: Evans’ surgery will be covered. The Medicaid provider refused to acknowledge the medical necessity of the surgery, instead agreeing to coverage in order to “amicably resolve” the situation. In plain English, they didn’t want to tangle with the ACLU.

Exclusions for transgender surgery and other trans-related health care continue. Iowa’s Medicaid ban on transition-related surgeries remains.

Nationally, Medicare excluded these surgeries until May 2014, categorizing gender-affirming surgery as “experimental.” The U.S. Department of Health and Human Services (HHS) Departmental Appeals Board ruled in 2014 that transition-related care decisions should be made like other Medicare care decisions: on an individual basis. While Medicare insurers are not required to cover gender-affirming surgery, they are scrutinized if they refuse medically necessary services related to gender transition.

Unlike Medicare, Medicaid is largely implemented by individual states. Iowa Administrative Code classifies transition-related surgeries as “a cosmetic, reconstructive or plastic surgery”, and so bans Medicaid coverage for it. Tell that to a transgender person who has met all candidate criteria for surgery, including undergoing significant medical and psychological evaluations, medical therapies and behavioral trials. You can find the language excluding transition-related surgery from Medicaid coverage in IAC 441.78.1(4)(d).

Iowa is proud of its history as a state that stands for justice and equality. Yet our privatized Medicaid system denies quality healthcare to transgender Iowans. Whether that is based on outdated and prejudiced science, the decision to simply make a buck or a combination of both is unclear.

What is clear is this: Iowa’s blanket Medicaid ban on transition-related surgery and the decisions of for-profit companies managing Iowa’s Medicaid system are not good for patients or providers. To exclude an entire group of people from medically necessary care is discriminatory and dangerous. Iowa needs to be better than this.

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