March 15, 2019

Jenner & Block represented amici in a case pending in the Iowa Supreme Court that resulted in a victory last Friday for two transgender women who argued that the state’s failure to cover gender-affirming surgery constituted impermissible discrimination based on gender identity.
The two women, EerieAnna Good and Carol Beal, were Iowa Medicaid recipients who had been diagnosed with gender dysphoria and whose physicians had concluded that gender-affirming surgery was necessary to treat their gender dysphoria.  Both women were denied coverage for the surgery based on an Iowa regulation that excluded coverage for surgery related to gender identity disorders and which considered such surgery to be “cosmetic” or “performed primarily for psychological purposes.”  They filed a successful petition for review in the Iowa District Court.  The Iowa Department of Human Services (IDHS) then appealed to the Iowa Supreme Court.  The women were represented by the ACLU of Iowa Foundation and the John Knight of ACLU Foundation LGBT & HIV Project, and by Nixon Peabody LLP.  
The firm authored an amicus brief on behalf of The American Medical Association, The Iowa Medical Society, The American College of Physicians, Mental Health America, National Association of Social Workers, and GLMA: Health Professionals Advancing LGBT Equality.  The brief argued explained that gender dysphoria is a serious medical condition and that transgender individuals have significantly higher rates of depression, suicide attempts and substance abuse than the rest of the population.  The brief described the nature and symptoms of gender dysphoria, explained the pertinent diagnostic criteria, and described current standards of treatment.  It explained that for certain individuals suffering from gender dysphoria, gender-affirming surgery is a medically necessary and effective treatment.   The brief argued that IDHS’s decision to deny coverage for such treatment was discriminatory and violated the standards of care for treating the condition.  
On Friday, the Iowa Supreme Court unanimously ruled that the IDHS discriminated against the women on the basis of gender identity, in violation of state law.  Associate Lindsey A. Lusk authored the brief, with supervision by Partners Robert R. Stauffer and Devi M. Rao.  A statement from the ACLU on the decision is available here, and an ACLU of Iowa statement can be found here.