EerieAnna Good and Carol Beal are two women whose medical providers determined that surgery was medically necessary to treat their gender dysphoria. The Iowa Department of Health and Human Services denied approval for Medicaid coverage to move forward with the surgery

The American Civil Liberties Union, the ACLU of Iowa, and Nixon Peabody LLP filed an administrative challenge on behalf of EerieAnna Good and Carol Beal to an outdated Iowa regulation that denies Iowans who are transgender Medicaid coverage for gender-affirming surgery.

Iowa’s Medicaid program provides coverage for medically necessary care for a broad range of medical conditions. However, Iowa denies transgender individuals Medicaid coverage for gender-affirming surgery to treat gender dysphoria, a medical condition only experienced by people who are transgender, even though Medicaid coverage is provided for the same surgical procedures for other medical conditions. This discriminatory ban on coverage has no basis in medical science and has been uniformly condemned by leading medical organizations. Our case challenges the ban as a violation of the Iowa Civil Rights Act (“ICRA”) and the Iowa Constitution’s equality guarantees.

EerieAnna and Carol are two women whose medical providers determined that surgery was medically necessary to treat their gender dysphoria and requested approval for Medicaid coverage to move forward with the surgery. Both were denied coverage due to the regulatory ban and we challenged those denials. The two cases which were later consolidated before one district judge.


Ten states and the District of Columbia currently cover transition-related surgical care through their public health insurance programs.  Transition-related surgery is also covered by Medicare.

The case is filed against the Iowa Department of Human Services, and demands that Iowa end its discriminatory practice of excluding transgender individuals from accessing all of their needed health care.

Cooperating attorneys in the case include: F. Thomas Hecht, Tina B. Solis and Seth A. Horvath of Nixon Peabody LLP; Rita Bettis of the ACLU of Iowa, and John Knight of ACLU. 

Stay Informed