Iowa Gov. Signs Law Allowing Medicaid to Deny Coverage for Transition-Related Health Care | National Center for Transgender Equality

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David Farmer
May 3, 2019

Iowa Gov. Signs Law Allowing Medicaid to Deny Coverage for Transition-Related Health Care

Correction: A previous version of this press release incorrectly stated that the newly-signed law would prohibit Medicaid coverage of transition-related care. The law does not include an outright prohibition of coverage, but states that the Iowa Civil Rights Act does not require the Department of Human Services (DHS) to cover transition-related care under Medicaid in an effort to allow DHS to reinstate its previous coverage exclusion. DHS is expected to now put in place a ban on coverage for transition-related care under Medicaid.

In an extreme move against the rights of transgender Iowans, Governor Kim Reynolds has signed into law a bill that opens the door to a ban on Medicaid coverage for medically necessary transition-related care. 

This discriminatory provision was snuck into the state budget at the last minute by legislators reacting to the state Supreme Court, which ruled exclusions of transition-related care in Iowa’s Medicaid program illegal under the state’s Civil Rights Act. Numerous federal courts have likewise found such exclusions illegal under the Medicaid Act of 1965 and the nondiscrimination provisions of the Affordable Care Act. The newly signed law claims that, in defiance of the state Supreme Court's opinion, Iowa's Civil Rights Act does not require Medicaid to cover transition-related care, paving the way for the coverage exclusion to be reinstated.

This is the first explicitly anti-transgender state law signed by a governor since North Carolina’s notorious HB 2 was signed by then-Gov. Pat McCrory in 2016, a mistake for which the state economy paid dearly and the governor paid for by losing his reelection.

Mara Keisling, executive director of the National Center for Transgender Equality, condemned the new policy:

“This bill will not save Iowan taxpayers a nickel but will force transgender Iowans to face severe hardship. The entire medical world knows exclusions like these put dangerous barriers between people and the safe and effective health care their doctors say they need. I’m sorely disappointed to see Governor Reynolds put her signature on such a backwards policy, one that will certainly stain Iowa’s reputation as a welcoming place for employers, current  residents, and visitors.”

Coverage of transition-related care is recognized throughout the insurance industry as cost-effective, so much so that 90% of private insurers have already removed exclusions from their policies. According to an analysis by Johns Hopkins University, insurance coverage for transition-related health care is estimated to cost insurers less than two cents per subscriber. Twenty states and the District of Columbia prohibit any insurer from carrying such exclusions. 

National medical bodies such as the American Medical Association, the American Psychological Association, the American Psychiatric Association, and the American Academy of Pediatrics endorse transition-related health care as safe, effective, and deserving of insurance coverage.

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