DES MOINES — The Iowa Supreme Court has upheld a lower court ruling requiring the state Medicaid program to pay for sex-change surgery for two transgender individuals.

The Department of Human Services appealed the lower court ruling and in oral arguments in January, lawyer Matthew Gillespie said the action did not violate the Iowa Civil Rights Act. “This case is not about whether transgender Iowans have suffered and continue to suffer from pernicious discrimination. This case is not about whether transgender Iowans have legitimate medical needs related to gender dysphoria,” Gillespie says. “In fact, this case is not about transgender Iowans at all.” He says the case centers on the rules followed by the state which denies coverage for performed primarily for psychological reasons.

The case involved trasngender women EerieAnna Good and Carol Anne Beal. Their attorney, John Knight, said during the January oral arguments that the state is wrong about the need for the surgery. “In a sense they have recharacterized the nature of this surgery here as cosmetic by their use of the language psychological services. The record evidence however shows that this surgery is medically necessary, and that it is really life-saving treatment for a number of individuals — including my clients,” Knight says.

The Supreme Court ruling says the record does not support the DHS’s position that its rule is nondiscriminatory because its exclusion of coverage for gender-affirming surgical procedures encompasses the broader category of “cosmetic, reconstructive, or plastic surgery” that is “performed primarily for psychological purposes.”

Here’s the ruling: Supreme Court transgender surgery ruling-PDF