Hundreds gathered at the Iowa State Capitol Feb. 24, 2025 to protest legislation that would remove protections for gender identity under the Iowa Civil Rights Act. (Photo by Robin Opsahl/Iowa Capital Dispatch)
Iowa Republican lawmakers are trying again to pass a ban on Medicaid funding going to gender-affirming care for transgender Iowans, this time by including language in the proposed budget for health and human services programs.
A Senate subcommittee advanced Senate Study Bill 1237 Wednesday, the HHS appropriations bill for fiscal year 2026. The measure included language that the funding allocated for Iowa’s Medicaid program “shall not be used for sex reassignment surgery or treatment related to an individual’s gender dysphoria diagnosis.”
Iowa has attempted to ban Medicaid coverage for gender-affirming care law before, but these laws were struck down by the courts for violating the Iowa Constitution and the Iowa Civil Rights Act. The Iowa Supreme Court ruled in 2019 that the state’s denial of two transgender women’s transition-related care through Medicaid violated the Iowa Civil Rights Act. A Polk County District Court judge also ruled in 2021 that a law passed after that state Supreme Court decision, which amended the Iowa Civil Rights Act to allow for the exclusion of Medicaid coverage for transition-related health care, violated the Iowa Constitution.
Earlier this year, Gov. Kim Reynolds signed into law a measure that removed gender identity as a protected class in the Iowa Civil Rights Act. As activists rallied against the measure for potentially allowing for the legal discrimination against transgender Iowans, one of the arguments posed by lawmakers was the fact that previous laws attempting to deny Medicaid coverage for transition-related health care were blocked through the state Civil Rights Act.
Keenan Crow, policy and advocacy director at One Iowa, said Thursday that one of the major differences between the language in this year’s Senate appropriations bill and previous attempts to ban Medicaid coverage for gender-affirming care was the reference to all “treatment related to an individual’s gender dysphoria diagnosis,” not just sex reassignment surgery. This could impact transgender Iowans’ ability to access mental health care and other services, Crow said.
“Our first line of intervention on any gender dysphoria case is going to be mental health counseling, period, that is the primary treatment for gender dysphoria,” Crow said. “And obviously I am not okay with restricting surgical care either, but to go even further and and get into restricting medications and mental health supports and all this other stuff, that is truly wrong.”
Even with the removal of gender identity from the Iowa Civil Rights Act, denying transgender Iowans gender-affirming care could still be unconstitutional under the Equal Protection Clause. The 2021 district court ruling found the law prohibiting Medicaid coverage of transition care violated both state civil rights laws and the state constitution. The Iowa Supreme Court declined to rule on the constitutionality of the law in 2023.
House bill does not include Medicaid restriction, for now
The House Health and Human Services Appropriations Subcommittee met Thursday to discuss its version of the HHS budget bill, House Study Bill 342, which passed unanimously. The House legislation, in its current form, does not include the Senate’s language.
But House Speaker Pat Grassley told reporters Thursday that the House supports restricting Medicaid funds going toward transition-related health care.
“We don’t believe the taxpayers … should be paying for surgeries and other hormone therapies,” Grassley said. “I know that there’s a piece of that that’s in the Senate bill, I think you will see a piece focused on those two things that I just said on our side. But again, we have not negotiated the Senate language out with them. They may have some different languages where we may settle, but I think you could expect to us to, at least, have that conversation about the taxpayer paying for those two items.”
The chair of the House HHS appropriations subcommittee Rep. Ann Meyer, R-Fort Dodge, said she has spoken with Grassley about the provision, and that there will be discussions with the full House Republican caucus. However, she said that the House would likely consider different language on the measure that would not impact Medicaid coverage for mental and behavioral health care for transgender Iowans.
“If this were to come before the House, we would just be talking about surgery and hormone therapy,” Meyer said.
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