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The Court is not convinced that singling out transgender individuals for cost saving in this way is rational.129 Justifying a discriminatory classification without at least some credible rationale is the epitome of an arbitrary classification.This is akin to the tenuous justification offered by the State in , in which the Iowa Supreme Court rejected a financial benefits argument for disparate tax treatment between excursion boats and racing tracks.130 A financial benefit to the State resulting from discrimination against transgender individuals in Iowa Medicaid based upon their status as transgender is palpably arbitrary.[…] Petitioners’ have provided ample medical evidence establishing the current medical consensus regarding the diagnosis of Gender Dysphoria and how, in some cases, sex reassignment surgery can be medically necessary to treat the condition.DHS cannot rely on outdated medical evidence as a timeless justification for the Regulation.Judge Gamble rejected almost every legal argument the Iowa Attorney General’s office raised on behalf of the DHS.
[…] As previously noted, the Regulation has not kept pace with law and medicine.
A two-decade-old state administrative rule “clearly discriminates against transgender Medicaid recipients on the basis of gender identity by excluding coverage for medically necessary gender affirming surgery” while covering the same surgeries for non-transgender Iowans, a Polk County District Court ruled on June 7.
Chief Judge Arthur Gamble found the rule violates both Article I, section 6 of the Iowa Constitution, which guarantees equal protection, and the Iowa Civil Rights Act, which has prohibited discrimination on the basis of gender identity since 2007.
But Judge Gamble observed that in its decision, the Iowa Supreme Court rejected “a similar argument in the context of excluding same-sex couples from civil marriage.” DHS also claimed the rule was drafted to reflect the “evolving nature of the diagnosis and treatment of gender identity disorder and the disagreement regarding the efficacy of sex reassignment surgery.” However, the Court finds that the medical consensus has shifted since the exclusion of sex reassignment was first added to the Regulation back in 1995.
Notably, despite this evolution within the medical community, DHS has not reviewed or studied the language regarding sex reassignment surgery in the Regulation since its original adoption. Finally, even assuming DHS’s description of the drafting of the Regulation was accurate, that does not justify enforcement of the Regulation today.