Transgender Iowans with low-incomes are postponing or canceling gender-affirming surgeries since Medicaid in Iowa no longer covers the procedures.
A provision in a state health budget bans Medicaid coverage for:
- Hormone replacement therapy
- Sexual reassignment surgery or associated procedures
- Medical interventions intended to alter primary or secondary sex characteristics
Mental health treatment for gender dysphoria is still covered by Medicaid. The provision went into effect July 1.
Since the changes took effect, transgender patients using Medicaid for treatments for gender dysphoria have had to find other ways to pay for medically necessary care.
CEO and President of Planned Parenthood North Central States, Ruth Richardson, said Iowa clinics are still offering care to transgender patients on Medicaid, but patients are having to turn to secondary insurance or pay out of pocket.
“Our patients are just in need of more support as all of these barriers are being erected and the really sort of hostile landscape that is being seen," Richardson said.
University of Iowa Health Care said in a statement that its LGBTQ clinic is still open, but patients on Medicaid will have to find another way to pay for some care.
The provision was able to pass after Gov. Kim Reynolds signed a bill into law that removed gender identity from the Iowa Civil Rights Act.
According to Movement Advancement Project, Iowa is one of 11 states that restricts Medicaid from covering some gender-affirming treatments.
Some transgender Iowans are turning to mutual aid, according to Max Mowitz, a co-founder of Iowa Trans Mutual Aid Fund. It's the only one in the state for transgender support.
"We disperse $10,000 a month to folks. I'd say our average right now is like 90 to 120 applicants," Mowitz said. "That number has only continued to grow."
Everyone who applies receives funding, so if there are 100 approved applications, then each person receives $100 that can go toward therapy co-pays, clothing and other expenses related to gender-affirming care.
Mowitz said that recently more people are requesting aid for less expensive ways to affirm their gender identity, such as for wigs or chest compression garments.
“Because if you can't pay for a $5,000 surgery, but you can pay for clothing that makes you feel more like yourself — that's harm reduction. So, I will say that there's been a shift to those kind of smaller asks, so that people can just kind of survive for the time being," Mowitz said.
Numerous studies show access to gender-affirming care decreases depression and suicidality in transgender patients. A study published in March of 2024 found Medicaid coverage of gender-affirming care improves mental wellness in transgender people.
Mowitz said gender dysphoria is like having a migraine all the time and it's "very, very oppressive."
"When we're looking at gender-affirming care, not only is it allowing us to save lives so that people can be more themselves, they can get rid of that migraine or at least lessen the severity of it," Mowitz said. "But also because it allows trans people to thrive."
If you or someone you know is experiencing a mental health crisis, call or text the Suicide and Crisis Lifeline at 988.
