Iowa Gov. Kim Reynolds (R) signed a bill this week that bans the state’s Medicaid program from covering gender-affirming care.

According to The Gazette, House File 1049 includes a provision preventing money allocated for Medicaid from paying for hormone replacement therapy (HRT), gender-affirming surgery, and other medical interventions related to the treatment of gender dysphoria. An early version of the bill was updated after opponents warned that its language could also be interpreted as banning coverage for mental health treatment for gender dysphoria.

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However, the judge left other questionable parts on the law in place.

“If someone is in mental distress, if someone is suicidal, the treatment for those issues is not surgery. It’s not hormone treatment,” state Rep. Ann Meyer (R) argued in May. “It’s behavioral health, which we fully commit to covering.”

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State Rep. Aime Wichtendahl (D), Iowa’s first out trans legislator, meanwhile, explained that gender-affirming care had saved her life. “I am still here today because of it,” she told fellow lawmakers, according to The Gazette. “I do not see any reason why this government should deny its citizens health care and deny them the ability to live their best lives.”

State Sen. Molly Donahue (D) described the bill’s provision as “cruel” and “inhumane,” adding that denying coverage for medical care based on a person’s gender identity “is a violation of equal protection, plain and simple.”

“That is discriminatory. It is harmful and that is unconstitutional under the equal protections clause of our state constitution, something that the Iowa courts and others across the nation have already repeatedly affirmed,” Donahue argued.

Nevertheless, both the state House and Senate passed the bill last month, and Reynolds signed it Wednesday. The ban on Medicaid coverage is set to take effect on July 1.

Keenan Crow, director of policy and advocacy at One Iowa, blasted Reynolds for signing into law “an obviously discriminatory bill that limits healthcare simply because someone is transgender.”

House File 1049, Crow told Advocate, “provides these same medications and procedures for non-transgender Iowans without issue. It is unconscionable to restrict access to healthcare because of who someone is.”

According to the Movement Advancement Project, Iowa joins 10 other states that ban Medicaid coverage for gender-affirming care for people of all ages. But as Donahue noted in May, the state’s previous attempts to ban Medicaid coverage for gender-affirming care have been struck down. A 2019 decision by the Iowa Supreme Court found that an Iowa Department of Human Services rule banning the state’s Medicaid program from covering transition-related surgical procedures violated state law. As Advocate notes, state Republicans passed a law in response allowing for such bans. But a district court judge struck down the law in 2023, ruling that it violated the Iowa Civil Rights Act and the Equal Protection Clause of the Iowa Constitution.

“Iowa courts have long noted that this is discriminatory and a violation of equal protection under the law,” Crow said of House File 1049 this week. “We will continue working toward an Iowa where everyone gets the healthcare they need, regardless of who they are or who they love.”

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