On Wednesday, Iowa Senate Republicans advanced a bill with a provision that would cut off funding for medical treatments for people with gender dysphoria, despite testimony pointing to a medical consensus that stopping access to such treatments can increase the risk of suicide among transgender people. This is the first piece of anti-trans legislation Iowa lawmakers have taken up since February, when Republicans passed a bill stripping gender identity protections from the Iowa Civil Rights Act.
SSB 1237 sets the budgets for the Iowa Department of Health and Human Services (HHS) and the Iowa Department of Veterans Affair for the next fiscal year (FY 2026 runs from July 1, 2025 to June 30, 2026). Section 13 of the bill states that money appropriated for HHS’s medical assistance fund “shall not be used for sex reassignment surgery or treatment related to an individual’s gender dysphoria diagnosis.” If that becomes law, Medicaid would no longer pay for treatments for patients with gender dysphoria, even though a doctor has determined they are medically necessary.
Testifying during a hearing by a subcommittee of the Senate Appropriations Committee on SSB 1237, Keenan Crow pointed out how broad the prohibition in Sec. 13 is. It would even ban Medicaid covering mental health services.
“The most common treatment for gender dysphoria is, in fact, counseling,” Crow, director of policy and advocacy for One Iowa, told the three-member subcommittee. “And so we’re restricting access to mental health counseling for these folks who desperately need it. This is the group of folks who has the highest suicide rate in our state.”
As the LGBTQ civil rights organization GLAAD explains on its site, “Every major medical association and leading world health authority supports health care for transgender people and youth.” GLAAD links to statements issued by more than 30 major medical associations, including the American Medical Association and the American Psychiatric Association.
SSB 1237 would establish as a matter of Iowa law that someone is unworthy of otherwise available public assistance for medical care just because they are trans.
“So you have two kids coming in, both need mental health care services — one is trans; one isn’t,” Crow said. “The one who isn’t gets the mental health care services. The one who is doesn’t. That seems completely unfair.”
The subcommittee approved the bill, 2-1. Both Republicans, Mark Costello of Imogene and Kara Warme of Ames, voted in favor of SSB 1237. Sen. Molly Donahue of Marion, the lone Democrat on the subcommittee, opposed it.
“It’s already been in the courts and ruled unconstitutional,” Donahue said about the state attempting to ban Medicaid coverage of gender-affirming care. “So I think we’re just going to throw this back in the courts and waste more money.”
In 2019, the Iowa Supreme Court struck down an Iowa Department of Human Services (DHS) regulation that prohibited state funds from being used for gender-affirming care. (DHS merged with the Iowa Department of Public Health in 2022 to create HHS.) In a unanimous decision, the justices found the regulation illegally discriminated against transgender Iowans.
Republicans in the Iowa Senate responded by introducing a last-minute amendment to the budget bill for the DHS, which recreated the ban rejected by the Supreme Court, but made it a law instead of a departmental regulation. A preliminary injunction stopped the new law from going into effect, and in November 2021, a Polk County District Court judge struck it down, finding the ban “violate[s] the Iowa Civil Rights Act and the Equal Protection Clause of the Iowa Constitution.”
In his 60-page ruling, Judge William Kelly found the state had presented “no facts” to demonstrate it had a legitimate interest for its ban on the use of Medicaid funds. Attorneys for the Reynolds administration defending the law also presented no evidence to show the use of Medicaid funds would be a financial burden on the state, while the plaintiffs submitted information demonstrating that “providing insurance coverage for transgender patients has been shown to be “affordable and cost-effective, and has a low budget impact,” according to Kelly.
The plaintiffs also provided the court with medical literature “revealing there is a greater medical cost associated with denying transgender people access to medically necessary transition-related care and procedures.” Because providing that care leads to “significant reductions in suicide attempts, depression, anxiety, substance abuse” and other related problems.
The administration’s attorneys left that evidence “unrebutted,” the judge noted.
The governor’s office appealed the decision to the Iowa Supreme Court, but the court declined to hear the appeal.
SSB 1237 now goes to the full Senate Appropriations Committee for consideration. If approved by the committee and in a floor vote, it would go to the Iowa House. The House has its own bill funding HHS, which does not currently contain the ban on Medicaid funding for gender-affirming care. But that may change.
Speaking to reporters on Wednesday, Rep. Ann Meyer, the Fort Dodge Republican who chairs the House’s health and human services appropriations subcommittee, said the ban is “something that we’ll have to talk about as a caucus.” Meyer added, “We passed that in 2019 in the HHS budget, and it was overturned by the court.”
She did say she believed the ban would have to be narrowed to allow funding of mental health services to win support in the House.
“No, that would not be something we would ever exclude would be mental health services for gender dysphoria,” Meyer said.
Gov. Reynolds, a vocal supporter of the two previous bans on funding for gender-affirming care that were struck down, has not made any public statements about the current effort to end such care for Iowans who receive Medicaid. Presumably she supports it, not only because of her previous position — and her unbroken record of support for anti-trans legislation as governor — but also because the governor’s office worked with Senate Republicans to draft that chamber’s budget bills.
In 2023, Gov. Reynolds signed into law a ban on gender-affirming care for trans Iowans under the age of 18, regardless of whether parents support that care or doctors consider it medically necessary, so the ban in SSB 1237 would only cut off funding to adults seeking medical care.