Transgender Iowans’ Medicaid can be used for transition-related needs, the Iowa Supreme Court ruled Friday.

In a unanimous decision, the justices struck down an administrative code categorizing transition-related surgeries as “cosmetic, reconstructive or plastic surgery” and explicitly bans “surgeries for the purpose of sex reassignment.”

The court agreed with a district judge’s ruling that the Medicaid code “has not kept up with law and medicine” and went against protections in the Iowa Civil Rights Act, according to the Des Moines Register.

Justice Susan Christensen wrote to the court that the law’s “gender identity classification encompasses transgender individuals — especially those who have gender dysphoria — because discrimination against these individuals is based on the nonconformity between their gender identity and biological sex.”

This decision appears to be one of the first in the country that rules transgender people have a right to transition-related care and could lead to rulings in other states, half of which have similar language in their code.

“As the ruling showed, this case presented a difficult question involving individual rights and the state’s interests,” said Lynn Hicks, spokesman for the Attorney General’s Office. “This issue was a first for Iowa’s courts, and we thank the court for its guidance and for resolving this issue.”

The two-year legal battle began when two transgender individuals sued the state, saying the ban went against the state constitution and the Iowa Civil Rights Act. They won their lawsuit in the district court, but the state appealed.

“We are covering these surgeries in the same instances when the primary purpose is to address a non-psychological purpose,” Assistant Attorney General Matthew Gillespie said during oral arguments. “And we don’t cover surgeries in the same instance, regardless of gender identity, when the surgery is performed primarily for a psychological purpose.”

The plaintiffs’ attorney, John Knight from the ACLU, told the justices that the surgery is not just a cosmetic surgery and is needed.

“The record evidence shows that this surgery is medically necessary,” Mr. Knight, who is representing Carol Ann Beal and EerieAnna Good, told the justices when the case was argued. “It’s really lifesaving treatment for a number of individuals.”

The Iowa Department of Human Services, which oversees Medicaid benefits, declined to comment on this story.

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