Two transgender individuals sued the state of Iowa on Thursday because the state’s Medicaid coverage does not provide insurance for sex reassignment surgery.

The two biological men — now identified by the names Carol Ann Beal and EerieAnna Good — filed a lawsuit against the Iowa Department Of Human Services, alleging discrimination over the state government’s refusal to cover the cost of transgender surgeries, The Des Moines Register reported. Transition related surgeries not covered include: cosmetic, reconstructive, or plastic surgery.

“As the result of this sweeping exclusion, all surgical treatments for gender dysphoria are excluded from coverage, even though the same or substantially equivalent treatments are provided to non-transgender Iowans,” said Rita Bettis, Iowa’s American Civil Liberties Union legal director. Bettis is representing the transgender individuals in the case.

Insurance providers will pay for cancer patients to receive mastectomies to remove breast tissue, the Iowa newspaper notes.

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“You go through so many years transitioning, and now I hit a brick wall with Iowa’s discriminatory ban on Medicaid coverage for transition-related care,” Beal said at a press conference Thursday. “It has caused me stress and depression and affects every aspect of my life, but I remain determined to change this outdated law and move forward with my life.” Beal began taking hormones to become a woman at age 14.

The sum of surgeries required to fully transition is more than $100,000, Philadelphia Center for Transgender Surgery estimates.

This is not the first lawsuit or negotiation that has involved Iowa’s ACLU. The advocacy group negotiated in November with Americorps to cover the cost of breast removal surgery for a biological woman. The ACLU also filed a workplace discrimination suit in August on behalf of a former prison nurse disgruntled because she was not allowed to use the male restroom corresponding to her identified gender. (Related: Transgender Told To Use Unisex Bathroom At Work, Moves To Sue).

Iowa’s Department of Human Services declined to comment to The Daily Caller News Foundation on the pending lawsuit.

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