Iowa Gov. Reynolds signed HF1049 barring Medicaid coverage of gender-affirming care for transgender Iowans

On June 11, 2025, Iowa Governor Kim Reynolds signed House File 1049 into law, enacting a roughly $2.47 billion appropriations act for the Iowa Department of Veterans Affairs and the Department of Health and Human Services. Folded into that budget vehicle was a provision prohibiting the state's Medicaid program from reimbursing "sex reassignment surgery or associated procedures, including hormone therapy or other medical interventions intended to alter primary or secondary sex characteristics" related to a gender-dysphoria diagnosis.

The provision removed existing Medicaid coverage of gender-affirming care from transgender Iowans, who had previously been able to obtain such treatment through the program. Because the exclusion was carried inside a large appropriations bill rather than a standalone measure, it advanced alongside routine health and veterans funding. The law was one of several measures from Iowa's 2025 legislative session affecting LGBTQ Iowans, a session that also removed gender identity from the state's civil-rights code.