A district court judge has ordered the state to cover the costs of sex-change surgeries for two transgender women.

The judge ruled denying Medicaid coverage of the procedure violates Iowa’s Constitution and the state’s civil rights law. State regulations dating back to 1995 have banned Medicaid coverage for sex change surgeries. The judge called the rules outdated.

A spokesman for the Iowa Department of Human Services would not comment on the likelihood of an appeal.

The American Civil Liberties Union of Iowa filed the lawsuit on behalf of Carol Ann Beal of northwest Iowa and EerieAnna Goode of the Quad Cities. Their doctors have called the surgeries “medically necessary.”

(Reporting by Iowa Public Radio’s Joyce Russell)

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Judge rules Medicaid must cover sex change surgeries