Verna Pinneke began life as a male, but quickly became uncomfortable with the male “gender identity.” After extensive testing, doctors concluded that she had a transsexual personality, and required sex reassignment surgery. She underwent sex reassignment surgery on April 20, 1976. As a Supplemental Security Income recipient, Pinneke was eligible for benefits under the Medicaid program, 42 U.S.C. § 1396 (1976). She applied for funding of her sex reassignment surgery under the Medicaid program, but the Cerro Gordo County office of the Iowa Department of Social Services refused funding. The Commissioner of the Iowa Department of Social Services affirmed this decision on the basis that the State of Iowa’s Medicaid plan specifically excludes coverage for sex reassignment surgery. Pinneke then filed a lawsuit seeking remedial injunctive and declaratory relief from the denial of her constitutional rights to equal protection and due process and her statutory right to Medicaid benefits. The trial court found the surgery was “the only medical treatment available” to address his transgender status and the U.S. Court of Appeals for the 8th Circuit affirmed.