It's final: Iowa cannot enforce a regulation barring Medicaid coverage for gender-affirming surgery.

But other aspects of the decision raise questions about how the Iowa Supreme Court may approach future challenges to state laws designed to discriminate against transgender people.
https://www.bleedingheartland.com/2023/05/13/good-news-bad-news-in-iowa-supreme-courts-latest-ruling-on-trans-rights/