DES MOINES, Iowa (AP) — An Iowa judge has found that the state cannot deny two transgender women Medicaid coverage for sex reassignment surgery, declaring that denying their care policy violates the state’s Constitution and civil rights law.

Carol Ann Beal of northwest Iowa and EerieAnna Good of the Quad Cities in eastern Iowa filed the lawsuit last year after the Iowa Department of Human Services denied surgery requests recommended by doctors.

On Thursday Judge Arthur Gamble said the denial violated their rights concluding Iowa “has not kept pace with law and medicine.” An Iowa attorney general’s office spokesman says no decision has been made on an appeal.

American Civil Liberties Union of Iowa attorney Rita Bettis says the women, born male but identified as female since childhood, may proceed with surgeries.