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States Split on Medicaid Coverage for Transgender Health Care

A recent Pew Charitable Trusts analysis shows diverging state policies about Medicaid coverage for gender reassignment services, including hormone treatments and surgery.

Medicaid policies in eight states exclude sexual reassignment treatment and transition-related services. Iowa is the latest state to enact a law denying coverage for transition services.

In contrast, Maine recently announced it would begin covering transition services under Medicaid, and judges in California, Minnesota, and Wisconsin have ruled health care providers cannot discriminate based on gender identity. In total, 22 states and the District of Columbia prohibit discrimination in health care based on gender identity.

Meanwhile, 21 states have no explicit policy on health coverage and care for transgender people.

The Department of Health and Human Services (HHS) in June proposed to overturn an Obama-era policy prohibiting discrimination by gender identity under the Affordable Care Act. In a comment letter to the HHS Office of Civil Rights, America’s Essential Hospitals expressed concern that changes to nondiscrimination protections will decrease access to care and worsen health outcomes for transgender people.

Contact Senior Director of Policy Erin O’Malley at or 202.585.0127 with questions.


About the Author

Kelcie Jimenez is a former state policy analyst at America's Essential Hospitals.

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