More than half lack guaranteed access to coverage for gender-affirming care under state law.
Over 150,000 transgender adults are enrolled in Medicaid in the U.S., according to a new analysis by the Williams Institute at UCLA School of Law. Eighteen states and D.C. have chosen to specifically include coverage for gender-affirming care under their Medicaid programs or are in the process of extending coverage, while 12 states exclude coverage for such care and 20 states have not expressly addressed coverage.
Gender-affirming care includes a range of services, such as surgical procedures, hormone therapy, and other forms of treatment related to gender transition.
Key Findings
- 4 million adults in the U.S. identify as transgender and approximately 152,000 of them are enrolled in Medicaid.
- Fewer than half (69,000) of transgender Medicaid beneficiaries live in states with express policies guaranteeing coverage for gender-affirming care.
- For 51,000 transgender Medicaid beneficiaries, coverage is uncertain because they live in states where the laws are silent on coverage for gender-affirming care.
- An estimated 32,000 transgender Medicaid beneficiaries live in states with express bans that deny access to covered gender-affirming care.
“This patchwork of protections creates uncertainty for transgender people who are enrolled in Medicaid,” said study co-author Christy Mallory, state and local policy director at the Williams Institute. “Absent further policy changes in states that have bans or lack clear language addressing coverage, many transgender people in the US will continue to face obstacles when seeking health care just because of where they live.”
Additional policy changes in states that still have bans or lack clear language addressing coverage would ensure that all transgender Medicaid beneficiaries nationwide have access to coverage for necessary medical care.