A new study published in Health Services Research finds that Medicaid coverage of gender-affirming facial surgery is less common than gender-affirming chest and genital surgeries.
In 2022, when the study was conducted, 26 states and D.C. provided Medicaid coverage for gender-affirming care. Researchers from the Williams Institute at UCLA School of Law, UCLA Health, and Harvard University examined each state’s Medicaid policies to assess the coverage of gender-affirming surgeries in four categories: chest, genital, craniofacial and neck reconstruction, and miscellaneous procedures.
Among the 27 states analyzed, explicit coverage for gender-affirming chest and genital reconstruction was found in 17 states (63%). Explicit coverage for gender-affirming craniofacial and neck reconstruction was found in only eight states (30%). Ten states (37%) did not describe specific procedures.
“Even in states that provide access to gender-affirming care under state Medicaid policies, there’s often a lack of clarity around the types of care that are covered,” said study co-author Christy Mallory, Legal Director at the Williams Institute. “This uncertainty could create obstacles to obtaining or providing care for patients and surgeons.”
Additional Findings
- In 2022, 53% of states had policies that provided coverage for gender-affirming care under Medicaid.
- The most common explicitly covered gender-affirming chest surgery was breast reduction/mastectomy (63%), followed by breast augmentation/implants (56%).
- The most common explicitly noncovered chest surgery was mastopexy (22%).
- The most common explicitly covered gender-affirming genital surgery was hysterectomy (63%), followed by penectomy (56%), orchiectomy (56%), and vaginoplasty (56%).
- Less frequent explicitly covered genital surgeries included penile prosthesis placement (30%), vulvectomy (26%), and prostatectomy (23%).
- The most common explicitly covered gender-affirming facial surgery was voice modification surgery/laryngoplasty (63%).
“Anatomical sources of gender dysphoria differ among individuals and may not be limited to chest or genital areas,” said author Justine Lee, M.D., Ph.D., craniofacial and pediatric plastic surgeon at the UCLA David Geffen School of Medicine, UCLA. “Facial feminization surgeries can result in improved mental health and quality of life for people whose face is a source of gender dysphoria and should be more explicitly covered in state Medicaid policies.”