Executive Summary
Medicaid beneficiaries who are transgender face a patchwork of policies across the U.S. that leave many of them without access to coverage for gender-affirming care. Half of the states and D.C. specifically include coverage for gender-affirming care under their Medicaid programs or are in the process of extending coverage, while seven states expressly exclude coverage for such care. Coverage is unclear in 18 states. Gender-affirming care includes a range of services, such as hormone therapy, surgical procedures, and other forms of treatment related to gender transition.
The Williams Institute estimates that
- 1.3 million adults in the U.S. identify as transgender and approximately 276,000 of them are enrolled in Medicaid.
- Sixty percent (164,000) of transgender Medicaid beneficiaries have affirmative access to coverage for gender-affirming care under express policies in state law.
- For 27 percent (74,000) of transgender Medicaid beneficiaries, coverage is uncertain because they live in states where the laws are silent or unclear on coverage for gender-affirming care.
- Fourteen percent (38,000) of transgender Medicaid beneficiaries live in states with express bans that deny access to covered gender-affirming care.
Despite inconsistent coverage across the U.S., a number of federal and state laws and policies support access to gender-affirming care through Medicaid programs. At the federal level, these laws and policies include statutes, like the Affordable Care Act and the Medicaid Act, as well as the U.S. Constitution. In addition, a number of state-level non-discrimination statutes and constitutional provisions support access to care. Bans have been successfully challenged in court under these laws in several states, resulting in changes to Medicaid policies that have increased care and coverage for transgender beneficiaries.
Additional policy changes in states that still have bans or lack clear language addressing coverage would ensure that transgender Medicaid beneficiaries have access to coverage for gender-affirming medical care no matter where they live. In addition, more transgender people could benefit from Medicaid-covered services if all states adopted Medicaid expansion and if barriers to accessing public benefits, such as requirements pertaining to identity documents, were removed.