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. 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.
The Williams Institute estimates that:
- 1.4 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 have affirmative access to coverage for gender-affirming care under express policies in state law.
- 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.
Although regulations issued by the U.S. Department of Health & Human Services in 2016 bar Medicaid programs from categorically excluding insurance coverage for all types of gender-affirming care, the Department has recently proposed to eliminate these provisions. Nonetheless, a number of laws and policies continue to support access to gender-affirming care through Medicaid programs, including the Affordable Care Act, the Social Security Act, and the U.S. Constitution. 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 necessary 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.