Does Medicaid Cover Gender-Affirming Care? (2026)

Direct Answer: It Depends on Your State

It depends on your state. About 20 states and DC cover gender-affirming care under Medicaid for adults; about 25 states ban or restrict it. Federal Medicaid law requires states to cover medically necessary services but leaves states discretion to define which services qualify. Check Medicaid income limits to confirm you qualify for coverage before proceeding. The 2025 Supreme Court ruling in United States v. Skrmetti confirmed state authority to restrict this care for minors.

States That Cover Gender-Affirming Care Under Medicaid (2026)

As of 2026, the following states and DC have Medicaid policies that explicitly cover gender-affirming care for enrollees: California (Medi-Cal), Colorado, Connecticut (HUSKY Health), Delaware, Hawaii (Med-QUEST), Illinois, Maine (MaineCare), Maryland, Massachusetts (MassHealth), Minnesota, Nevada, New Jersey (NJ FamilyCare), New Mexico, New York, Oregon (Oregon Health Plan), Rhode Island, Vermont, Washington (Apple Health), and the District of Columbia. Coverage in these states typically includes hormone therapy, mental health evaluation and counseling for gender dysphoria, and for adults, gender-affirming surgical procedures when a provider documents medical necessity.

Even within covering states, benefit packages vary. Some states reimburse the full spectrum of gender-affirming procedures (chest reconstruction, orchiectomy, gonadectomy, hysterectomy, phalloplasty, vaginoplasty, facial feminization surgery) while others limit coverage to hormone therapy and mental health services. Prior authorization requirements also differ across managed care plans operating within the same state. Always confirm the specific services covered by your managed care plan before scheduling care.

States That Ban or Restrict Medicaid Coverage (2026)

As of 2026, the following states have enacted bans or significant restrictions on gender-affirming care under Medicaid: Alabama, Arkansas, Arizona, Florida, Georgia, Idaho, Indiana, Kansas, Kentucky, Louisiana, Mississippi, Montana, Nebraska, North Dakota, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, West Virginia, and Wyoming. Some bans apply to all Medicaid enrollees regardless of age. Others are structured as minor-specific restrictions that apply on top of broader state policies. Adults in some ban states have pursued coverage through appeals and litigation, with inconsistent outcomes that vary by state and by the scope of the specific ban law.

Several of these state laws were challenged in federal court, and some were temporarily blocked by injunctions. Many restrictions are now fully in force following the Supreme Court's 2025 Skrmetti ruling, which removed the primary constitutional theory used to challenge minor-focused bans. Litigation over adult coverage continues in some states. Because the legal status of specific restrictions can change, residents of ban states should confirm current rules with their state Medicaid office before assuming coverage is unavailable.

What the Supreme Court Ruling in United States v. Skrmetti Means

In United States v. Skrmetti (2025), the U.S. Supreme Court held that state laws banning gender-affirming care for minors do not violate the Equal Protection Clause of the 14th Amendment. The case involved a Tennessee law restricting minors' access to puberty-suppressing hormones and cross-sex hormone therapy. The Court's decision means states may enforce those restrictions against Medicaid enrollees under 18 without constitutional challenge under the equal protection theory. States with existing minor-specific bans have relied on this ruling to maintain or expand their restrictions.

The Skrmetti ruling does not directly resolve adult coverage. Adults in states with broad bans can still challenge coverage denials on grounds that a state has arbitrarily excluded a medically necessary service under federal Medicaid statute, though courts have reached different conclusions on this theory. The ruling also does not affect coverage in the approximately 20 states and DC that have affirmatively extended Medicaid coverage to gender-affirming care for all ages.

What Services Are Covered in States That Allow Gender-Affirming Care

In states with explicit Medicaid coverage, the services typically reimbursed as of 2026 include: mental health evaluation and counseling related to gender dysphoria; hormone therapy (estrogen, testosterone, anti-androgens); puberty-suppressing treatment for minors where permitted under state law; and gender-affirming surgeries for adults (chest reconstruction, orchiectomy, gonadectomy, hysterectomy, phalloplasty, vaginoplasty, depending on the state's covered-service list). Aftercare, follow-up visits, and labs are generally covered as part of routine Medicaid medical care.

Federal Section 1557 of the ACA prohibits sex discrimination, which has been interpreted to include gender identity discrimination, in programs receiving federal financial assistance. Medicaid receives federal funding and is technically subject to Section 1557, but enforcement has been uneven under different administrations and is currently subject to ongoing litigation. Section 1557 has not, as of 2026, been applied by courts in a way that overrides state Medicaid coverage bans across the board.

How to Access Gender-Affirming Care Through Medicaid

Medicaid has no enrollment window. You can apply year-round at Medicaid.gov or through your state Medicaid agency. Under Medicaid expansion (adopted by 40 states plus DC as of 2026), adults with income at or below 138% of the 2026 Federal Poverty Level ($22,025 for a single individual) generally qualify. To access gender-affirming care once enrolled, the typical process in a covering state involves: (1) verifying you are enrolled in Medicaid or applying for enrollment; (2) identifying an in-network provider experienced with gender-affirming care using your managed care plan's provider directory or the GLMA provider finder; (3) obtaining a referral and documentation of medical necessity from a primary care or behavioral health provider; (4) submitting prior authorization if the specific service requires it; and (5) scheduling the service after prior authorization is confirmed.

If your Medicaid plan denies coverage, the denial notice must state the specific reason. You have the right to an internal appeal, typically within 60 to 90 days of the denial notice, and can request continuation of benefits during the appeal. If the internal appeal fails, you can request a state fair hearing through your state Medicaid agency. In states with active litigation around coverage, organizations including Lambda Legal, the ACLU LGBTQ+ Rights Project, and Transgender Law Center offer legal resources for Medicaid coverage disputes.

Alternatives If Your State Restricts or Bans Medicaid Coverage

Residents of states that ban or restrict gender-affirming care under Medicaid have several options to explore. The practical availability and cost of each depends on income, location, and individual circumstances.

• Federally Qualified Health Centers (FQHCs): FQHCs receive federal funding and must serve patients regardless of ability to pay, with sliding-scale fees. Many FQHCs specialize in LGBTQ+ affirming care and offer hormone therapy independent of state Medicaid coverage policy. Find a center at findahealthcenter.hrsa.gov.
• Planned Parenthood affiliates: Planned Parenthood clinics in many states offer hormone therapy on a sliding-scale fee basis regardless of Medicaid policy in that state. The Planned Parenthood website provides a clinic finder.
• Interstate care: Traveling to a nearby state that covers gender-affirming care under Medicaid is an option some patients pursue. Your home-state Medicaid plan typically does not cover out-of-state elective services, but some covering states have established travel funds for patients from states with bans.
• Nonprofit and mutual aid funds: Trans Lifeline, Point of Pride, and many state-specific LGBTQ+ organizations offer financial assistance for gender-affirming healthcare when insurance or Medicaid does not cover it.
• ACA marketplace plans: In some ban states, ACA marketplace plans are subject to Section 1557 nondiscrimination requirements. Whether a marketplace plan must cover specific gender-affirming procedures has been disputed in courts, but some marketplace plans in ban states do cover hormone therapy when medically necessary. Compare plans at healthcare.gov during open enrollment (November 1, 2025 through January 15, 2026 for the 2026 plan year).

Medicare and Dual-Eligible Enrollees

Original Medicare does not have a categorical policy covering gender-affirming surgery or hormone therapy. Medicare does cover services when a provider documents medical necessity under standard Medicare criteria for an individual clinical encounter, and CMS has not issued a national coverage determination categorically excluding or including gender-affirming procedures. Medicare Advantage plans (Part C) may offer additional benefits beyond Original Medicare, and some plans include expanded coverage for gender-affirming services. Check your specific Medicare Advantage plan's Summary of Benefits for gender-related services.

For dual-eligible individuals who have both Medicare and Medicaid, Medicare pays first. If Medicare does not cover a specific gender-affirming service, Medicaid may cover it if the enrollee lives in a state with Medicaid coverage. Approximately 12 million Americans are dual-eligible. Dual-eligible individuals in covering states may access a broader range of gender-affirming services than those with only Medicare.

Does Medicaid cover hormone therapy for transgender adults in 2026?

It depends on your state. In approximately 20 states and DC, Medicaid explicitly covers hormone therapy (estrogen, testosterone, anti-androgens) for transgender adults when a provider documents medical necessity. In states with bans, hormone therapy is excluded from Medicaid reimbursement, though Federally Qualified Health Centers may offer sliding-scale services regardless of state Medicaid policy.

Does Medicaid cover gender-affirming surgery?

Only in states that explicitly include it in their Medicaid benefit package. As of 2026, states including California (Medi-Cal), New York, Washington (Apple Health), Oregon (Oregon Health Plan), and Massachusetts (MassHealth) cover gender-affirming surgeries for adults when medically necessary. Prior authorization and medical necessity documentation are required even in covering states.

What did the 2025 Supreme Court ruling in United States v. Skrmetti say about Medicaid?

In Skrmetti (2025), the Supreme Court held that state laws banning gender-affirming care for minors do not violate the Equal Protection Clause of the 14th Amendment. The ruling directly upheld Tennessee's ban on puberty blockers and hormone therapy for minors, meaning states may enforce those restrictions on Medicaid enrollees under 18. The decision does not directly address adult coverage and does not affect the approximately 20 states that cover gender-affirming care.

Can a state refuse to cover gender-affirming care under Medicaid even though federal law requires medically necessary care?

Yes, under the current legal landscape as of 2026. States define what counts as medically necessary within federal limits. The Skrmetti ruling confirmed state authority to restrict care for minors. For adults, courts have reached different conclusions, and litigation continues in some states, but many bans are now in force. Section 1557 of the ACA has not been applied by courts in a way that uniformly overrides state Medicaid coverage exclusions.

Does Original Medicare cover gender-affirming care?

Original Medicare does not have a categorical national coverage determination either covering or excluding gender-affirming procedures. Medicare covers services when a provider documents medical necessity under standard Medicare criteria for an individual clinical encounter. Medicare Advantage plans may include additional benefits beyond Original Medicare. Dual-eligible individuals in states with Medicaid coverage may access gender-affirming services through the Medicaid side of their coverage.

What alternatives exist if my state bans gender-affirming care under Medicaid?

Federally Qualified Health Centers (FQHCs) offer sliding-scale hormone therapy regardless of state Medicaid policy. Planned Parenthood affiliates in many states provide hormone therapy on a sliding-scale basis. Interstate care (traveling to a covering state) is an option some patients pursue. Nonprofit funds including Trans Lifeline and Point of Pride offer financial assistance. ACA marketplace plans in some ban states may cover hormone therapy when medically necessary even where Medicaid does not.

How do I find a gender-affirming care provider that accepts Medicaid?

Start with your Medicaid managed care plan's provider directory filtered by specialty (endocrinology for hormones, urology or OB/GYN for surgical care). GLMA: Health Professionals Advancing LGBTQ+ Equality maintains a provider directory at glma.org. Federally Qualified Health Centers at findahealthcenter.hrsa.gov often have affirming providers who accept Medicaid. Your state Medicaid agency may also maintain a list of participating gender-affirming care providers.

What if my Medicaid plan denies gender-affirming care in a state that covers it?

Request the denial in writing. The notice must state the specific medical or policy reason. File an internal appeal within the deadline on the notice, typically 60 to 90 days. If the internal appeal is denied, request a state fair hearing through your state Medicaid agency. In states with ongoing coverage disputes, Lambda Legal, the ACLU LGBTQ+ Rights Project, and Transgender Law Center provide legal resources for Medicaid coverage appeals.