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Medicaid Coverage of Transgender-Related Health Care

State Medicaid policies reflect varying interpretations of federal regulations that prohibit discrimination based on gender identity. Some state policies explicitly say that the state's Medicaid program covers medically necessary care for transgender people, whereas other state policies explicitly exclude such care. Still other states have no explicit policy either way. Importantly, even in states without an explicitly inclusive policy, transgender people may still be able to access transgender-inclusive coverage or benefits, but when states have no explicit policy, transgender people are more likely to report obstacles to receiving care, including being denied needed care.  

Additionally, a growing number of states have enacted bans on best practice medical care for transgender youth, as shown by the caution icon on the map below. These policies are not specific to Medicaid coverage, but because the health care itself is banned in those states, those states' Medicaid programs presumably will not cover such medical care for minors.

United States Map
Washington New York U.S. Virgin Islands Puerto Rico Guam Commonwealth of the Northern Mariana Islands American Samoa New Hampshire Vermont Virginia Pennsylvania New York Maine West Virginia Ohio Kentucky Indiana Michigan Illinois Wisconsin North Carolina South Carolina Tennessee Georgia Florida Mississippi Missouri Arkansas Louisiana Iowa Minnesota Oklahoma Kansas Nebraska South Dakota North Dakota Texas 33 Colorado Wyoming Montana Idaho Arizona Utah Nevada Oregon California Hawaii Alaska Massachusetts Rhode Island Connecticut New Jersey Delaware Maryland Washington D.C. New Hampshire Vermont
  • State Medicaid policy explicitly covers transgender-related health care (26 states , 1 territory + D.C.)
  • State Medicaid has unclear or no explicit policy regarding transgender-related health care (12 states, 4 territories)
  • State Medicaid policy explicitly excludes transgender-related health care for minors (2 states)
  • State Medicaid policy explicitly excludes transgender-related health care for all ages (10 states)
  • State bans or restricts best practice medical care for transgender youth (see this map for more information) (25 states)

*Notes (see also the "Citations & More Information" tab or link below the map legend for more info about every state):  

Court rulings:
--In Arkansas, in June 2023, a federal judge blocked the state's ban on best practice medical care for transgender minors, including in the state's Medicaid program. However, the state is appealing the decision. This map will be updated as the case progresses. 
--In Florida, in June 2023, a federal judge blocked the state's ban on Medicaid coverage, meaning that transgender Floridians on Medicaid should be able to access medically necessary care. However, the state is appealing the decision. This map will be updated as the case progresses. 
--In North Carolina and West Virginia, an April 2024 ruling from the 4th Circuit Court of Appeals found unconstitutional the state's previous exclusions of transgender-related care in its state plans, but the decision is being appealed. This map will be updated as the case progresses.
--South Carolina is also in the 4th Circuit, and so the same ruling affecting North Carolina and West Virginia sets an important precedent, but may require further legal action before South Carolina's exclusion is explicitly addressed.


Other notes:
--In Hawai`i, the state Medicaid policy is unclear. Hawai`i has a law banning gender identity discrimination in health insurance and banning exclusions of gender-affirming care, but the state also has a pre-existing regulation that explicitly excludes transgender-related health care from being covered or paid for by the state Medicaid program. 
--Idaho's ban on Medicaid coverage of transgender-related care does not go into effect until July 1, 2024. 
--Ohio policy explicitly excludes transgender-related care, but as of mid-2019, The Washington Post and Bloomberg News both reported that state officials said they were not enforcing the exclusion. However, in 2024, the state enacted a ban on transgender youth's medical care, added at least some new exclusions.
--In Louisiana and Utah, the states have no explicit policy, but TLDEF reports that the individual health organizations that operate Medicaid in the state each have inclusive policies for covering transgender-related care.


For further information and details, please also visit the Transgender Legal Defense & Education Fund (TLDEF)'s Trans Health Project resources and research.

Federal law prohibits discrimination in health care on the basis of gender identity. Under Section 1557 of the Affordable Care Act (ACA), health facilities, programs, and activities receiving federal funding may not deny insurance coverage or care on the basis of, among other things, sex and gender identity and expression. This means several things for transgender people. First, sex-specific care cannot be denied simply because someone identifies as another gender. For example, a transgender man could not be denied care for ovarian cancer if such care is medically necessary. Second, “blanket bans” on all transition-related care are considered discriminatory, though some transition-related care can still be denied on a case-by-case basis. Finally, transition-related care that would be approved were it not related to transition cannot be denied.

If you have experienced discrimination in health care, you can file a complaint with the Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services within 180 days of when the discrimination occurred. OCR also investigates violations involving the improper disclosure or use of your private medical information.

Recommended citation:
Movement Advancement Project. "Equality Maps: Healthcare Laws and Policies: Medicaid." https://www.mapresearch.org/equality-maps/healthcare/medicaid. Accessed [day of access]. 


Percent of Adult LGBTQ Population Covered by Laws

*Note: These percentages reflect estimates of the LGBTQ adult population living in the 50 states and the District of Columbia. Estimates of the LGBTQ adult population in the five inhabited U.S. territories are not available, and so cannot be reflected here.

58%

58 % of LGBTQ population lives in states that explicitly cover transgender-related health care in Medicaid

12%

12 % of LGBTQ population lives in states that have unclear or no explicit policy regarding transgender-related health care in Medicaid

2%

2 % of LGBTQ population lives in states that explicitly exclude transgender-related health care for minors in Medicaid

28%

28 % of LGBTQ population lives in states that explicitly exclude transgender-related health care for all ages in Medicaid

Key
  • State has this lawMedicaid policy explicitly includes coverage
  • ,
  • Unclear or no explicit Medicaid policy
  • ,
  • State does not have this lawMedicaid policy explicitly excludes coverage for minors
  • ,
  • State does not have this lawMedicaid policy explicitly excludes coverage for all ages
State Medicaid
  Citations
Alabama
Alaska State has this law
American Samoa
Arizona State does not have this law
Arkansas State does not have this law
California State has this law
Colorado State has this law
Connecticut State has this law
Delaware State has this law
District of Columbia State has this law
Florida State does not have this law
Georgia State has this law
Guam
Hawaii
Idaho State does not have this law
Illinois State has this law
Indiana
Iowa State has this law
Kansas
Kentucky State does not have this law
Louisiana
Maine State has this law
Maryland State has this law
Massachusetts State has this law
Michigan State has this law
Minnesota State has this law
Mississippi State does not have this law
Missouri State does not have this law
Montana State has this law
Nebraska State does not have this law
Nevada State has this law
New Hampshire State has this law
New Jersey State has this law
New Mexico
New York State has this law
North Carolina
North Dakota State has this law
Northern Mariana Islands
Ohio State does not have this law
Oklahoma
Oregon State has this law
Pennsylvania State has this law
Puerto Rico State has this law
Rhode Island State has this law
South Carolina State does not have this law
South Dakota
Tennessee State does not have this law
Texas State does not have this law
U.S. Virgin Islands
Utah
Vermont State has this law
Virginia State has this law
Washington State has this law
West Virginia
Wisconsin State has this law
Wyoming


Data current as of 05/21/2024
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Sexual Orientation Policy Tally

The term “sexual orientation” is loosely defined as a person’s pattern of romantic or sexual attraction to people of the opposite sex or gender, the same sex or gender, or more than one sex or gender. Laws that explicitly mention sexual orientation primarily protect or harm lesbian, gay, and bisexual people. That said, transgender people who are lesbian, gay or bisexual can be affected by laws that explicitly mention sexual orientation.

Gender Identity Policy Tally

“Gender identity” is a person’s deeply-felt inner sense of being male, female, or something else or in-between. “Gender expression” refers to a person’s characteristics and behaviors such as appearance, dress, mannerisms and speech patterns that can be described as masculine, feminine, or something else. Gender identity and expression are independent of sexual orientation, and transgender people may identify as heterosexual, lesbian, gay or bisexual. Laws that explicitly mention “gender identity” or “gender identity and expression” primarily protect or harm transgender people. These laws also can apply to people who are not transgender, but whose sense of gender or manner of dress does not adhere to gender stereotypes.

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