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 explicit 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.
*Notes (see also the "Citations & More Information" tab or link below the map legend for more info about every state):
--In Hawai`i and West Virginia, 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 gender-affirming health care from being covered or paid for by the state Medicaid program. West Virginia had a court ruling that overturned its previous exclusion of transgender-related care, but the state is appealing that decision. See the "Citations" tab for more information.
--Idaho has no explicit policy, but a 2022 court case against the state shows that at least some transgender people on Medicaid have been denied coverage for transgender-related care. See the "Citations" tab for more information.
--Ohio policy explicitly excludes transgender-related care, but as of mid-2019, The Washington Post and Bloomberg News both report that state officials say they are not enforcing the exclusion. See the "Citations" tab for more information.
--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.
Movement Advancement Project. "Equality Maps: Healthcare Laws and Policies: Medicaid." https://www.lgbtmap.org/equality-maps/healthcare/medicaid. Accessed 03/29/2023.
*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.
60 % of LGBTQ population lives in states that explicitly cover transgender-related health care in Medicaid
12 % of LGBTQ population lives in states that have no explicit policy regarding transgender-related health care in Medicaid
1 % of LGBTQ population lives in states that explicitly exclude transgender-related health care for minors in Medicaid
27 % of LGBTQ population lives in states that explicitly exclude transgender-related health care for all ages in Medicaid
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