While many state Medicaid programs cover aspects of gender-affirming health services for adults, only Maine and Illinois reported covering five standard gender-affirming services in 2021: hormone therapy, gender-affirming surgery, mental health counseling related to gender-affirming care, voice and communication therapy, and fertility assistance for adult transgender enrollees, according to a KFF survey. Nine states, including Michigan, Connecticut, and Colorado, reported covering four of the five services. Alabama and Texas reported not covering any of these services under Medicaid.

The survey of states on coverage of sexual and reproductive health services for adult enrollees was conducted in Summer 2021. Forty-one states and the District of Columbia responded to the survey.

Despite protections implemented by the Biden administration, several states have recently moved to implement bans or consider actions limiting access to gender-affirming health care, particularly for youth. Coverage of specific services for adults varies and policies like requiring prior authorization can limit access. Additionally, some states do not have policies addressing coverage in their state Medicaid programs, potentially leaving many low-income transgender and nonbinary individuals without a clear path to coverage for medically necessary health services.

Read the brief on the full survey findings