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.
State Medicaid policy explicitly covers transgender-related health care
State Medicaid policy explicitly excludes transgender-related health care for minors
State Medicaid has unclear or no explicit policy regarding transgender-related health care
State Medicaid policy explicitly excludes transgender-related health care for all ages
State bans or restricts best practice medical care for transgender youth (see this map for more information)
*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].
key
- Indicates state law or policy
- Indicates local laws or policies and/or partial law
- Indicates no law or policy
- Enumeration not applicable
- State has law that only covers sexual orientationLaw covers sexual orientation
- State has law that covers sexual orientation and gender identityLaw covers sexual orientation and gender identity/expression
-
Law covers association
- Law prevents schools from adding LGBTQ protections
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Law bans transgender students from using school facilities consistent with their gender identity
| State | Anti-bullying | Nondiscrimination | Year Passed |
| Citations | Citations | ||
| Alabama | |||
| Alaska | |||
| American Samoa | |||
| Arizona | |||
| Arkansas |
State has law that covers sexual orientation and gender identity |
2011 | |
| California |
State has law that covers sexual orientation and gender identity |
State has law that covers sexual orientation and gender identity |
|
| Colorado |
State has law that covers sexual orientation and gender identity |
State has law that covers sexual orientation and gender identity |
|
| Connecticut |
State has law that covers sexual orientation and gender identity |
State has law that covers sexual orientation and gender identity |
2021 |
| Delaware | |||
| District of Columbia |
State has law that covers sexual orientation and gender identity |
State has law that covers sexual orientation and gender identity |
|
| Florida | |||
| Georgia | 2011 | ||
| Guam |
State has law that only covers sexual orientation |
||
| Hawaii |
State has law that covers sexual orientation and gender identity |
||
| Idaho | |||
| Illinois |
State has law that covers sexual orientation and gender identity |
State has law that covers sexual orientation and gender identity |
|
| Indiana | |||
| Iowa |
State has law that covers sexual orientation and gender identity |
State has law that only covers sexual orientation |
|
| Kansas | |||
| Kentucky | |||
| Louisiana | |||
| Maine |
State has law that covers sexual orientation and gender identity |
State has law that covers sexual orientation and gender identity |
|
| Maryland |
State has law that covers sexual orientation and gender identity |
State has law that covers sexual orientation and gender identity |
|
| Massachusetts |
State has law that covers sexual orientation and gender identity |
State has law that covers sexual orientation and gender identity |
|
| Michigan |
State has law that covers sexual orientation and gender identity |
||
| Minnesota |
State has law that covers sexual orientation and gender identity |
State has law that covers sexual orientation and gender identity |
|
| Mississippi | |||
| Missouri | State does not have this law | State does not have this law | 2006 |
| Montana | |||
| Nebraska | |||
| Nevada |
State has law that covers sexual orientation and gender identity |
State has law that covers sexual orientation and gender identity |
|
| New Hampshire |
State has law that covers sexual orientation and gender identity |
State has law that covers sexual orientation and gender identity |
|
| New Jersey |
State has law that covers sexual orientation and gender identity |
State has law that covers sexual orientation and gender identity |
|
| New Mexico |
State has law that covers sexual orientation and gender identity |
State has law that covers sexual orientation and gender identity |
|
| New York |
State has law that covers sexual orientation and gender identity |
State has law that covers sexual orientation and gender identity |
|
| North Carolina |
State has law that covers sexual orientation and gender identity |
||
| North Dakota | |||
| Northern Mariana Islands | |||
| Ohio | |||
| Oklahoma | |||
| Oregon |
State has law that covers sexual orientation and gender identity |
State has law that covers sexual orientation and gender identity |
|
| Pennsylvania | |||
| Puerto Rico |
State has law that covers sexual orientation and gender identity |
||
| Rhode Island |
State has law that covers sexual orientation and gender identity |
||
| South Carolina | |||
| South Dakota | State does not have this law | State does not have this law | 2012 |
| Tennessee | |||
| Texas | |||
| U.S. Virgin Islands |
State has law that only covers sexual orientation |
||
| Utah | |||
| Vermont |
State has law that covers sexual orientation and gender identity |
State has law that covers sexual orientation and gender identity |
|
| Virginia |
State has law that covers sexual orientation and gender identity |
||
| Washington |
State has law that covers sexual orientation and gender identity |
State has law that covers sexual orientation and gender identity |
|
| West Virginia |
|
||
| Wisconsin |
State has law that only covers sexual orientation |
||
| Wyoming |
