Medicaid coverage for gender‐affirming surgery: A state‐by‐state review

• Published in: Health services research 2024-12, Vol.59 (6), p.e14338-n/a
• Main Authors: LaGuardia, Jonnby S., Chin, Madeline G., Fadich, Sarah, Morgan, Katarina B. J., Ngo, Halena H., Bedar, Meiwand, Moghadam, Shahrzad, Huang, Kelly X., Mallory, Christy, Lee, Justine C.
• Format: Article
• Language: English
• Subjects: Anatomy; Chest; Cross-Sectional Studies; Data collection; Extraction; Female; Gender; Gender-affirming care; gender‐affirming surgery; Government programs; Health care policy; Health Policy; Humans; Hysterectomy; insurance; Insurance Coverage - statistics & numerical data; Legislatures; Male; Mastectomy; Medicaid; Medicaid - legislation & jurisprudence; Medicaid - statistics & numerical data; Neck; Policies; public health; Reconstructive surgery; Sex Reassignment Surgery - economics; Sex Reassignment Surgery - legislation & jurisprudence; State Government; State legislatures; Surgery; Transgender Persons - statistics & numerical data; United States
• ISSN: 0017-9124; 1475-6773
• DOI: 10.1111/1475-6773.14338

Objective To systematically review Medicaid policies state‐by‐state for gender‐affirming surgery coverage. Data Sources and Study Setting Primary data were collected for each US state utilizing the LexisNexis legal database, state legislature publications, and Medicaid manuals. Study Design A cross‐sectional study evaluating Medicaid coverage for numerous gender‐affirming surgeries. Data Collection/Extraction Methods We previously reported on state health policies that protect gender‐affirming care under Medicaid coverage. Building upon our prior work, we systematically assessed the 27 states with protective policies to determine coverage for each type of gender‐affirming surgery. We analyzed Medicaid coverage for gender‐affirming surgeries in four domains: chest, genital, craniofacial and neck reconstruction, and miscellaneous procedures. Medicaid coverage for each type of surgery was categorized as explicitly covered, explicitly noncovered, or not described. Principal Findings Among the 27 states with protective Medicaid policies, 17 states (63.0%) provided explicit coverage for at least one gender‐affirming chest procedure and at least one gender‐affirming genital procedure, while only eight states (29.6%) provided explicit coverage for at least one craniofacial and neck procedure (p = 0.04). Coverage for specific surgical procedures within these three anatomical domains varied. The most common explicitly covered procedures were breast reduction/mastectomy and hysterectomy (n = 17, 63.0%). The most common explicitly noncovered surgery was reversal surgery (n = 12, 44.4%). Several states did not describe the specific surgical procedures covered; thus, final coverage rates are indeterminate. Conclusions In 2022, 52.9% of states had health policies that protected gender‐affirming care under Medicaid; however, coverage for various gender‐affirming surgical procedures remains both variable and occasionally unspecified. When specified, craniofacial and neck reconstruction is the least covered anatomical area compared with chest and genital reconstruction.