Pennsylvania Medicaid removes prohibition on gender transition services



Pennsylvania is now covering gender transition services under Medicaid. 

The state recently posted an update that medically-necessary gender transition services would now be covered. That may include hormone therapy and sex reassignment surgery.

Thomas Ude, policy director at the Mazzoni Center in Philadelphia, thinks a lot of people stand to benefit from the change.

“People who are denied care many times become depressed or suicidal because they’re unable to resolve differences between physical selves and their sex,” he said, adding that people who are transgender are more likely to live in poverty, and therefore covered by Medicaid. “It effects many people because the exclusions that were in place prohibited not just surgery, but they also prohibited any other transition related care or treatment, including hormones, which many more people who are transgender need hormones than need surgery.”

This spring, the federal government said that excluding gender transition services under medicaid was discriminatory. Many other private and public insurers now cover the services. Medical groups like the American College of Physicians have supported non-discrimination protections.

According to the National Center for Transgender Equality, Pennsylvania is the twelfth state, along with the District of Columbia, to make overt changes to its exclusion policies.

In April, Pennsylvania’s insurance department came out with guidance for private insurers on lifting transition-related exclusions.

Pennsylvania’s new Medicaid policy makes trans-specific exclusions illegal, but it does not automatically cover transition-related services. It’s “case-by-case,” according to Ude, based on what’s deemed medically necessary for a patient. 

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