Transgender and Gender Non-Binary Healthcare Coverage in State Medicaid Programs: Recommendations for More Equitable Approaches

Abstract

Transgender and gender non-binary (TGNB) individuals face discrimination in healthcare settings and barriers to healthcare access, resulting in health disparities. These inequities are compounded by the intersection of lower socioeconomic status and geography. To understand the differences in how states provide healthcare to TGNB individuals in poverty, we ask: What are state Medicaid programs offering TGNB residents, and how can coverage be more equitable across jurisdictions? To answer these questions, we examine medical services covered by 15 diverse Medicaid programs and compare them to the services recommended by the World Professional Association for Transgender Health (WPATH). Unsurprisingly, the analysis reveals inconsistent TGNB health coverage across states. While some states include coverage for TGNB-related care, some do not, and others place access to services in the hands of medical providers. These coverage disparities leave many TGNB Medicaid recipients across the U.S. without coverage for medically necessary services, prompting equity questions for both research and practice.