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Gender-Affirming Care for Oregon Health Plan (OHP) Members

What is gender-affirming care?   Getting care   What OHP covers   Criteria

Health care is a constitutional right in Oregon, and gender‑affirming care is protected by state law under 2023’s Oregon House Bill 2002. Oregon Health Authority (OHA) is taking action to preserve access to gender-affirming care as is required by state law.

The U.S. Centers for Medicare and Medicaid Services have announced a new federal rule to prohibit the use of federal Medicaid and Children's Health Insurance Program funding for certain gender-affirming care services for minors. We know this news has caused deep fear, frustration, and anger in many of our communities. This rule will not change benefits covered by Oregon’s Medicaid program, which is called the Oregon Health Plan (OHP). More information is in the below section titled “Will Federal Changes Affect OHP Benefits?”

Despite uncertainty at the federal level, OHA will continue to do everything it can to ensure everyone in Oregon can receive the quality, compassionate health care they need and deserve. OHA is determined to protect and preserve health freedoms for everyone in Oregon - including transgender and gender-diverse people.

For more information about what state law says about gender-affirming care, visit the Oregon Department of Justice's webpage.

What Is Gender-Affirming Care?

Broadly speaking, gender-affirming care is health care that meets people’s physical, mental and social health needs while respectfully affirming their gender identity. Transition-related care is a type of gender-affirming care that provides health services during gender transition.

How to Get Gender-Affirming Care

Start with any member of your health care team, including your primary care provider, specialty care provider or mental health clinician. Your physician and mental health provider can refer you for services.

Need more help?

  • If you are in a CCO, call your CCO or use their online provider search tools. Find CCO contact information here.
  • If you are not in a CCO, call OHP Open Card Care Coordination at 800-562-4620 or use the online provider search.
  • If you do not know your CCO, call OHP Client Services at 800-273-0557.

You may not be able to get an appointment for gender-affirming care right away. This is because there may not be enough clinicians available to immediately provide all services. Please talk with your providers about the urgency of your health care needs.

What Does OHP Cover?

OHP covers all medically necessary treatments that are prescribed by a health care provider according to the Standards of Care for the Health of Transgender and Gender Diverse People, Version 8 (SOC 8). Despite a federal rule change that is scheduled to take effect Oct. 13, 2026, Oregon will continue to cover gender-affirming care for all OHP members. This rule will not change OHP benefits. More information is below.

Covered services may include:

Non-surgical treatments

  • Hair removal
  • Hormone therapy
  • Lab work
  • Medical tattooing
  • Mental health therapy
  • Physical therapy
  • Puberty blockers
  • Speech therapy

Facial surgery

Surgery to make the face more masculine or feminine for gender confirmation, such as:

  • Jaw, chin, lip, nose, eye or eyebrow surgery
  • Tracheal augmentation
  • Vocal cord surgery
  • Hair transplantation

Breast/chest surgery (top surgery)

  • Breast reconstruction (augmentation/implants or reduction)
  • Liposuction (fat removal)
  • Mastectomy (breast removal))

Gonadectomy (removing testes or ovaries)

  • Hysterectomy (uterus removal)
  • Orchiectomy (removing testicles)
  • Salpingo-oophorectomy (removal of ovaries and/or fallopian tubes)

Genital surgery (bottom surgery)

  • Metoidioplasty (small penis construction)
  • Phalloplasty (penis construction)
  • Vaginoplasty (vagina construction or repair)
  • Vulvoplasty (vulva construction)
  • Genitoplasty (creating gender-neutral look in groin area)

Body contouring

  • Lipofilling (fat transfer)
  • Liposuction (fat removal)
  • Monsplasty (mons reduction or “pubic lift”)

Criteria to Access Gender-Affirming Care May Include:

According to standards of care, OHP members who may need to:

  • Have mental health and medical professionals fully assess them.
  • Have marked and sustained gender dysphoria.
  • Show they understand and consent for the treatment.
  • Understand how the treatment will affect fertility (if applicable).
  • Have explored options to keep their fertility.
  • Have a health care professional:
    • Confirm that there are no other possible causes for gender dysphoria.
    • Assess their mental and physical health and whether treatment would harm them.
    • Discuss the risks and benefits of treatment.
  • For surgery: If hormone treatment is being pursued, have completed at least six months of hormone treatment. While hormone therapy is not required before surgery and can be contraindicated for some patients, hormone therapy may be recommended in some situations to improve surgical outcomes.

Adolescents may also need to:

  • Have mental health and medical professionals fully assess them.
  • Have their parent(s) or guardian(s) take part in the assessment, unless this is harmful or not possible.
  • Have entered stage 2 of puberty (when physical changes start).
  • For surgery: Have completed at least 12 months of hormone therapy.

Will Federal Changes Affect OHP Benefits?

Oregon will continue to cover gender-affirming health care for all OHP members even though a new federal rule is expected to prohibit federal Medicaid funding from covering some forms of gender-affirming care for people under 18 starting on Oct. 13, 2026.

To create a distinction between state and federal Medicaid funding, OHP will cover certain gender-affirming services for members under 18 separately from its contracts with CCOs. When affected services are determined to be medically necessary and clinically appropriate for OHP members under 18, OHA will directly pay for these services through its Open Card program, which is also known as fee-for-service, or FFS. CCOs will continue to manage all other gender-affirming care benefits that are covered by OHP, including care coordination

Guidance for OHP Members Under 18:

If an OHP member or their guardian has a concern about receiving gender-affirming care because of the federal rule change, they should:

  • Speak with their current providers and ask if those providers either are or will be enrolled in the OHP Open Card/fee-for-service program.
  • If their provider is or will be enrolled, OHP members do not need to do anything. They can continue to have their care covered by OHP without interruption.
  • If a provider doesn’t enroll in Open Card/fee-for-service, members will need to see another provider that takes Open Card.

Where to get help

  • CCO members who need help with care coordination or finding health care providers should first contact their CCO. Contact information for all CCOs is available at OHP.Oregon.gov/CCO-Contacts.
  • CCO members can also search OHPOpenCard.org to find providers who are in network for OHP FFS/Open Card.
  • OHP members who have questions about Open Card should call OHP Client Services (1-800-273-0557, Ask.OHP@odhsoha.oregon.gov).
  • If additional assistance is needed, OHP members can also contact the OHA Ombuds Program (1-877-642-0450, OHA.OmbudsOffice@odhsoha.oregon.gov).