Massachusetts Medicaid policy covers transgender-related health care.
Guidance and Announcements:
- Boston Medical Center HealthNet Plan - Gender Affirmation Surgeries
- Fallon Health - Gender Affirming Services
- Tufts Health Plan - Transgender Surgical Procedures
There are some outdated and unenforced provisions in Massachusetts law including "sex-reassignment surgery" under the definition of "experimental or unproven procedures" but as a matter of practice, this care is covered under MassHealth. Mass Gen. Laws ch. 118E § 8A, Mass Gen. Laws ch. 118E § 64.
- Repealed: 130 Mass. Code Regs. 405.418(A) read: “MassHealth does not pay a CHC for performing, administering, or dispensing experimental, unproven, or otherwise medically unnecessary procedures . . . including . . . sex reassignment surgery . . . and any other related surgeries and treatments including pre- and post-sex-reassignment surgery hormone therapy.”
- Repealed: 130 Mass. Code Regs. 406.413(C)(2)(c), Limitations on Coverage of Drugs, read: “(2) The MassHealth agency does not pay for the following types of drugs or drug therapy without prior authorization: … (c) drugs related to sex-reassignment surgery, specifically including but not limited to, presurgery and postsurgery hormone therapy. The MassHealth agency, however, will continue to pay for post sex-reassignment surgery hormone therapy for which it had been paying immediately prior to May 15, 1993.”
If you have been denied transgender-related health care under MassHealth, Health Law Advocates is an organization that assists transgender people to challenge those denials.
Updated on Jun 14, 2020