Medicaid Act Protections for Gender-Affirming Care

From the conclusion:

“In terms of Medicaid coverage, court opinions from the past decade have agreed that gender-affirming care (“GAC”) is medically necessary, efficacious, and appropriate when patients meet the relevant criteria. When those treatments are mandatory under the Act or otherwise covered for other diagnoses, exclusion of GAC violates the availability and comparability requirements. State Medicaid plans must provide sufficient GAC to achieve the purpose of alleviating gender dysphoria for the individual patient. Courts have also found that providing GAC imposes no additional fiscal burden on the states. Utilization control procedures may set the requirements that beneficiaries must follow to make coverage requests and that the state must follow in reviewing requests, but those procedures cannot exclude particular treatments for specific diagnoses, illnesses, or conditions. Petitioners challenging Medicaid exclusions should focus primarily on claims under the Act itself, rather than relying on constitutional or other statutory arguments. The Act mandates equality of benefits for all beneficiaries. Denying medically necessary GAC while simultaneously covering the same treatments for other diagnoses denies that equality in violation of the availability and comparability requirements.”