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Apple Health (Medicaid) has an extensive Transhealth Program. For details please see the Transgender Health Services section of the Physician-Related Services/Health Care Professional Services Billing Guide.
Washington State Medicaid covers a variety of services for our enrolled clients. Each provider must enroll with the Health Care Authority to serve our clients. We are actively recruiting new providers for this program.
Some services will be covered through the client's managed care organization. Delineation of these services are found in the provider guide.
Managed care plans have certain benefit limitations, and currently provide all services except for surgical procedures, which are covered under fee-for-service. All surgical services require prior authorization. For instructions on how to obtain prior authorization, see the Physician-Related Services/Health Care Professional Services Billing Guide.
Covered services include, but are not limited to:
- Pre and post surgical hormone replacement therapy
- Pre puberty suppression therapy
- Mental health services
- Physicians services
- Hospitalization and physician services related to postoperative complications of procedures performed for gender reassignment surgery (GRS).
Mental health treatment can be provided to a client, the client's spouse, parent, guardian, or child, or a person with whom the client has a child in common, if the treatment is:
- Directly related to the client's care.
- Medically necessary.
In accordance with WAC 182-531-1400.
- If a client applied for health coverage through Washington Healthplanfinder, they can report this change by either calling the Health Care Authority at 1-800-562-3022, email AskMagi@hca.wa.gov, or online at Washington Healthplanfinder. As of May 2020, the Washington Healthplanfinder application asks for a client’s “sex assigned at birth”. If they are seeking pregnancy coverage, they will need to answer “female”. Otherwise, they can continue to use their gender marker.
- Clients who applied for health coverage through the Department of Social and Health Services or Washington Connection, you must report this change by either calling, 1-877-501-2233 or online at Washington Connection.
The Health Care Authority, Department of Social and Health Services, and the Health Benefit Exchange are working together with other state agencies to incorporate gender identity into their applications and other processes.
Any Washington Apple Health client can call and choose a gender. Clients should be aware that other state agencies, such as the Department of Licensing, have different requirements.
Before making a name change, they should first obtain a name change through the Social Security Administration (SSA). If the client's name does not match the name on file with SSA, the system will generate an error and this could affect the client's coverage.
- Clients who applied through the Healthplanfinder must call toll-free 1-800-562-3022.
- Clients who applied through the Community Service Office (CSO) must call toll-free
1-877-501-2233 or report online at Washington Connection.