Transgender Health Services Program

Program overview

Apple Health (Medicaid) has an extensive Transgender Health Services Program. For details please see the Transgender Health Services section of the Physician Related Services/Professional Services Provider 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. 

Benefits

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/Professional Services Provider 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
  • Labs
  • Pathology
  • Anesthesiology
  • Radiology
  • Hospitalization
  • Hospitalization and physician services related to post-operative complications of procedures performed for gender reassignment surgery (GRS).

Mental health services

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.

Changing gender marker

  • Clients who applied through the Healthplanfinder must report this change by calling Health Care Authority at 1-800-562-3022.
  • 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.

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.

Changing names

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.

Resources

Ingersoll Gender Center (providing transgender and gender variant support)

World Professional Association for Transgender Health (WPATH)

Attestation for Mental Health Providers Treating Transgender Patients

Attestation for Medical Providers Treating Transgender Patients

Contact