Due to COVID-19, HCA’s lobby is closed. Learn more about HCA's customer service options during the pandemic.

Transhealth program

Find information about the Apple Health (Medicaid) Transhealth Program.

Apple Health (Medicaid) Transhealth program

Behavioral health services and hormone therapy, including puberty blockers are covered under Apple Health. If you are enrolled in a managed care plan these services will be covered through your plan. Contact your plan to request a list of providers.

Other gender-affirming treatments are covered directly by Apple Health using your ProviderOne services card, and not by your managed care plan. If you have questions about this coverage, email transhealth@hca.wa.gov.

Requirements

Gender-affirming treatments must be provided by a provider who is enrolled in Apple Health. Prior authorization is required for these services. Apple Health only authorizes and pays for medically necessary services.

General requirements

It is a general requirement that:

  • You have been on gender-affirming hormone therapy for a minimum of 12 months before surgery. Hormone therapy is not required if there is medical reason why you cannot take it. Hormone therapy is not required for mastectomy or reduction mammoplasty (chest masculinization).
  • You live in a gender role that matches your gender identity for a minimum of 12 months before surgery. This is not required if you have personal safety concerns that keep you from living in your desired gender identity. Certain procedures do not require you to live in your desired gender for 12 months. These procedures include: mastectomy or reduction mammoplasty (chest masculinization); orchiectomy (testicle removal); and hysterectomy (uterus removal).

Required documentation

  • A letter from a licensed mental health care provider. 
    • The letter must be less than 18 months old, signed by the provider and dated.
      • Full bottom surgery requires two letters (2 evaluations). Each letter must be from a different, independent licensed mental health care provider.
  • A letter from the provider who prescribes your hormone therapy. 
    • The letter must be less than 18 months old. The letter must be signed and dated. If you do not take hormones, then a letter of support from your primary care provider is required. 
  • Chart notes from the surgeon. 
    • This must include the surgeon’s evaluation and the surgical plan.

These letters should be given to your surgeon. The surgeon will include the documentation when they request prior authorization for your procedure.

For additional questions on the Transhealth Program you can email transhealth@hca.wa.gov.

Find a Provider

To find a list of providers for surgeries and other services, including hair removal, email transhealth@hca.wa.gov.

You can see any Apple Health enrolled surgeon that performs the surgery you are seeking. To get started, call the enrolled provider you are interested in seeing and schedule a consultation. Consultations do not require prior approval. The provider will need to get a prior authorization for the surgery.

To see if a surgeon you are looking for accepts Apple Health coverage, visit the ProviderOne Find a Provider tool.

Transportation services

You may be eligible for help with transportation to your health care appointments at no cost to you. The appointment must be for services covered by Apple Health. If you need help to find transportation or a doctor in your area, please call 1-800-562-3022. Visit the transportation services webpage to find a transportation broker for your county. Contact a broker 7-14 days before your appointment. Requests to your broker less than two business days before your appointment may not be scheduled.

To change your gender marker

  • If you applied for health coverage through Washington Healthplanfinder, report this change by either calling 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 your “sex assigned at birth”. If you are seeking pregnancy coverage, you will need to answer “female.” Otherwise, you can continue to use your gender marker.
  • If you 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 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.

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.

To change your name

Before making a name change, you should first obtain a name change through the Social Security Administration (SSA). If your name in the system does not match the name on file with SSA, an error will be generated and this could affect your coverage.

  • If you applied for health coverage through Healthplanfinder, you must report this change by either calling Health Care Authority at 1-800-562-3022 or online at Washington Healthplanfinder.
  • If you 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.

Contact

For questions email: transhealth@hca.wa.gov