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Transgender Health Program

Find information about gender confirming health care benefits for Apple Health (Medicaid) clients.

Apple Health (Medicaid) Transgender Health Program

If you're covered by a managed care organization (MCO) such as:

Contact the plan directly for program benefits.

Hormone therapy and mental health services are covered by your MCO. Contact your MCO to ask about providers.

Most surgical services will be covered by fee-for-service, which you may know as Provider One (your teal colored services card). The services may be provided by any provider who accepts Apple Health (Medicaid), with prior authorization by the Health Care Authority.

Transgender Health services may include, but are not limited to the following:

  • Breast reconstruction.
  • Genital surgery.
  • Genital electrolysis as required as part of the genital surgery.
  • Hysterectomy.
  • Mammoplasty with or without chest reconstruction.
  • Metoidioplasty.
  • Orchiectomy.
  • Phalloplasty.
  • Placement of testicular prosthesis.

There are different requirements depending on what service you want to have performed. For top surgery, we require a letter from a licensed mental health care provider, a letter from the provider managing your hormone therapy and a letter from the surgeon who will perform the surgery. For bottom surgery, the letters you need are the same with the addition of a second letter from a different licensed mental health care provider. These letters should be given to the surgeon who will submit them with the prior authorization request. 

Mental health services for transgender clients

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, is medically necessary and is in accordance with WAC 182-531-1400.

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.

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