Gender-Affirming Care for Oregon Health Plan (OHP) Members

What Is Gender-Affirming Care?

Gender-affirming care supports a person’s gender identity.

What Does OHP Cover?

OHP now covers all treatments according to the Standards of Care for the Health of Transgender and Gender Diverse People, Version 8 (SOC 8).

• The Prioritized List of Health Services pairs these treatments on Line 309.
• Guideline Note 127 notes that OHP must also cover other treatments approved according to SOC 8.

Covered services include:

Non-surgical treatments

• Hair removal
• Hormone therapy
• Medical tattooing
• Mental health therapy
• Physical therapy
• Puberty blockers
• Speech therapy

Facial surgery

Surgery to make the face more masculine or feminine, such as:

• Blepharoplasty (eyelid surgery)
• Chondrolaryngoplasty (tracheal shave)
• Rhinoplasty (nose job)
• Hair transplant

Breast/chest surgery (top surgery)

• Breast reconstruction
• Liposuction (fat removal)
• Mastectomy (breast removal)

Gonadectomy (removing testes or ovaries)

Genital surgery (bottom surgery)

Body contouring

Who Qualifies for Gender-Affirming Care?

OHP members who:

• Have marked and sustained gender dysphoria.
• Show they understand and consent for the treatment.
• Understand how the treatment will affect fertility.
• Have explored options to keep their fertility.
• For surgery, have completed at least six months of hormone treatment (or longer if needed for the surgery).
• Have a health care professional:
• Confirm that there are no other possible causes for gender dysphoria.
• Assess their mental and physical health and whether treatment would harm them.
• Discuss the risks and benefits of treatment.

Adolescents must also:

• Have mental health and medical professionals fully assess them.
• Have their parent(s) or guardian(s) take part in the assessment, unless this is harmful or not possible.
• Have entered stage 2 of puberty (when physical changes start).
• For surgery, have completed at least 12 months of hormone therapy (or longer if needed for the surgery).

To Get Gender-Affirming Care:

Start with your primary care provider (PCP). Your physician and mental health provider can refer you for services.

Don’t have a PCP? If you are in a coordinated care organization (CCO) that covers your physical health care, call your CCO.

If you are not in a CCO for your physical health care, try these resources:

• Call OHP Care Coordination at 800-562-4620.
• Use the online provider search.