What is gender-affirming care?
Getting care
What OHP covers
Criteria
Oregon Health Authority (OHA) is actively monitoring and assessing changes at the federal level for any impact on accessing quality and affordable health care in Oregon. Despite uncertainty at the federal level, OHA will continue to do everything it can to ensure the people of Oregon can receive the vital and compassionate health care they need and deserve.
OHA is aware of Kaiser Permanente's recent decision to discontinue gender-affirming surgery for people under the age of 19. OHA will be assessing and monitoring network adequacy to all types of gender-affirming care services required by state law.
OHA considers access to quality, affordable health care an essential human right for everyone, including transgender and gender-diverse people.
Gender-affirming health care is protected under Oregon state law.
- The Oregon Equality Act of 2007 prohibits discrimination on the basis of a person's gender identity.
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Oregon House Bill 2002 (2003) prohibits insurance carriers from denying gender-affirming treatment that is medically necessary as determined by a qualified health care provider. Oregon's public and many private health insurance plans cover medically necessary care that affirms an individual's gender identity according to accepted standards of care.
For more information about what state law says about gender-affirming care, visit the Oregon Department of Justice's web page.
If an OHP member has a concern about receiving gender-affirming care, they should contact their coordinated care organization (CCO). Those who do not have a CCO or need further assistance can also contact:
For more information about private health plan requirements, please visit the Department of Consumer and Business Affairs Division of Financial Regulation web page.
What Is Gender-Affirming Care?
Broadly speaking, gender-affirming care is health care that meets people’s physical, mental and social health needs while respectfully affirming their gender identity. Transition-related care is a type of gender-affirming care that provides health services during gender transition.
How to Get Gender-Affirming Care
Start with any member of your health care team, including your primary care provider, specialty care provider or mental health clinician. Your physician and mental health provider can refer you for services.
Need more help?
- If you are in a CCO, call your CCO or use their online provider search tools.
Find CCO contact information here.
- If you are not in a CCO, call OHP Open Card Care Coordination at 800-562-4620 or use the
online provider search.
- If you do not know your CCO, call OHP Client Services at 800-273-0557.
You may not be able to get an appointment for gender-affirming care right away. This is because there may not be enough clinicians available to immediately provide all services. Please talk with your providers about the urgency of your health care needs.
What Does OHP Cover?
OHP covers all medically necessary treatments that are prescribed by a health care provider according to the
Standards of Care for the Health of Transgender and Gender Diverse People, Version 8 (SOC 8).
Covered services may include:
Non-surgical treatments
- Hair removal
- Hormone therapy
- Lab work
- Medical tattooing
- Mental health therapy
- Physical therapy
- Puberty blockers
- Speech therapy
Facial surgery
Surgery to make the face more masculine or feminine for gender confirmation, such as:
- Jaw, chin, lip, nose, eye or eyebrow surgery
- Tracheal augmentation
- Vocal cord surgery
- Hair transplantation
Breast/chest surgery (top surgery)
- Breast reconstruction (augmentation/implants or reduction)
- Liposuction (fat removal)
- Mastectomy (breast removal))
Gonadectomy (removing testes or ovaries)
- Hysterectomy (uterus removal)
- Orchiectomy (removing testicles)
- Salpingo-oophorectomy (removal of ovaries and/or fallopian tubes)
Genital surgery (bottom surgery)
- Metoidioplasty (small penis construction)
- Phalloplasty (penis construction)
- Vaginoplasty (vagina construction or repair)
- Vulvoplasty (vulva construction)
- Genitoplasty (creating gender-neutral look in groin area)
Body contouring
- Lipofilling (fat transfer)
- Liposuction (fat removal)
- Monsplasty (mons reduction or “pubic lift”)
Criteria to Access Gender-Affirming Care May Include:
According to standards of care, OHP members who may need to:
- Have mental health and medical professionals fully assess them.
- Have marked and sustained gender dysphoria.
- Show they understand and consent for the treatment.
- Understand how the treatment will affect fertility (if applicable).
- Have explored options to keep their fertility.
- 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.
- For surgery: If hormone treatment is being pursued, have completed at least six months of hormone treatment. While hormone therapy is not required before surgery and can be contraindicated for some patients, hormone therapy may be recommended in some situations to improve surgical outcomes.
Adolescents may also need to:
- 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.