No Medicaid Coverage for Surgical/Pharmacologic (Hormonal) Gender-Affirming Care - Adults (21 and Older)
State Medicaid policy disallowing new (de novo) coverage or reimbursement for surgical and hormonal gender-affirming care for Kansas Medicaid adult members aged 21 and older; behavioral/psychological therapies remain governed separately. Affects providers billing Kansas Medicaid for such services.
Kansas Medicaid will not reimburse or provide de novo coverage for gender affirming health care for adult members aged 21 years and older effective September 1, 2025.
Members who received surgical and/or medical (hormonal) gender-affirming treatment prior to the effective date may be managed on a case-by-case basis.
Coverage Stance and Scope
Coverage prohibition and exceptions
Covered when ALL of the following are met:
Effective for dates of service on or after September 1, 2025.
Claims with related diagnosis codes will suspend for manual review to evaluate exceptions.
This policy does not apply to medically necessary psychological or behavioral therapies. Behavioral and psychological treatment services that are determined to be medically necessary should continue to be provided and billed under existing Medicaid coverage rules and are not subject to the prohibition on de novo surgical or pharmacologic gender-affirming care.
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