MedicaidCoverageHigh impact
Provider Letter 2026-11: Re: Immediate Medicaid Coverage Change; Senate Bill 904 (2026)
Oklahoma SoonerCare·OK · Endocrinology, Urology, Plastic Surgery +2 more·Medical Policy
Effective date
Jun 4, 2026
We identified it
Jun 20, 2026
Summary
Oklahoma Medicaid immediately prohibits coverage of surgical procedures and pharmaceuticals for gender transition under Senate Bill 904. Claims with gender dysphoria diagnoses will suspend for review, and prior authorization is now required for specific hormone therapies.
Action Required
Immediately: For Oklahoma Medicaid patients with gender dysphoria diagnoses, billing team must submit additional documentation supporting medical necessity with all procedure claims to avoid automatic suspension. For pharmaceutical billing, obtain prior authorization for all male patients requesting female hormones, all GnRH prescriptions, and testosterone products. Contact massunit@okhca.org for questions. Claims without proper documentation or prior auth will be denied or suspended for MAU review.