MedicaidCoverageMedium impact
OHP coverage of gender-affirming treatment, effective January 1, 2024
Oregon Health Plan·OR · Endocrinology, Psychiatry, Plastic Surgery +2 more·Plan
Effective date
Jan 1, 2024
We identified it
Jun 20, 2026
Summary
Effective January 1, 2024, Oregon Health Plan (Medicaid) will cover all gender-affirming treatments according to WPATH 8.0 standards. Services not listed on Line 309 of the Prioritized List will require prior authorization, but CCOs cannot deny treatments prescribed according to WPATH 8.0 guidelines.
Action Required
Effective January 1, 2024: Billing team must bill OHP for gender-affirming services according to the January 1 Prioritized List and Guideline Note 127. For services not on Line 309, request prior authorization before providing treatment. Update billing system to flag gender-affirming treatments that require prior auth.