MedicaidCoverageMedium impact
MSA 21-28
Michigan Medicaid - MDHHS·MI · Endocrinology, Plastic Surgery, General Surgery +2 more·Provider Bulletin
Effective date
Nov 1, 2021
We identified it
Jun 20, 2026
Summary
Michigan Medicaid now covers medically necessary gender affirmation services for beneficiaries with gender dysphoria, including medical, surgical, and pharmacologic treatments. Gender affirmation surgical procedures require prior authorization with a mental health evaluation from a qualified licensed professional meeting WPATH standards.
Action Required
Before November 1, 2021: Billing team must update prior authorization processes for gender affirmation surgical procedures to require mental health evaluations from licensed professionals with master's degree and gender dysphoria experience. Update documentation requirements to include WPATH standards compliance in medical records. For Michigan Medicaid patients only - claims for surgical interventions without proper mental health evaluations and prior authorization will be denied.