MedicaidPrior AuthMedium impact
Gender-affirming Services
Illinois Medicaid - HFS·IL · Plastic Surgery, General Surgery, Urology +1 more·Provider Notice
Effective date
Jan 1, 2020
We identified it
Jun 20, 2026
Summary
Illinois Medicaid now covers gender-affirming surgeries effective January 1, 2020, requiring prior authorization at least 30 days before the procedure. Non-genital surgeries need one practitioner letter, while genital surgeries require two letters from qualified practitioners.
Action Required
Immediately: Billing team must download and use the HFS Gender-affirming Services Prior Authorization Form for all gender-affirming surgeries. Submit prior authorization requests to HFS.GA-service@illinois.gov at least 30 days before planned procedures with required practitioner letters. Submit paper claims only to Illinois Department of Healthcare and Family Services in Springfield. For MCO patients, obtain prior authorization from the member's managed care plan instead.