MedicaidCoverageMedium 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 and specific medical necessity documentation. Non-genital procedures need one physician letter while genital surgeries require two letters from qualified practitioners.
Action Required
Immediately: Billing team must establish prior authorization workflow for gender-affirming surgeries by submitting requests to HFS.GA-service@illinois.gov. Providers must obtain required physician letters (one for non-genital, two for genital procedures) documenting medical necessity before scheduling surgeries. Update billing procedures to route MCO members' prior auth requests to their specific managed care plans instead of state Medicaid.