MedicaidCoverageMedium impact
Gender Affirming Care - MEDICAID - OHIO (New)
Humana·OH · Endocrinology, Plastic Surgery, Urology +3 more·Medicaid
Effective date
Jun 8, 2026
We identified it
Jun 24, 2026
Summary
Humana Ohio Medicaid has established a new comprehensive policy covering gender affirming care services including hormone therapy and sex reassignment surgeries. The policy establishes specific coverage criteria for members under 18 (limited to medically verifiable disorders of sex development) and applies EPSDT guidelines for members 18-20.
Action Required
Before June 8, 2026: Billing and clinical teams must review new gender affirming care coverage criteria for Humana Ohio Medicaid members. Update prior authorization workflows to ensure proper documentation of medical necessity for hormone therapy and surgical procedures. Verify member age and apply appropriate coverage criteria (EPSDT for 18-20 year olds, restrictive criteria for under 18). Contact Humana at 877-856-5707 for specific medical necessity criteria.