MedicaidCoverageMedium impact
Changes to ACA Section 1557 do not affect Oregon Health Plan coverage of gender transition services
Oregon Health Plan·OR · Psychiatry, Endocrinology, General Surgery·Plan
Effective date
Jun 25, 2020
We identified it
Aug 19, 2026
Summary
Oregon Health Plan (OHP) reaffirms that recent federal changes to ACA Section 1557 nondiscrimination regulations do NOT affect OHP coverage of gender transition services. OHP continues to cover hormone therapy, counseling, and certain surgeries for transgender members under HERC Guideline 127 and ORS 659.875(1), which provides state-level nondiscrimination protections based on gender identity and sexual orientation.
Action Required
By July 2020: Billing and clinical staff in Oregon practices serving OHP members should ensure continuity of coverage for gender transition services. No changes to current billing workflows are required. Verify that billing systems and provider encounter forms do NOT restrict or require additional authorization for gender transition services covered under HERC Guideline 127 (hormone therapy, counseling, surgeries). If any claims have been denied since June 19, 2020 for gender transition services previously approved under OHP, contact the member's CCO or OHP Provider Services at dmap.providerservices@dhsoha.state.or.us or 1-800-336-6016 for claim reconsideration. Inform clinical and billing staff that this federal regulatory change does not supersede Oregon's state nondiscrimination law and OHP's established coverage.