Gender Affirming Care Services for Youth: What Providers Need to Know

Gender Affirming Care Services for Youth: What Providers Need to Know#

California remains committed to taking appropriate action to enable providers to continue to render and be reimbursed for medically necessary gender affirming care services for Medi-Cal members under the age of 18 and CHIP members under the age of 19, and allowing Medi-Cal members to continue accessing those services outside of Medi-Cal by providing state-only funding for these services through HCAI’s grant program, as described in more detail below.

Medi-Cal and CHIP Programs – What Is and Is Not Changing?

On August 13, 2026, the federal Centers for Medicare & Medicaid Services (CMS) released a final rule, titled “Medicaid Program; Prohibition on Federal Medicaid and Children’s Health Insurance Program Funding for Sex-Rejecting Procedures Furnished to Children” (Title 42 of the Code of Federal Regulations (CFR) Parts 441 and 457 [CMS-2451-F]). As of October 13, 2026, consistent with the federal final rule, Medi-Cal will no longer reimburse specified gender affirming care services (i.e., hormone therapy, puberty blockers and surgical interventions to treat gender dysphoria as identified by a clinically appropriate ICD-10-CM diagnosis code) for Medi-Cal members under 18 and CHIP members under 19.

There are no changes for any services provided before October 13, 2026, or for Medi-Cal and CHIP members outside the affected age ranges.

Services Rendered on or after October 13, 2026

To comply with CMS’s final rule, effective for dates of service on or after October 13, 2026, Medi-Cal will no longer reimburse specified gender affirming care services (i.e., to treat gender dysphoria as identified by a clinically appropriate ICD-10-CM diagnosis code) for Medi-Cal members under 18 and CHIP members under 19. Instead, reimbursement will be through the Department of Health Care Access and Information (HCAI), as described in more detail below.  Reimbursement for gender affirming care services will be as follows:

Population & Age Range	Service Description	Reimbursement Status
Medi-Cal members under the age of 18 and CHIP members under the age of 19	Surgical interventions and medications (including puberty blockers and hormone therapy*) provided for a gender affirming care purpose (i.e., to treat gender dysphoria as identified by a clinically appropriate ICD-10-CM diagnosis code).	Reimbursed by HCAI through its grant program (see below for more details).
	Surgical interventions and medications (including puberty blockers and hormone therapy) provided for a non-gender affirming care purpose (i.e., to treat conditions other than gender dysphoria as identified by a clinically appropriate ICD-10-CM diagnosis code).	Reimbursed by Medi-Cal.
	Other services provided for a gender affirming care purpose (i.e., to treat gender dysphoria as identified by a clinically appropriate ICD-10-CM diagnosis code), including, but not limited to, office visits, laboratory tests, speech therapy and psychotherapy.	Reimbursed by Medi-Cal.
	Any services associated with “complications, including any infection, injury, disease, or disorder that has been caused by or exacerbated by the performance of sex-rejecting procedures”, as federally defined.	Reimbursed by Medi-Cal.
Medi-Cal members age 18 and older   (Note: CHIP only goes up to age 19, so this is not applicable)	All medical, pharmacy, and other services provided for a gender affirming care purpose (i.e., to treat gender dysphoria as identified by a clinically appropriate ICD-10-CM diagnosis code), including but not limited to surgical interventions, medications (including puberty blockers and hormone therapy), office visits, laboratory tests, speech therapy and psychotherapy.	Reimbursed by Medi-Cal.

*Note:  Medi-Cal and CHIP members who are already taking gender affirming hormones as of October 13, 2026 will continue to have these medications reimbursed by Medi-Cal through April 12, 2027, as the CMS final rule allows for this time-limited “transition period” of up to six months. After April 12, 2027, these medications will be reimbursed with state-only funding from HCAI’s grant program, as described below.

• During this transition period, providers should be working with impacted Medi-Cal and CHIP members to determine appropriate next steps relative to their plan of care.
• This transition period does not apply to puberty blockers or surgical interventions. It also does not apply to Medi-Cal members who are newly starting hormone therapy on or after October 13, 2026.

HCAI Grant Program

To support continued access to these services for Medi-Cal members, HCAI will administer a grant program and provide state-only funding for gender affirming care services for Medi-Cal members under 18 and CHIP members under 19, which will include services impacted by the final rule:

• Surgical Interventions
  • Providers with authorizations approved before October 13, 2026, but who have surgical interventions already scheduled for Medi-Cal members after that date should contact HCAI to ensure uninterrupted access to and funding for the services provided.
  • HCAI will accept previously approved authorizations as sufficient supporting documentation from DHCS or individual Medi-Cal MCPs.
  • Providers may email HCAI at genderaffirmingcare@hcai.ca.gov.
  • Providers may find additional information by visiting HCAI’s webpage.

• Medications (including hormone therapy and puberty blockers)
  • HCAI will reimburse medications, including hormone therapy and puberty blockers, and will have additional information soon regarding access to medications on or after October 13, 2026.

Subscribe
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DHCS:

• Medi-Cal Subscription Service – For updates on medical benefits, including implants/injections and surgical procedures.
• Medi-Cal Rx Subscription Service – For updates on pharmacy benefits, including hormone therapy and puberty blockers.
  
  HCAI:
• Subscribe to Email Updates – HCAI – For updates on the state-only grant pathway.
  

Resources#

• News | Medi-Cal Providers
• Provider Manual | Medi-Cal Providers
• Reproductive Health and Gender Affirming Care Programs – HCAI