many blue (Democratic-leaning) states in the U.S. do cover sex reassignment (gender-affirming) treatments for low-income individuals under their state Medicaid programs. However, coverage and scope vary by state.
Here’s a breakdown:
Blue States That Cover Gender-Affirming Care under Medicaid
These states explicitly cover procedures such as:
-
Hormone therapy
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Mental health services
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Gender-affirming surgeries (e.g., top and bottom surgery, facial feminization in some cases)
Examples:
| State | Medicaid Coverage for Sex Transition (as of 2025) |
|---|---|
| California | Full coverage (one of the most comprehensive) |
| New York | Covers HRT and surgeries |
| Oregon | Covers most procedures, including facial surgery |
| Washington | Covers HRT, surgeries, counseling |
| Colorado | Explicitly includes gender-affirming care since 2021 |
| Massachusetts | Comprehensive coverage |
| Illinois | Added coverage in 2019 for gender-affirming surgeries |
| Vermont | Strong support; covers surgery and hormones |
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