Virginia Medicaid: Gender dysphoria coverage changes

As of Oct. 13, 2026, to comply with a recent Department of Medical Assistance Services (DMAS) decision, we no longer cover certain gender-affirming procedures, including select drugs/hormones, for UnitedHealthcare Community Plan of Virginia members under the age of 18 and children under the age of 19 in the Children’s Health Insurance Program.

Procedures that are no longer covered

As of Oct. 13, 2026, the following procedures will no longer be covered:

• Puberty-suppressing medications (GnRH agonists/puberty blockers)
• Gender-affirming hormone therapy (estrogen or testosterone for secondary sex characteristic development)
• Surgical procedures including mastectomy, vaginoplasty and other gender-related surgeries

What this means for you

You may continue to provide these services; however, we will no longer cover them, due to the DMAS decision. These restrictions also prohibit states from using the federal Medicaid Early and Periodic Screening, Diagnostic and Treatment pathway to cover these services for children under age 18.

Procedures that will continue to have coverage

The following procedures will remain covered:

• Medically verifiable disorders of sexual development (i.e., congenital conditions affecting sexual anatomy or function)
• Procedures performed for purposes other than aligning a child's physical appearance or body with an asserted gender identity
• Treatment of complications such as infections, injuries, diseases or disorders caused by or exacerbated by prior gender-affirming procedures (including pharmaceutical interventions)
• Mental health services and psychotherapy for gender dysphoria

Gender-affirming hormone tapering period

Members who are already receiving gender-affirming hormone therapy as of Oct. 13, 2026, may continue that hormone therapy for up to 6 months.

CMS doesn’t intend the 6-month period as a clinical guideline, allowing you to retain discretion to recommend shorter timelines. This tapering period does not apply to puberty blockers. Managed care organizations contracted with Virginia DMAS will not create or enforce additional coverage criteria.