Gender-affirming care is provided consistently with state law and clinical guidelines and remains covered by qualified health plans and Washington Apple Health (Medicaid).
Preserving Washington Healthplanfinder access for gender-diverse people
Updates
Washington Health Benefit Exchange is committed to working with community members, partner agencies and carriers to ensure Washington Healthplanfinder remains accessible to all, including gender diverse Washingtonians. Plans available on Washington Healthplanfinder cover a range of medically necessary services including gender-affirming health care, consistent with state law and established clinical guidance.
Federal changes
On June 20, 2025, the Centers for Medicare & Medicaid Services (CMS) issued a federal rule barring coverage of gender-affirming care as an essential health benefit covered by qualified health plans.
This follows a CMS letter issued April 11, 2025, to Medicaid agencies about states’ responsibilities to ensure Medicaid payments are consistent with quality of care and covered services are provided in a manner consistent with the best interest of recipients.
These federal changes do not change Washington state law or requirements; gender-affirming care remains covered by qualified health plans and Washington Apple Health.
State insurance protections
Washington state law requires coverage of medically necessary gender-affirming treatment and prohibits discrimination in how these services are covered:
For people enrolled in Washington Healthplanfinder qualified health plans, RCW 48.43.0128 ensures medically necessary gender-affirming care cannot be denied or limited.
Under RCW 74.09.675, the Health Care Authority (HCA) and providers cannot apply blanket exclusions to this care in Medicaid.
State patient protections
Washington state has a Shield Law (Chapter 7.115 RCW) providing legal protection for patients who receive gender-affirming care or reproductive health services, which are lawful in Washington state. The law also prevents state agencies, courts, and law enforcement from cooperating with out-of-state investigations, subpoenas, or civil actions related to such care, particularly when those actions originate from states that restrict or ban these services.
These protections apply to actions within Washington state. People with legal concerns, particularly those related to potential federal investigations, should seek advice from legal counsel, as state law may not override federal enforcement authority in all circumstances.
State law protects providers, parents and others
Washington’s Shield Law (RCW 7.115) also protects providers, parents and others who assist in the provision or receipt of gender-affirming care or reproductive services in Washington state from legal actions originating in other states that restrict or ban such care.
Additionally, RCW 18.130.450 affirms the provision of medically necessary gender-affirming care by a Washington-licensed health care provider is professional conduct when delivered within their scope of practice.
State law protects patient information
Under RCW 70.02, health care providers and facilities are prohibited from disclosing personally identifiable health care information without patient consent, except under certain circumstances permitted by law. This includes gender-affirming care.
Added privacy protections may apply under Washington’s My Health My Data Act, which extends confidentiality obligations to certain non-clinical entities handling health-related data.
Providers should follow standard confidentiality and documentation practices and should consult with legal counsel or their compliance office if they receive any out-of-state requests for information related to gender-affirming care.
