Medicaid/transition services

AN ACT Relating to limiting state medicaid coverage for 1
transition-related surgical and nonsurgical interventions to only 2
adults; and amending RCW 74.09.675. 3
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:4
Sec. 1. RCW 74.09.675 and 2021 c 280 s 4 are each amended to 5
read as follows: 6
(1) In the provision of gender-affirming care services through 7
programs under this chapter, the authority, managed care plans, and 8
providers that administer or deliver such services may not 9
discriminate in the delivery of a service provided through a program 10
of the authority based on the covered person's gender identity or 11
expression. 12
(2) Beginning January 1, 2022: 13
(a) The authority and any managed care plans delivering or 14
administering services purchased or contracted for by the authority 15
may not apply categorical cosmetic or blanket exclusions to gender-16
affirming treatment. 17
(b) Facial feminization surgeries and facial gender-affirming 18
treatment, such as tracheal shaves, hair electrolysis, and other care 19
such as mastectomies, breast reductions, breast implants, or any 20
combination of gender-affirming procedures, including revisions to 21
S-3842.1
SENATE BILL 6191
State of Washington 69th Legislature 2026 Regular Session
By Senators Christian, Fortunato, and Torres
Read first time 01/16/26. Referred to Committee on Health & Long-
Term Care.
p. 1 SB 6191
prior treatment, when prescribed as gender-affirming treatment, may 1
not be excluded as cosmetic. 2
(c) The authority and managed care plans administering services 3
purchased or contracted for by the authority may not issue an adverse 4
benefit determination denying or limiting access to gender-affirming 5
treatment, unless a health care provider with experience prescribing 6
or delivering gender-affirming treatment has reviewed and confirmed 7
the appropriateness of the adverse benefit determination.8
(d) If the authority and managed care plans administering 9
services purchased or contracted for by the authority do not have an 10
adequate network for gender-affirming treatment, they shall ensure 11
the delivery of timely and geographically accessible medically 12
necessary gender-affirming treatment at no greater expense than if 13
they had an in-network, geographically accessible provider available. 14
This includes, but is not limited to, providing case management 15
services to secure out-of-network gender-affirming treatment options 16
that are available to the enrollee in a timely manner within their 17
geographic region. The enrollee shall pay no more than the same cost 18
sharing that the enrollee would pay for the same covered services 19
received from an in-network provider. 20
(3) The authority may not purchase or contract the following 21
services for individuals under the age of 18 even if the individual 22
has a gender dysphoria diagnosis: Breast augmentation procedures, 23
including but not limited to breast reductions and breast implants; 24
sex reassignment or confirmation surgery; puberty suppression 25
therapy; and hormone therapy, including but not limited to 26
presurgical and postsurgical hormone therapy.27
(4) For the purposes of this section, "gender-affirming 28
treatment" means a service or product that a health care provider, as 29
defined in RCW 70.02.010, prescribes to an individual to support and 30
affirm the individual's gender identity. Gender-affirming treatment 31
includes, but is not limited to, treatment for gender dysphoria. 32
Gender-affirming treatment can be prescribed to two spirit, 33
transgender, nonbinary, and other gender diverse individuals.34
(((4))) (5) Nothing in this section may be construed to mandate 35
coverage of a service that is not medically necessary.36
(((5))) (6) The authority shall adopt rules necessary to 37
implement this section. 38
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p. 2 SB 6191