Does Medi-Cal cover hormone replacement therapy?

Medi-Cal is California's Medicaid health insurance program. It provides free or low-cost health coverage for low-income individuals, including families with children, seniors, persons with disabilities, pregnant women, and people in need of hormone replacement therapy (HRT).
HRT, also known as gender-affirming hormone therapy, involves taking estrogen, testosterone, or other hormones to align a person's physical characteristics with their gender identity. For transgender people, HRT is often medically necessary treatment and can be covered by health insurance plans including Medi-Cal.

Medi-Cal coverage for transgender services follows the same standards as private plans under California law. The key requirements are:

Medi-Cal cannot categorically exclude sex reassignment surgeries and must evaluate medical necessity on a case-by-case basis.

Gender dysphoria diagnoses and hormone therapy must be covered if medically necessary.

Services must be provided promptly and effectively within network capacity.

This means Medi-Cal is required to cover medically necessary hormone replacement therapy for gender dysphoria, which can involve:

Feminizing hormones like estradiol and spironolactone for transgender women

Masculinizing hormones like testosterone for transgender men

Puberty blockers for transgender teens

Ongoing lab work and provider visits to monitor hormone levels and health

To obtain HRT coverage with Medi-Cal:

You must have a gender dysphoria diagnosis from a licensed mental health professional.

Your medical provider submits a treatment authorization request (TAR) documenting medical necessity.

Medi-Cal reviews the TAR to approve or deny coverage for specific services based on established criteria. Approval timelines depend on the type of request.

Common challenges with Medi-Cal that can affect access to transition-related care include:

Having an inadequate provider network in some rural areas

Staff lacking competency in treating transgender patients

Difficulty navigating the bureaucratic TAR process

Coverage denials if medical necessity is not adequately documented

If your TAR gets denied or you need help connecting to trans-competent providers that take Medi-Cal, resources are available such as:

Transgender Law Center helpline

Local LGBTQ health centers and advocacy groups

Check if you qualify for Medi-Cal based on income and household size. If eligible, you can receive low or no-cost hormone therapy following the process outlined above. Reach out for help addressing any barriers along the way.

At Second Spring Hormone Clinic, we specialize in hormone replacement therapy for transgender clients. Dr. Pat Smith has over 10 years experience providing gender-affirming care. We offer: