The new policy will include Medicaid members in HealthChoice Illinois, the state’s managed care program, as well as those receiving their care through traditional fee-for-service. Under the proposed coverage rules, Medicaid members age 21 and older who are diagnosed with gender dysphoria will now be eligible for genital and breast-related surgeries.
In studying other state policies, the HFS said gender affirming surgery is cost-effective and can help prevent negative health impacts, including depression and suicide.
The HFS said 17 states and Washington, D.C. also offer these services and have not reported significant cost increases. The most recent data available shows that 1,400 of the state's 3.1 million Medicaid members are diagnosed with gender dysphoria, and last year around 2,500 prescriptions for hormone therapy were covered.