Does OHP Cover Gender-Affirming Care? A 2026 Guide for Trans Oregonians
Last checked October 7, 2026. WERQ TOGETHER is a certified OHP application assister organization, and our help applying is free. This is a coverage guide, not medical advice.
Yes. Oregon law requires the Oregon Health Plan (OHP) to cover medically necessary gender-affirming care, including hormones, top and bottom surgery, facial surgery, hair removal and voice care. Many services need preapproval. For adults, nothing changed in 2026. For members under 18, starting October 13, 2026, OHA pays for gender-affirming medications and surgery through OHP Open Card instead of your CCO, using state money.
Get free help applying for OHP
What OHP covers
Hormones and ongoing care: hormone therapy, puberty blockers, lab work, mental health therapy, physical therapy, speech therapy.
Hair removal and tattooing: electrolysis, laser hair removal, medical tattooing.
Top surgery: mastectomy, breast or chest reconstruction (augmentation or reduction), liposuction.
Bottom surgery: metoidioplasty, phalloplasty, vaginoplasty, vulvoplasty, gender-neutral genitoplasty, hysterectomy, orchiectomy, salpingo-oophorectomy.
Face and voice: jaw, chin, lip, nose, eye and eyebrow surgery; tracheal surgery; vocal cord surgery; hair transplantation.
Body contouring: lipofilling, liposuction, monsplasty.
Source: OHA, Gender-Affirming Care for OHP Members. OHA covers all medically necessary care prescribed under the WPATH Standards of Care, Version 8.
The rules that protect you
It's the law. HB 2002 (2023), now ORS 414.769, requires OHP to cover gender-affirming treatment.
No "cosmetic" denials. OHP can't call a medically necessary procedure cosmetic, including tracheal shave, electrolysis, facial gender-affirming surgery and revisions.
Only an expert can say no. A denial has to be approved by a provider with experience in gender-affirming care.
Your plan has to find you a provider. CCOs must have enough gender-affirming providers, or help you reach one outside their network.
What changed in 2026
October 13, 2026: OHA starts paying for under-18 gender-affirming medications and surgery through OHP Open Card, with state money. Families: ask your provider whether they take Open Card. If not, find one at OHPOpenCard.org.
September 2, 2026: Oregon and a coalition of states sued to stop the federal rule. As of October 7, no court has blocked it.
August 13, 2026: A federal rule was finalized. Starting October 13, it ends federal Medicaid money for gender-affirming medications and surgery for people under 18. Oregon says coverage continues for every OHP member.
July 4, 2025: The federal budget law (H.R. 1) passed without a ban on gender-affirming care. Adult coverage is unchanged. The law does add work rules in 2027 (see below).
How to get gender-affirming care on OHP
Start with any provider. Your primary care provider, a specialist or a mental health clinician can refer you.
Find providers in your plan. Use your CCO's provider search: Health Share of Oregon, 503-416-8090, or Trillium Tri-County, 1-877-600-5472. Not sure which CCO you have? Call OHP Client Services at 1-800-273-0557.
Your provider asks for preapproval. Health Share decides most requests within 7 days (up to 21), and urgent ones in about 72 hours.
If you're denied, appeal. You have 60 days from the denial letter. After that, you can ask for a state hearing within 120 days of the appeal decision. The OHA Ombuds can help: 1-877-642-0450.
Expect a wait. OHA says there may not be enough clinicians, and CareOregon says laser hair removal and medical tattooing take the longest to schedule.
Who qualifies and how to apply
OHP Plus: adults 19 to 64 with income up to 138% of the federal poverty level, about $1,836 a month for one person.
OHP Bridge: income above that, up to 200% of the poverty level ($31,920 a year for one person). OHA describes Bridge benefits as almost the same as OHP Plus.
Cost: no premiums, copays or deductibles.
Apply any time: at ONE.Oregon.gov, or call 1-800-699-9075, Monday to Friday, 7am to 6pm. You can apply for SNAP food benefits at the same time.
New to Oregon? You can apply as soon as you live here. You don't need a permanent address.
Free help: WERQ TOGETHER is a certified OHP assister organization. Book a free appointment.
Earn too much? The Oregon Health Insurance Marketplace is at 855-268-3767, and Oregon law requires state-regulated private plans to cover gender-affirming care too.
What you'll need to apply
Your full legal name and birthdate
Your Social Security number, if you have one
Income information, like recent pay stubs
Immigration documents, if they apply to you
Information about any health insurance you can already get
The application has space for your gender identity. If the ONE website gives you trouble, the tech support line is 1-833-978-1073.
Phone numbers
Coverage questions, which CCO you're in, Open Card: OHP Client Services, 1-800-273-0557
Apply, renew or report changes: ONE Customer Service, 1-800-699-9075
Open Card care coordination: 800-562-4620
Health Share of Oregon members: 503-416-8090
Trillium Tri-County members: 1-877-600-5472
Help with a denial or complaint: OHA Ombuds, 1-877-642-0450
Private insurance: Oregon Health Insurance Marketplace, 855-268-3767
Questions people ask
Does OHP cover HRT?
Yes. OHP covers hormone therapy and lab work. For members under 18, starting October 13, 2026, hormones and puberty blockers are paid through OHP Open Card.
Does OHP cover top surgery?
Yes. OHP covers mastectomy and chest reconstruction. Expect preapproval, and if you're denied, you can appeal.
Do I have to be on hormones before surgery?
No. OHA says hormones aren't required before surgery. If you are taking them, the standard is at least six months first.
What about trans youth on OHP?
Oregon keeps covering their care with state money. From October 13, 2026, medications and surgery come through Open Card, so families should confirm their provider is enrolled in it.
Will the 2027 work rules affect me?
Starting in 2027, some adults 19 to 64 will need more than $580 a month in income, or 80 hours a month of work, school, volunteering or caregiving, to keep OHP. There are many exemptions, and the rules don't apply to OHP Bridge. Watch your mail for an OHA notice.
