Federal Employee Health Benefits program to End Coverage of Gender-Affirming Care
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Washington, D.C. – August 20, 2025 – In a significant policy shift, the Office of Personnel Management (OPM) announced it will eliminate coverage for “chemical and surgical modification of an individual’s sex traits through medical interventions,” including gender transition services, within the Federal Employee Health Benefits (FEHB) program beginning with the 2026 plan year. This decision impacts millions of federal employees, retirees, and their families who rely on the FEHB for healthcare coverage.
Background and Policy Changes
The OPM’s recent directive reverses earlier guidance issued this year that allowed carriers to continue offering gender-affirming care to individuals over the age of nineteen, while eliminating it for those under nineteen. That previous guidance stemmed from two executive orders issued during the trump administration: ”Defending Women from Gender Ideology Extremism and restoring Biological Truth to the Federal Government” and “Protecting Children from Chemical and Surgical Mutilation.” This latest notice removes any carrier discretion, enacting a complete prohibition on coverage for gender-affirming care for all ages under the FEHB program.
This change represents a departure from the evolving landscape of healthcare coverage for transgender individuals,and raises questions about access to essential medical care for federal employees and their families. The Williams Institute at UCLA School of Law estimates that approximately 1.6 million adults in the United States identify as transgender [[1]],highlighting the potential impact of this policy.
Exceptions to the New Policy
While comprehensive gender-affirming care will no longer be covered, the OPM outlined several key exceptions to the new policy:
- Mental Health Services: Counseling for individuals experiencing gender dysphoria will continue to be covered, provided it is indeed delivered by a licensed mental health professional or a qualified faith-based counselor.
- Ongoing Treatment: Individuals currently undergoing hormone therapy or surgical treatment for diagnosed gender dysphoria will be eligible for continued coverage. Specific details will be outlined in each plan brochure and assessed on a case-by-case basis by the respective carrier.
- Non-Gender Related Hormone Therapy: Hormone treatments prescribed for conditions unrelated to gender affirmation, such as cancer or tumor prevention, will remain eligible for coverage.
The OPM also directed carriers to update their online provider directories to remove listings for healthcare providers offering services related to “chemical and surgical modifications of an individual’s sex traits.”
Did You No? The FEHB program is the largest employer-sponsored health insurance program in the United States, covering over 8.7 million people as of 2024.
Impact and Concerns
Advocacy groups have expressed strong concerns regarding the OPM’s decision,arguing it will create significant barriers to healthcare access for transgender federal employees and their families. Critics contend that denying coverage for medically necessary care is discriminatory and harmful. The World Professional Association for Transgender Health (WPATH) Standards of Care outline evidence-based guidelines for gender-affirming care [[2]],and this decision potentially conflicts with those established standards.
What impact will this decision have on the well-being of transgender federal employees? How will this policy affect the recruitment and retention of diverse talent within the federal workforce?
Pro Tip: Federal employees with questions about their health benefits should consult their agency’s human resources department or contact the OPM directly.
Key Dates and Decisions
| Date | Event |
|---|---|
| Earlier 2025 | OPM issues guidance allowing carriers to continue gender-affirming care for those over 19. |
| August 20, 2025 | OPM announces the elimination of coverage for gender-affirming care under the FEHB program, effective 2026. |
| 2026 | New policy takes effect; gender-affirming care no longer covered under FEHB. |
The debate surrounding gender-affirming care is a rapidly evolving area of healthcare and public policy.Historically, access to such care has been limited by insurance coverage and societal stigma. recent years have seen increasing recognition of the medical necessity of gender-affirming care for individuals experiencing gender dysphoria, with major medical organizations like the American Medical Association issuing statements of support. However, political and legal challenges continue to shape the landscape of access to these services.
Frequently Asked Questions
- what is gender-affirming care? gender-affirming care encompasses a range of medical, psychological, and social services designed to support individuals in aligning their gender expression with their gender identity.
- Who is affected by this OPM decision? This decision impacts federal employees, retirees, and their families who are enrolled in the Federal Employee Health Benefits (FEHB) program.
- What does this mean for current treatment plans? Individuals currently undergoing gender-affirming care may be eligible for continued coverage, but details will vary by plan.
- Are there any resources available for federal employees? Yes, federal employees can contact their agency’s human resources department or the OPM for more information.
- What is gender dysphoria? Gender dysphoria is the distress a person experiences when their gender identity and sex assigned at birth do not align.
This is a developing story. We will continue to provide updates as more information becomes available.
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