Clarification of Funding for Gender-Affirming Care
The Centers for Medicare & Medicaid Services (CMS) published a final rule in the Federal Register on August 13, 2026, that limits federal Medicaid and Children's Health Insurance Program (CHIP) funding for certain gender-affirming medical care provided to minors, scheduled to take effect October 13, 2026. This rule prohibits federal matching funds for puberty blockers, cross-sex hormone therapy, and surgical interventions when used for gender transition for Medicaid beneficiaries under 18 and CHIP enrollees under 19.
The rule does not prohibit states from using state-only funds to cover these services. Maine law requires MaineCare to cover medically necessary treatment for or related to gender dysphoria and protects members from discrimination based on gender identity or gender expression.
Providers should continue to provide these services as usual. Specific guidance for providers on Maine’s implementation of state-only coverage, including billing guidance, will be forthcoming.
To help ensure MaineCare members receive the health care services they need, and have the information necessary to make informed decisions, OMS will continue to communicate with members about covered services through the Member Handbook and the OMS website.
For questions, please contact Provider Relations Specialist, Lisa Bouchard.