The bill amends RCW 74.09.675 to limit state Medicaid coverage for transition-related surgical and nonsurgical interventions to adults only, explicitly prohibiting the purchase or contracting of certain services for individuals under the age of 18. These services include breast augmentation procedures (such as breast reductions and implants), sex reassignment or confirmation surgery, puberty suppression therapy, and hormone therapy (including presurgical and postsurgical hormone therapy). The bill also emphasizes that gender-affirming care services must be provided without discrimination based on gender identity or expression, and it outlines the responsibilities of the authority and managed care plans in ensuring access to these services.

Additionally, the bill reinforces that gender-affirming treatments cannot be categorically excluded as cosmetic and mandates that any adverse benefit determinations regarding these treatments must be reviewed by a qualified healthcare provider. It also requires that if adequate networks for gender-affirming treatment are not available, timely and accessible treatment must be provided at no greater cost than in-network services. The bill clarifies that nothing within it mandates coverage for services deemed not medically necessary and requires the authority to adopt necessary rules for implementation.

Statutes affected:
Original bill: 74.09.675