Transhealth program

Apple Health (Medicaid) Transhealth program

Primary care, behavioral health services, speech therapy (including voice training), and hormone therapy (including puberty blockers), are covered under Apple Health. If you are enrolled in a managed care plan these services will be covered through your plan. Contact your plan to request a list of providers.

You may request a case manager through your managed care plan who can assist you with coordination of care. The phone number to member services can be found on the back of your insurance card.

Other gender-affirming treatments are covered directly by Apple Health using your ProviderOne services card, and not by your managed care plan.

Requirements

Gender-affirming treatments must be provided by a provider who is enrolled in Apple Health. Prior authorization is required for these services. Apple Health only authorizes and pays for medically necessary services.

General requirements

It is a general requirement that:

• You have been on gender-affirming hormone therapy for a minimum of 12 months before surgery. Hormone therapy is not required if there is medical reason why you cannot take it. Hormone therapy is not required for mastectomy or reduction mammoplasty (chest masculinization).
• You live in a gender role that matches your gender identity for a minimum of 12 months before surgery. This is not required if you have personal safety concerns that keep you from living in your desired gender identity. Certain procedures do not require you to live in your desired gender for 12 months. These procedures include: mastectomy or reduction mammoplasty (chest masculinization); orchiectomy (testicle removal); and hysterectomy (uterus removal).

Requirements for gender affirming voice surgery

• Completion of speech or voice therapy.
• Otolaryngologists consult and evaluation.
• Live in a gender role that matches clients gender identity for a minimum of 12 months preceding treatment/surgery, unless otherwise noted, or have been unable to live in their desired gender identity due to personal safety concerns.
• Gender affirming hormone therapy is not required for voice feminization.
  • It is a general requirement to be on gender-affirming hormone therapy for a minimum of 12 months preceding treatment or surgery, or have a medial contraindication to hormone therapy.

Required documentation

Commonly requested procedures (top, bottom, hysterectomy, orchiectomy, and facial feminization surgery)

• A letter from a licensed mental health care provider. 
  • The letter and evaluation must be less than 18 months old, signed and dated by the provider and provided by the following licensed health care professionals who are eligible providers under chapter 182-502:
    • Psychiatrist
    • Psychologist
    • Psychiatric advanced registered nurse practitioner (ARNP)
    • Psychiatric mental health nurse practitioner- board certified (PMHNP-BC)
    • Licensed Mental Health Counselor (LMHC)
    • Licensed Independent Clinical Social Worker (LICSW)
    • Licensed Advanced Social Worker (LASW)
    • Licensed Marriage and Family Therapist (LMFT) and:
      • Full bottom surgery requires two letters (2 evaluations). Each letter must be from a different, independent licensed mental health care provider.
  • Each comprehensive psychosocial evaluation must include the following:
    • Independently confirms the diagnosis of gender dysphoria as defined by the Diagnostic Statistical Manual of Mental Disorders,
    • Documents that confirm you have lived in a gender role that is congruent with your gender identity for a minimum of 12 months, preceding surgery, or have
    • Been unable to live in your gender identity due to personal safety concerns (not a requirement for mastectomy, orchiectomy, or hysterectomy), and
    • Documents that you have been evaluated for any coexisting behavioral health conditions, and if any are present, the conditions are adequately managed.
• A letter from the provider who prescribes your hormone therapy.
  • The letter must be less than 18 months old. The letter must be signed and dated. If you do not take hormones, then a letter of support from your primary care provider is required.
• Chart notes from the surgeon or provider.
  • This must be less than 12 months old and include the provider's or surgeon’s evaluation and the treatment plan for gender affirming treatment.

Hair removal from face and body

• Letter from the provider managing the client’s gender affirming hormone therapy.
  • The letter must be less than 18 months old. The letter must be signed and dated. If you do not take hormones, then a letter of support from your primary care provider is required.
• Letter of medical necessity from your dermatologist or primary care provider.
  • The letter must be completed within 18 months prior to the request for hair removal.
  • Description of medical condition and attempted treatments that prohibit you from shaving or utilizing other hair removal techniques (except electrolysis or laser).
  • Examples include:
    • Documented folliculitis,
    • Documented sensitivity to hair removal techniques, or
    • Thick male pattern hair growth prohibiting adequate hair removal.
  • Photos of requested area for hair removal.
    • Photos should be taken from approximately two feet away.
    • Include method of hair removal in documentation.
    • Provide the photos:
      • Prior to hair removal.
        • Include length of time from last hair removal. An 8 - 12 hour period of time from last hair removal is recommended for face, and 3-5 days of hair growth for body).
      • Immediately after hair removal.
• Letter of medical necessity from the treating provider performing the hair removal.
  • Letter should include the size and location of the area to be treated, and the number of expected units needed to complete treatment.

Gender affirming voice surgery

• Letter of Support from speech language pathologist (SLP).
  • Letter should be within the past 12 months and confirm completed speech therapy or voice therapy which includes the outcome.
• History and physical and treatment plan from the Otolaryngologist who will perform the procedure.
  • Letter should be from the past 12 months.
• Letter of medical necessity supporting the request for voice modification procedure from the primary care provider.
  • Letter should be from the past 18 months.
• For voice masculinization - Letter from the managing provider of hormone therapy. 
  • Letter should be from the past 18 months.

These letters should be given to your provider that will be performing the gender affirming treatment. To get started, call the provider you are interested in seeing and schedule a consultation. The provider will include the documentation when they request prior authorization for your treatment.

For additional questions on the Transhealth Program you can email applehealth.transhealth@hca.wa.gov.

Find a Provider

To find a list of providers for primary care, behavioral health services, speech therapy, and hormone therapy (including puberty blockers) contact your managed care plan. The number can be found on the back of your plan health card.

To find a list of providers for gender affirming surgeries and other treatment, including hair removal, email applehealth.transhealth@hca.wa.gov.

You can see any Apple Health enrolled provider that performs the gender affirming treatment you are seeking. To get started, call the enrolled provider you are interested in seeing and schedule a consultation. Consultations do not require prior approval. The provider will need to get a prior authorization for the treatment.

To see if a provider you are looking for accepts Apple Health coverage, visit the ProviderOne Find a Provider tool.

Transportation services

You may be eligible for help with transportation to your health care appointments at no cost to you. The appointment must be for services covered by Apple Health. If you need help to find transportation or a doctor in your area, please call 1-800-562-3022. Visit the transportation services webpage to find a transportation broker for your county. Contact a broker 7-14 days before your appointment. Requests to your broker less than two business days before your appointment may not be scheduled.

To change your gender marker

• If you applied for health coverage through Washington Healthplanfinder, report this change by either calling Health Care Authority at 1-800-562-3022, email AskMAGI@hca.wa.gov, or online at Washington Healthplanfinder. As of May 2020, the Washington Healthplanfinder application asks for your “sex assigned at birth”. If you are seeking pregnancy coverage, you will need to answer “female.” Otherwise, you can continue to use your gender marker.
• If you applied for health coverage through the Department of Social and Health Services or Washington Connection, you must report this change by either calling 1-877-501-2233 or online at Washington Connection.

Any Apple Health client can call and choose a gender. Clients should be aware that other state agencies, such as the Department of Licensing, have different requirements.

The Health Care Authority, Department of Social and Health Services, and the Health Benefit Exchange are working together with other state agencies to incorporate gender identity into their applications and other processes.

To change your name

Before making a name change, you should first obtain a name change through the Social Security Administration (SSA). If your name in the system does not match the name on file with SSA, an error will be generated and this could affect your coverage.

• If you applied for health coverage through Healthplanfinder, you must report this change by either calling Health Care Authority at 1-800-562-3022 or online at Washington Healthplanfinder.
• If you applied for health coverage through the Department of Social and Health Services or Washington Connection, you must report this change by either calling 1-877-501-2233 or online at Washington Connection.