Oregon retreats from enforcing landmark trans health care coverage mandate

Three years after Oregon lawmakers passed a law requiring insurers to cover transgender medical services, state regulators have quietly delayed their efforts to ensure the law is making a difference for a group that’s long faced barriers to care.

The paused oversight stems from financial uncertainty facing Medicaid and the Trump administration’s intensifying attacks on gender-affirming care. The delay means an incomplete picture of whether the new law has shortened wait times or removed bureaucratic obstacles for transgender patients. It’s also a departure from the urgency officials and advocates directed to the high-profile law that supporters called life-saving.

Oregon’s efforts to protect gender-affirming care are being tested by a federal government actively hostile to it. Advocates for transgender people don’t agree on how the state should respond, but they worry gender-affirming care could become harder to come by in Oregon. State officials won’t know how many providers have been lost.

“This is the end game of instilling fear in people,” said Jenn Burleton, the Beaverton-based founder of the TransActive Gender Project, of regulators’ plans to not evaluate whether Oregon’s commercial and Medicaid insurers are meeting transgender patients’ needs.

Burleton said regulators’ decisions means lawmakers won’t have to account for the law’s effectiveness, and that they’re playing into the Trump administration’s attempt to disrupt access to gender-affirming care. Meanwhile, transgender patients are at risk of being “dropped and forgotten,” she said.

However, Basic Rights Oregon, the state’s leading LGBTQ+ advocacy group, supports the paused oversight out of concerns that tracking whether the law is working could make it easier for federal authorities to target providers and patients.

Since returning to office, President Donald Trump’s administration has taken a series of actions targeting medical care for transgender people, whose internal sense of their gender differs from their sex assigned at birth. The administration has focused on blocking adolescents’ access to gender-affirming care, moving to cut off federal funding while threatening providers with prosecution and sending subpoenas to clinics.

Oregon has lost providers, particularly in rural areas, because of the Trump administration “seeking out and weaponizing sensitive provider and patient information from the state to intimidate providers out of providing reproductive and gender affirming care,” according to a statement provided by Kyndall Mason, Basic Rights Oregon’s executive director.

“At a time when transgender and nonbinary people, their families and their providers are being targeted at the federal level, we support the state’s efforts to ensure Oregonians can continue to access medically necessary care across their lifespan without putting patients or providers at greater risk,” the group wrote in the statement.

A state report released last year points to gaps in medical care for transgender people. The report also found no comprehensive data on the availability of gender-affirming care in Oregon while anticipating demand to grow, particularly as other states restrict access to it.

There are 33,200 adult Oregonians who identify as transgender, according to the Williams Institute at the UCLA School of Law’s 2025 estimate. That’s a nearly 67 percent increase from the institute’s 2022 estimate.

The institute also estimated there are 9,000 transgender teenagers under 18 in Oregon, a near tripling from its last estimate that it attributed to improved data availability as well as changes to its methodology.

Department cites fears that federal government would use data

Gender-affirming care covers a wide range of treatments, including hormone therapies, hair electrolysis and facial feminization. For minors, doctors may prescribe medications to suppress puberty and prevent changes like breast development, menstruation, deepening voices and facial hair. Doctors might also prescribe hormone therapy. These treatments are broadly supported by major medical organizations.

Oregon lawmakers passed House Bill 2002 in 2023 to prevent commercial insurers from denying patients gender-affirming treatments that their health care providers deemed medically necessary.

The law puts the Department of Consumer and Business Services in charge of enforcement, directing it to examine all insurance carriers subject to the new requirements to ensure compliance by January 2027. The department was to report to lawmakers on its implementation of HB 2002 by Dec. 31.

Both would require regulators to collect “detailed carrier, provider and individual claims information” about gender-affirming care, Jason Horton, spokesperson for the department’s Division of Financial Regulation, wrote in an email.

“Given recent federal actions directed at people who provide and receive this care, we have reason to believe an exam by this date could put Oregonians’ private health information at risk,” he wrote. Regulators have also been focused on stabilizing the individual insurance market in response to strains from federal policy changes, he wrote.

He added that the work will continue when “it can be done confidently without putting patients and providers at risk.”

Meanwhile, HB 2002’s coverage requirements remain in effect and are enforced by regulators, he wrote.

Horton declined to elaborate on what private health information could be put at risk by federal actions.

Dr. Kara Connelly, a pediatric endocrinologist and medical director of the gender clinic at Oregon Health and Science University’s Doernbecher Gender Clinic, told a legislative panel earlier this year that the clinic has faced multiple death threats and seen providers doxed.

“The political and legal threats, in addition to fears about doxing, have had a chilling effect on individual providers and clinics,” she wrote.

As a result, other speciality clinics removed their websites entirely, causing confusion about what services are available, she wrote. Efforts by her team to improve access to gender-affirming care in central and eastern Oregon, as well as Willamette Valley have also been undone, she wrote.

Connelly’s testimony was in support of House Bill 4088, which Gov. Tina Kotek signed into law earlier this year. The law restricts the state’s cooperation with federal investigations or inquiries into legally protected reproductive or gender-affirming health care, among other provisions.

Horton did not respond to a question about whether the bill provides adequate protections.

Medicaid users also affected

The Oregon Health Authority has similarly dropped its earlier effort to ensure regional Medicaid insurers, known as coordinated care organizations, have enough gender-affirming care providers to meet their low-income members’ needs.

The effort began in 2024 under then-Director Sejal Hathi after an advisory committee warned that 160,000 trans people and families were leaving states that were restricting access to gender-affirming care. Hathi laid out her plan in a letter to the Oregon Health Policy Board, calling gender-affirming care a “critical factor for the safety and thriving” of trans and non-binary people.

Hathi, who stepped down in August, called for evaluating claims data on gender-affirming care services before directing coordinated care organizations to determine how many members required this care. The work was supposed to be concluded by early 2026.

In September, six months after this reporter sought public records related to the analysis Hathi ordered, the health authority said there were no responsive records.

The health authority had expected coordinated care organizations to share numbers on how many members require gender-affirming care by fall 2025, spokesperson Franny White wrote in an email.

But by then, challenges facing the Oregon Health Plan, the state’s version of Medicaid, eclipsed that work, according to White. Those challenges included financial instability facing coordinated care organizations and federal changes to Medicaid. Additionally, an insurer did not renew its contract for Lane County.

“In the coming months and as workloads permit, OHA will renew this data request and clarify that CCOs will be required to respond in full by a firm deadline,” she wrote.

The health authority held listening sessions to hear about transgender Oregonians’ health care needs, White wrote. Providers, advocates and community members told officials that “many patients must travel multiple hours because they don’t have a local provider they trust and wait months or even years for an appointment because demand for gender-affirming care exceeds available providers.”

Oregon promises care, doesn’t always provide it 

Oregon was one of the first states to cover gender-affirming health services through its Medicaid program beginning in 2015.

None of Oregon’s coordinated care organizations agreed to speak on the record for this story.

Burleton said she’s heard from transgender people that the Oregon Health Plan does cover their care but there are not enough providers and there are wait times for treatments. She said that providers also don’t have much incentive to include more transgender patients or publicize that they serve this group.

Several people familiar with the coordinated care organizations’ work said they have long been committed to meeting the needs of transgender members. But they acknowledged gaps in care and two mentioned complications with electrolysis, a treatment that removes hair follicles.

A 2020 study based on interviews with 25 transgender women in Oregon suggested the state is “relatively trans-friendly.” Study participants reported ease in getting hormone therapy through the Oregon Health Plan, but encountered difficulties in navigating health services.

“What the letter of the law provides in terms of access to health care doesn’t always result in people receiving that care when it is being implemented,” said Jonathan Garcia, associate professor in Oregon State University’s College of Health, who is the study’s lead author. “It’s great that we have a legal framework that provides access to gender-affirming care. I also think we also have a long journey to implementing that access in a meaningful way.”

Transgender youth with Oregon Health Plan will continue to receive care 

The Oregon Health Authority will use state funds to cover medical treatments for transgender youth in response to the Trump administration blocking Medicaid funds for gender-affirming care for minors.

Beginning Oct. 13, a new federal rule prohibits states from using Medicaid dollars to pay for puberty-suppressing drugs, hormone treatment and gender-affirming surgeries for patients under the age of 18. Research has found the latter to be rare. The rule applies the same restrictions to youth under 19 covered by the Children’s Health Insurance Program, or CHIP.

The rule follows other efforts by the Trump administration to prevent adolescents from accessing medical treatments for gender dysphoria, a condition marked by distress from a mismatch between a patient’s sex assigned at birth and sense of self.

More than half of states have restricted adolescents from accessing gender-affirming care. The Trump administration’s efforts are reaching into states where this care is legal.

In Oregon, the state will continue paying for gender-affirming care for minors because of House Bill 2002, which lawmakers passed three years ago to ensure access to gender-affirming care and reproductive health services.

“Trans youth, like all of us, deserve the healthcare they need when they need it,” Diego Sanchez, vice president of policy and government affairs for PFLAG, a national organization that advocates for LGBTQ+ people and their loved ones. “It’s good to see that states like Oregon, where transgender healthcare is legal, are making sure that the health and well-being of Oregonians is prioritized and not politicized.”

Health authority spokesperson Franny White said in an email that state law requires the agency to uphold access to gender-affirming care and that coverage won’t change for adolescent patients covered by the Oregon Health Plan, the state’s version of Medicaid, even as new restrictions on federal health spending take effect.

The authority expects that about 600 Oregon Health Plan members under 18 receive gender-affirming services affected by the federal rule change, she wrote.

The federal rule specifies that adolescents can still receive gender-affirming care through Medicaid programs with “state-only funds.” To comply with the rule and state law, the health authority will directly cover certain gender-affirming services for Oregon Health Plan patients under 18. These services would normally be covered by regional Medicaid insurers known as coordinated care organizations.

The agency plans to submit a budget adjustment to lawmakers next year to cover the cost, according to White.

California is also paying for gender-affirming care for adolescents with state funds. However, Colorado will suspend its coverage of this care with officials telling The Colorado Sun that resuming it would require an act from lawmakers.

The Centers for Medicare and Medicaid Services proposed the rule in December out of skepticism toward gender-affirming care for adolescents, which it refers to as “sex-rejecting procedures.” Mental health services for children with gender dysphoria would still be funded under the rule.

The rule describes these treatments it bans funding for as untested and harmful, citing how several European countries have restricted their use following reviews of evidence.

Federal health officials received roughly 11,000 comments from a mix of individuals, elected officials, state agencies, medical associations and advocacy groups. More than 90% were opposed to the rule.

The American Academy of Pediatrics has opposed the rule and other moves by the Trump administration to restrict gender-affirming care, calling them a “baseless intrusion into the patient-physician relationship.”

The American Medical Association and the American Academy of Family Physicians also submitted comments opposing the rule, calling it an overreach of federal authority.

A coalition of Democratic state attorneys general that includes Oregon’s Dan Rayfield has already challenged the rule in court.

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• October 14, 202610:03 amThis article was updated to correct an outdated reference to PFLAG, an advocacy organization that dropped its acronym in 2014.