Know Your Healthcare Rights

The Federal Employees Health Benefits (FEHB) Program, which includes the Postal Service Health Benefits (PSHB) Program, provides health insurance benefits to approximately 8.2 million federal employees, U.S. Postal Service employees and their eligible family members, as well as certain Tribal employees and their eligible family members. The U.S. Office of Personnel Management finalized benefit changes for plan year 2026.

• Key Gender-Affirming Care Exclusion: The recent changes remove coverage for “medical or surgical modification of sex traits, including gender transition procedures,” which the administration defines to include both gender-affirming surgery and hormone treatments, for all ages. This represents a significant policy change from 2025, when coverage was available for adults.

• Key Exceptions and Requirements:The FEHB Program Carrier Letter issued on August 15, 2025 noted that as an exception, counseling services for possible or diagnosed gender dysphoria must still be covered. Additionally, carriers must establish an exceptions process for enrollees who are mid-treatment within a surgical and/or hormonal regimen for diagnosed gender dysphoria.

There is an ongoing lawsuit over this policy which alleges that the policy discriminates against transgender federal employees and federal employees with transgender dependents. You can read more about the lawsuit at the Human Rights Campaign Federal Employee Health Benefits Class action info site.

In August 2026, CMS issued a final rule barring federal Medicaid and Children’s Health Insurance Program (CHIP) funds from covering gender-affirming care services for trans youth, including puberty blockers, hormone therapy, and surgery. The rule affects enrollees under 18 in the Medicaid program and under 19 in the CHIP program. The rule does not prevent states from paying for these services with state funds, but may make it more difficult for states to cover the cost. The rule is set to take effect on October 13, 2026. For Medicaid or CHIP enrollees who are receiving hormone therapy as of that date, the rule allows states to continue using federal funds to cover hormone therapy for up to 6 months.

You can read the full rule in the Federal Register, here.

What does this mean for Illinois? This rule does not take effect until October 13, 2026. Additionally, there has been a legal challenge to the rule, co-led by Illinois Attorney General Kwame Raoul, arguing that the rule is unlawful and should not be allowed to take effect. You can read more about this legal challenge, here. We do not yet know how this federal action will impact Illinois’ or other states’ ability to cover gender-affirming care for youth enrolled in Medicaid and CHIP. If you have questions about how this may impact your access to care, call the IL Pride Connect Legal Hotline at 855-805-9200.

U.S. v. Skrmetti is a Supreme Court case that was decided in June 2025. The case began as a legal challenge by three transgender adolescents, their families, and a medical provider against a Tennessee law banning gender-affirming hormone treatment for trans youth. The Supreme Court ruled that the Tennessee law was allowed to remain in effect in that state. The decision says that Tennessee's state ban on gender affirming care for youth is legal, but the decision does not outlaw gender affirming care in the US or impact states like Illinois that choose to protect gender affirming care for youth.

Why are some Illinois hospitals no longer providing gender-affirming care? It is not illegal to provide or receive gender affirming care, including gender affirming care for youth, in the state of Illinois. Some hospitals have chosen to stop providing this care to youth under 19, even though there is no legal ban on providing this care in Illinois. Reasons why hospitals and other providers may choose to stop providing this care include fears of being sued or of losing federal funding. If your care is affected or you are unsure about your access to services, call the IL Pride Connect Legal Hotline at 855-805-9200.

Illinois Medicaid is a health insurance program that provides affordable health insurance coverage to qualified Illinois residents.

• In Illinois, Medicaid covers gender-affirming care, including youth gender-affirming care. See Medicaid Basics, Services that are Covered by Medicaid, and Prescription Policy for Medicaid.

• You can call the IL Pride Connect Legal Hotline at 855-805-9200 if you have questions about Illinois Medicaid, like how to apply, what services are covered, or how to appeal a denial of coverage.

Private health plans in Illinois, including Affordable Care Act plans and many employer-based plans, may not exclude gender-affirming care or specific gender-affirming care services from coverage simply because it relates to gender transition. Insurance companies in Illinois cannot:

• Refuse to enroll you in a plan because you are trans

• Cancel your coverage because you are trans

• Charge you higher rates because you are trans

• Deny you coverage for treatment just because the gender listed on your insurance does not match the gender associated with a particular service

For more information on health insurance protections in Illinois:

• Illinois Department of Insurance (IDOI) Guidance to Insurance Companies on Trans Health Coverage Guidance‍ ‍

  • This guidance reminds health insurers that they cannot flatly refuse to cover medically necessary gender-affirming care — including surgeries — for people with gender dysphoria. Insurers must use up-to-date, evidence-based medical standards when deciding what care is medically necessary, and cannot use blanket exclusions to deny care that meets those standards. They also cannot label a treatment "experimental" if it aligns with current accepted medical practice. When coverage is denied, patients must still have access to an appeals process.

  • If you feel your health insurance plan has discriminated against you, you can file a complaint with the Illinois Department of Insurance. Filing a complaint may help resolve your individual case, and may also help Illinois hold insurance companies accountable for any illegal coverage exclusions of trans health services. Visit the Illinois Department of Insurance Help Center to file a complaint.

• For more information about health insurance discrimination, see the Advocates for Trans Equality Healthcare Know Your Rights page.

• If you have experienced an insurance denial of gender-affirming care, call the Illinois Pride Connect Legal Hotline at 855-805-9200 for assistance.