OPM will offer gender-affirming care exemptions for those with mental health, current treatment or non-gender related hormone therapy. Douglas Rissing/Getty Images
Coverage for gender-affirming care will be eliminated from FEHB plans in 2026
The federal HR agency removed all coverage of gender-affirming care from its health benefits program, barring three exceptions, following two recent executive orders.
In a new letter, the Office of Personnel Management has informed carriers that “chemical and surgical modification of an individual’s sex traits through medical interventions (to include gender transition services)” will no longer be covered in the Federal Employee Health Benefits program for plan year 2026.
Earlier this year, OPM issued guidance that eliminated gender-affirming care for individuals under the age of 19 but preserved the option for carriers to continue offering it to older patients. That directive was tied to two executive orders issued by President Trump: “Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government” and “Protecting Children from Chemical and Surgical Mutilation.”
This latest notice from OPM now eliminates that discretion entirely, prohibiting coverage of gender-affirming care for individuals of any age under the FEHB program.
Several exceptions remain in place:
- Mental Health Support: Counseling for individuals with possible or diagnosed gender dysphoria must continue to be covered, provided it’s delivered by a licensed mental health professional or a qualified faith-based counselor.*
- Ongoing Treatment: Individuals currently undergoing surgical or hormonal treatment for diagnosed gender dysphoria qualify for continued coverage. These types of exceptions will be outlined in each plan brochure and evaluated by the carrier on a case-by-case basis.
- Non-Gender Related Hormone Therapy: Hormone treatments unrelated to gender-affirming care, such as for cancer, tumor growth prevention and other medically necessary uses, remain eligible for coverage.
The notice also requires carriers to update their online provider directories “…to not list or otherwise recognize providers for the purpose of providing chemical and surgical modifications of an individual’s sex traits.”
Kevin Moss is a senior editor with the Guide to Health Plans for Federal Employees provided by Consumers’ Checkbook. Watch more of his free advice and check here to see if the Guide is available for free from your agency. You can also purchase the Guide and save 20% with promo code GOVEXEC.
Editor's note: While the rule does not explicitly mandate conversion therapy, its allowance for “faith-based counselors” could enable practices that resemble it.