Federal employees to be fully barred from gender affirming care coverage, starting next year

By Jane Migliara Brigham

The Office of Personnel Management (OPM) has issued a directive to all health insurance plans for federal employees, informing them that they must stop covering gender affirming care for trans patients starting next year, or they will lose their contracts with the federal government. 

The OPM issued a similar letter last year barring federal health insurance barring trans care as a general rule, but allowing coverage to continue “on a case-by-case basis” for people who were “mid-treatment” This could include people whose bodies cannot naturally produce sex hormones, such as women with orchidectomies and men with hysterectomies.

It is unknown how many people received an exemption. The Needle was unable to locate any  such exemptions being granted. 

The latest rule ends those few remaining exceptions by mandating that “Carriers must remove any exceptions process… for coverage of excluded services for members who are mid-treatment within a surgical and/or hormonal regimen for diagnosed gender dysphoria.” Not content to merely end coverage in practice, this rule would also end the coverage in theory.

The letter does not have the force of law, but the previous letters on trans care from the OPM were implemented with little hassle, and insurance companies are likely to comply to keep their federal contracts.

Federal health insurance contracts are renewed at the beginning of each calendar year, meaning these restrictions will be added to contracts next January.

Over 11 million people are on these plans, either as federal employees, retirees, or as their family members. That means that any of these 11 million people seeking to transition (or maintain their body and avoid health issues like loss of bone density, cardiovascular problems, or cognitive difficulties) would either have to pay out of their own pocket, or find employment elsewhere.

For those who need external hormones to live, this is a choice that will weigh heavily. Federal employment is the only job sector with such strict bans on trans care, (with the exception of the military). These jobs tend to pay poorly in exchange for excellent benefits, such as cheap healthcare. The combination of low pay, restricted benefits and rising out of pocket costs can pressure trans people to leave public service.

The only type of ‘trans care’ that is covered under this rule is counseling. The OPM is fine providing coverage for people to talk about their feelings on their body and gender, just so long as it is in a clinical setting where they can’t take any meaningful actions to change their body. If they want to change their sex, their insurance will be barred from covering that.

This is consistent with the Republican attitude to trans identity in general and transsexuality in particular; that it is a social contagion which a person can be talked out of. The actions they are taking are intended to remove trans people from public life, who they falsely see as the source of that so-called ‘social contagion’.

This policy is part of a wider strategy. The actions that Republicans are taking here demonstrate what they will do in any other setting where they have full control over trans healthcare.

As recent court filings by the Department of Justice demonstrate, Republican lawyers are arguing that trans healthcare is not truly healthcare, and that the government has no responsibility to provide it. In that case, the government was arguing about the healthcare it provides to trans people in prisons, a setting where the government has total control over a person’s access to medicine.

The administration made a similar argument when it declared that trans people are unfit for military service due to being diagnosed with gender dysphoria. This too is a setting where the government has near total control of the medicine that people can use.

Federal employee health insurance plans do not have the same level of control over the bodies of their customers as prisons and the military have over people within them, but they can dictate what gets paid for and what doesn't. In all three cases, the administration is implementing the largest restrictions on trans healthcare that they can while staying within the law as it exists today.

At the same time, Republicans  implementing these bans are also pushing for the laws to be further restricted, such that all adults will be barred from changing their sex, regardless of their employer or whether they are in prison. The head of the Heritage Foundation, the organization at the center of Project 2025, said in February that gender affirming care for trans adults should be banned as well.

We are seeing this plan enacted, as a growing number of adults are barred from the hormones they need to live. Restrictions which as recently as 2024 had only applied to children and prisoners are now being rolled out to the entire population.

These new restrictions on government health insurance are merely a part of a broader campaign that is intended to make changing one’s sex impossible.