By Jane Migliara Brigham and Artemis T. Douglas
Ambetter Insurance, owned by the largest provider of Medicare and Medicaid insurances in the nation, has stopped covering hormones and other transition medicine for trans adults on private plans.
This comes from an investigation into the matter performed by The Needle. We reviewed insurance documents issued by Ambetter and its parent company Centene showing that they quietly removed coverage for trans care across 19 states, and then failed to inform its customers about the change.
The Needle spoke to several people who have been deprived of coverage. Many of them shared firsthand evidence that Ambetter and its parent company have been obscuring the reason for their claim denials.
At the same time, the leadership of Ambetter’s parent company Centene has been campaigning for many policies championed by Robert Kennedy Jr. and the Make America Healthy Again movement, both of whom have a longstanding interest in eliminating transition medicine.
Join The Needle's mailing list:
Denial As Policy
Beginning in April, Ambetter customers began reporting that they were being denied coverage for Estrogen, Testosterone, and other forms of HRT. Since the company never addressed the issue publicly, it was assumed that these were individual denials rather than part of a coordinated campaign or insurer policy change.
However, their website’s policy document for topical testosterone has been changed to specifically exclude coverage for trans men in 19 states, most of which are controlled by Republicans.
This section, which was added on February 24th, indicates states where trans men will be denied testosterone on the basis that they are trans men. This restriction only applies to those assigned female who are requesting testosterone, meaning it only applies to trans men. Older versions do not have this rule.
The states where Ambetter has ended coverage for trans healthcare are Alabama, Arizona, Arkansas, Florida, Georgia, Indiana, Iowa, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Nebraska, New Hampshire, North Carolina, Ohio, Oklahoma, South Carolina, and Tennessee.
Another document governing the pellet form of long-acting testosterone has nearly identical language dropping coverage from the same states.
There is no equivalent document covering the forms of estrogen used by trans women. However, seeing as the underlying rule they are referencing makes no distinction between trans men and trans women, it may be safe to assume that trans women will be denied estrogen in the same way that trans men are denied testosterone.
On the website for Superior Healthplan, Ambetter’s sister company in Texas, their policy guideline for gender affirming care was retired on May 14, with nothing to replace it. This is around the time that people started to report their care being denied by Ambetter plans across multiple states.
The Needle has not found any statements addressing this from Ambetter or its parent company Centene.
Loosening Restrictions on Anti-Trans Discrimination
In 2024, the Department of Health and Human Services implemented a ruling on anti-trans discrimination in medicine. This required insurers to cover the medicine of trans patients that is also available for cis patients.
The current court and administration have been working to undo this precedent. Last October, a federal court struck down that guidance, claiming that the HHS overstepped its authority by enforcing anti-discrimination guidance.
It was this ruling that has given Ambetter legal cover to act as they have done. They have not broken the law by refusing to give trans patients HRT, because access to HRT through private insurance is no longer considered a legal right.
The notice that this ruling exists was only published online on June 2, as this story was being written, despite existing and being in force since Oct. 2025.
According to Samantha Boucher of Trans Liberty PAC, only two things currently stop other insurers from following in Ambetter’s footsteps: “corporate pressure and state laws. Other carriers still cover gender affirming care because big employers still demand inclusive benefits, but that's voluntary and it's eroding.”
As for how to maintain protections, she says that “The only real protection left for trans Americans is state law, and only 24 states and DC have those in place. More states need to pass these protections now, because we can't rely on corporate goodwill to guarantee vital medical care for millions of people, and once the exclusions spread they'll be far harder to claw back.”
The list of states with any meaningful trans healthcare protections and the list of states where Ambetter will no longer cover trans medicine has no overlap. When Ambetter operates in states that protect trans medicine, they do not cut coverage.
Most of those state laws only apply to individual marketplace and fully-insured group plans - not ERISA plans, which are the self-funded employer plans. This means most big employer insurance could opt-out even in states where it is mandated on the Marketplace.
There are states that do dictate it as an EHB instead of just banning exclusions, these include California, Colorado, New Mexico, Vermont, and Washington.
If you support our coverage, consider subscribing to The Needle as a Platinum tier supporter, at $24 a month- you'll get access to all content AND credited as a supporter! For a limited time, you can get 60% off your first three months!
The Patients Denied Medicine
These changes are already affecting trans patients as they go to refill their hormones. Since at least April, people insured by Ambetter have been reporting that coverage for their HRT has been denied outright.
One source, a trans man in Kansas, shared documents showing his testosterone was denied because the requested service was not covered by his insurance. No further details were given by Ambetter. He was never told why this was being done, nor was he told what he could do to appeal the decision.
He is one of several trans people denied coverage who The Needle interviewed over the last several weeks. Nearly everyone we spoke to initially thought that their case was an isolated mistake rather than part of a broader pattern.
Those who called Ambetter’s customer insurance line for answers were given contradictory information. A recording of such a call by a trans man who had been denied testosterone showed a representative falsely claiming that testosterone would always be covered, and that the caller simply hadn't paid Ambetter enough money.
This isn't even true for cis men taking testosterone. Testosterone is a Schedule III controlled substance, meaning it can only be prescribed and covered under a narrow set of circumstances. That an insurance representative would falsely claim it would always be available likely indicates either that they are incompetent at their job, or that they are trying to hide something.
A separate source told The Needle that an Ambetter insurance representative told him that gender affirming care would no longer be covered for trans patients. This appears to be close to the truth.
From these varying experiences, it appears that Ambetter employees were not told about these changes in advance, and were not instructed on how to address their customers' concerns.
Additionally, various posts over the last few months show a pattern of random denials for transition medicine (including HRT) from people on Ambetter Insurance. The Needle was unable to individually verify these claims.
According to Lilliana Young, Chair of the Bloomington DSA Stonewall Working Group, this style of behavior isn’t entirely unexpected from insurers, but it is a notable escalation.
“Insurance companies have always been an enemy of the trans community, but Ambetter shows us what it looks like in its worst form: preemptively capitulating to Republican state governments rather than facing what would likely amount to nothing more than a slap on the wrist, as far as any kind of legislative or Attorneys General actions would go.”
For most trans people, HRT is how they stave off the effects of the wrong puberty or adult physical development. To deprive them of HRT is to forcibly detransition them.
For many others, they take HRT because their bodies no longer produce hormones internally. Cutting this care is forcing them to go without either sex hormone, which has massive negative health impacts, including osteoporosis.
Every document reviewed as part of this investigation was publicly available, with most of them being online for months. We weren't the first people to hear about it, but The Needle’s team were the first people to put this information together for the public.
If you want to support investigations like this, you can do so at whatever tier you’re able to do so at. We have member tiers ranging from $5 to $99 a month. All plans at Gold or above provide full access to all our content.
Make America ‘Healthy’ Again
Ambetter’s move to end transition coverage for trans people is not isolated. It comes at the same time that Ambetter’s parent company Centene is embracing Secretary Kennedy’s so-called “Make America Healthy Again” (MAHA) campaign.
On May 11, three Centene executives wrote an article in Health Affairs arguing that Medicare should prioritize covering healthier foods as preventative medicine, rather than prioritizing medicine as the primary means of care.
According to The Hill, this article had “leadership members of Centene call[ing] on the Centers for Medicare and Medicaid Services (CMS) [to] “remove unnecessary barriers” preventing Medicare Advantage plans from providing food as medicine benefits.”
This is in line with the policy of various Trump Administration agencies regarding healthy food as the ideal source of health, and medicine as a last resort. That a health insurance company is encouraging policies that deprioritize their traditional field of business, in favor of methods championed by the current government, shows that the two see eye to eye on questions of healthcare.
Secretary Kennedy, the primary champion of MAHA Medicine in the Trump Administration, has also been pushing to remove access to trans medicine. In December, he chaired the HHS press conference announcing that all public funding would be cut for hospitals that provided trans care to minors.
Kennedy views all medicine that people take for their whole lives as dangerous, and those who need them to live as dangers to themselves and others.
He believes that all chronic conditions can be cured with the right combination of healthy foods and ‘natural’ living. While he typically uses anti-depressants to make this point, the same principle also applies to HRT used by trans patients.
To ‘cure’ such people, he proposes sending people to forced labor camps that he euphemistically calls “wellness farms”. He also says that people convicted of drug offenses could be sent there as an alternative to prison.
Testosterone, the primary form of HRT used by trans men, is a controlled substance, and the unauthorized handling and usage of it can result in prosecution. Kennedy has also repeatedly used the HHS to create new regulations regarding who can legally be prescribed testosterone, making it harder to comply with the law.
If Kennedy had his way, those convicted under such laws could be sent to his proposed forced labor camps, where they would then be denied access to the medicine they need to live.
At the same time that trans men’s access to testosterone is being cut off, the Food and Drug Administration, which Kennedy oversees, proposed allowing testosterone to be given to cis men whose doctors deemed to have insufficiently low levels. Access is being widened for cis men, and at the same time, criminalized for trans men.
Ambetter’s parent company Centene has supported this administration with its money, donating $50,000 to Trump’s Inauguration Fund.
The Needle reached out to Centene, Ambetter, and Superior Health Plans. All three didn't respond to requests for comment.
Conclusion
The ease with which Ambetter has been able to shut off access to HRT shows how vulnerable many trans people are to losing the medicine they need to live.
Of the people Jane spoke to, those who stockpiled HRT were far more secure than those who did not. While those who had stockpiles were able to take their time and evaluate their options, those who did not were relocating to freer states.
Having HRT can mean the difference between security and being driven from your home.
If you can, it might be time to stockpile your HRT.