When determining coverage of treatment and surgery for members with gender dysphoria, SCFHP uses nationally recognized medical and clinical guidelines, and considers the knowledge and expertise of providers qualified to treat gender dysphoria.
In the treatment for gender dysphoria, the core services are:
- Mental health services;
- Hormone therapy; and
- Surgical procedures and treatments that bring primary and secondary gender characteristics into conformity with the individual’s identified gender.
Use the Prior Authorization Request Form to propose a treatment plan for your patients with gender dysphoria.
Learn more about coverage determination for members with gender dysphoria in the Department of Health Care Services (DHCS) All Plan Letter 20-018.