LANSING, Mich. (Michigan News Source) – New Medicaid reimbursement data obtained through a Michigan News Source Freedom of Information Act (FOIA) request shows that taxpayers have funded more than $13.8 million in gender-affirming services in Michigan since 2021 – a spending trend that has grown steadily each year despite mounting national debate on the issue.
According to the Michigan Department of Health & Human Services (MDHHS), Medicaid paid out:
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• 2021: $2,453,957 across 11,522 claims
• 2022: $3,406,171 across 16,009 claims
• 2023: $3,990,480 across 17,921 claims
• 2024: $3,974,595 across 17,801 claims
Behavioral health services make up the bulk of the claims, while gender-affirming surgeries – 335 in 2021, 511 in 2022, 700 in 2023, and 726 in 2024 – remain the least common but the most expensive.
Behavioral health is a broad label that covers therapy sessions, counseling, psychiatric care, and the mental-health evaluations required before starting hormones or undergoing surgery. It can also include crisis-intervention visits and care-coordination services. These appointments occur far more often than medical or surgical procedures, which is why behavioral-health claims dominate the state’s gender-affirming-care reimbursement data.
The county leaderboard: a four-year repeat front-runner.
Five counties dominate the provider-county totals every single year: Washtenaw, Wayne, Kent, Oakland, and Ingham. But one of them isn’t just leading – it’s lapping the field. Washtenaw County has the highest Medicaid transgender-related spending in all four years, significantly outranking every other Michigan county despite not always having the highest number of claims.
Why? Most likely because Ann Arbor is home to Michigan Medicine, the state’s premier provider of gender-affirming care. It performs a wide array of surgeries and attracts patients from across Michigan.
Even when Wayne and Kent counties dominate in raw claim volume – both topping 3,000 claims each in 2024 – the high-cost procedures and specialty services provided in Ann Arbor push Washtenaw to the top in total dollars every time with a total of $3.54 million spent in the county over four years.
Michigan’s Medicaid spending on trans care.
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As of today, Michigan’s Medicaid program (administered by MDHHS) explicitly covers medically necessary gender-affirming care for eligible beneficiaries diagnosed with gender dysphoria. Michigan is one of the 25 states (plus D.C.) with policies ensuring such coverage.
Coverage includes a range of services deemed medically necessary, such as hormone therapy, mental health counseling and psychotherapy, surgeries, puberty blockers and fertility preservation.
Meanwhile in Washington – a policy fight over transgender care.
A policy fight in Washington is unfolding just as Michigan’s Medicaid spending on transgender care surges. The Biden-era interpretation that gender-affirming care qualifies as an “essential health benefit” under Obamacare is set to end on January 1, following a new Trump Administration rule reversing that standard.
The Trump administration is also trying to tighten Medicaid rules on gender-affirming care with policy directives like Executive Order 14168, “Defending Women From Gender Ideology Extremism and Restoring Biological Truth to the Federal Government,” which defines sex biologically. Combined with a series of CMS administrative actions and proposed rules, the order sets the stage for potentially removing some transgender-related treatments from Medicaid’s reimbursable benefits, though those changes are still subject to legal and regulatory review.
With Michigan’s costs climbing, the state now sits at the crossroads of rising demand and a fast- changing federal landscape. What comes next will depend heavily on how aggressively federal regulators move to restrict coverage – and how Michigan chooses to respond.
