OPM Says FEHB Carriers Will Not Cover Gender-Affirming Care in 2026

In a recent letter, the U.S. Office of Personnel Management (OPM) has informed all federal employee health benefits (FEHB) carriers that the program would not cover gender-affirming care for adults in 2026.

“For Plan Year 2026, chemical and surgical modification of an individual’s sex traits through medical interventions (to include “gender transition” services) will no longer be covered under the FEHB or PSHB Programs,” wrote D. Shane Stevens, OPM’s associate director of healthcare and insurance. Stevens noted that this exclusion expands upon Carrier Letter 2025-01a and applies regardless of age.

As an exception, counseling services for possible or diagnosed gender dysphoria must still be covered, according to OPM. Covered counseling services “must be provided by a licensed mental health provider and may include those who provide faith-based counseling,” the letter read.

Carriers must establish an exceptions process for coverage of excluded services for enrollees who are mid-treatment within a surgical and/or hormonal regimen for diagnosed gender dysphoria, according to OPM, which says the exception process should be applied on a case-by-case basis.

Carriers must also provide details of their exceptions process in their brochures. Enrollees determined eligible for the exception must be notified through the Carrier’s usual notification process. The exclusion on hormone treatments only pertains to chemical and surgical modification of an individual’s sex traits (including as part of “gender transition” services), the letter noted.

With the new directive, provider directors “must not list or otherwise recognize providers for the purposes of providing chemical and surgical modification of an individual’s sex traits,” Stevens wrote, adding that agencies can consult with their health insurance specialists to “make appropriate adjustments” to their FEHB brochures.

LGBTQ+ advocates such as Lambda Legal have criticized the directive, with the organization’s Counsel and Healthcare Strategist Omar Gonzalez-Pagan saying it “tramples on the civil rights of hardworking transgender public servants.

“This discriminatory policy denying medical care to government employees and their dependents is not only cruel—it is illegal,” Gonzalez-Pagan said in a statement, adding that “multiple federal laws also prohibit this type of discrimination.”

Title VII of the Civil Rights Act, for instance, prohibits employment discrimination, including denying equal benefits to LGBTQ+ employees, Gonzalez said, adding that Section 1557 of the Affordable Care Act bars discrimination on the basis of sex in federally funded health programs.

“The federal government cannot simply ignore and violate these laws.”