The Office of Personnel Management (OPM) has issued new guidance that significantly restricts access to gender-affirming care under the Federal Employees Health Benefits (FEHB) and Postal Service Health Benefits (PSHB) programs. In Carrier Letter 2025-01b, released on August 15, OPM announced that beginning in Plan Year 2026, gender-affirming hormone therapy and surgical procedures will no longer be covered for enrollees of any age.
Counseling Remains Covered
While hormone therapy and surgical options are being removed from coverage, OPM clarified that counseling for possible or diagnosed gender dysphoria must continue to be included in all plans. Licensed mental health providers, including those with religious affiliations, are required to remain available within networks to provide this care.
For many transgender individuals and their families, this creates a stark divide: mental health services will still be supported, but the medical treatments that affirm gender identity and allow people to live authentically will not.
Exception Process for Ongoing Treatment
The new guidance does allow for limited exceptions. Federal employees, retirees, or their dependents who are already receiving hormone therapy or surgical treatment for gender dysphoria may request coverage to continue those services. Each request will be handled on a case-by-case basis, and carriers are required to include instructions in their brochures explaining how enrollees can apply for exceptions.
However, advocates note that exceptions place the burden on individuals at a time when stability and continuity of care are critical.
Part of a Broader Policy Shift
This update builds on OPM’s earlier Carrier Letter 2025-01a, issued in January, which excluded gender-affirming medical care for those under 19. Both letters stem from executive orders signed earlier this year, directing agencies to align with the administration’s position on what it calls “biological truth” and its prohibition on gender-affirming care for youth.
With the release of Carrier Letter 2025-01b, the restrictions now extend to all age groups, leaving only counseling as a guaranteed benefit.
Impact on Transgender Federal Workers and Families
For transgender federal employees and retirees, this decision represents more than just a policy change; it reshapes how and whether they can access essential healthcare. Gender-affirming medical care is widely recognized by leading medical associations, including the American Medical Association and the American Psychiatric Association, as safe, effective, and medically necessary. Removing access to it creates barriers that can have serious physical and emotional consequences.
Families and allies are likely to feel the impact as well. Parents supporting their transgender children, partners caring for loved ones, and communities working toward affirmation now face uncertainty about whether essential treatments will remain available or affordable.
The Bottom Line
The changes to FEHB and PSHB will take effect in 2026, but enrollees currently in care may qualify for exceptions. It remains critical for those affected to review plan brochures carefully and contact their carriers for guidance on transition-related services.
For many, this decision underscores the ongoing challenges facing the transgender community. While counseling remains covered, the removal of medical affirmation leaves federal workers and their families with fewer options and deepens the divide between recognized standards of care and the coverage available to those who serve the public every day.
