Health Care | Transgender Health Care | New Hampshire

There are currently no laws restricting access to transition-related healthcare for transgender adults under New Hampshire state law.

In 2024, New Hampshire enacted RSA Chapter 332-M, which prohibits physicians from performing “gender genital reassignment surgery on minors in the state of New Hampshire.” In 2025, lawmakers introduced HB 377 and HB 712, which would also prohibit “breast surgeries” on transgender adolescents under the age of 18 and the prescribing and administration of puberty blockers and cross-sex hormones for transgender adolescents under the age of 18. It is likely that these harmful bills will become law.

It is important to understand that, as written, HB 377 and HB 712:

• Will not go into effect until January 1, 2026.
• Do not prohibit providers from continuing to prescribe or administer puberty blockers and cross-sex hormones to transgender adolescents under the age of 18 who have already begun care as of the January 1, 2026, effective date.
• Do not impose criminal liability for administering care.
• Do not prohibit providers from referring transgender adolescents under the age of 18 for care out-of-state.

If you believe that your care will be impacted, please contact us at NHMedicalCare@gladlaw.org

In general, under federal and New Hampshire state law, nearly all health plans cannot discriminate on the basis of sex, and, because the Supreme Court ruling in Bostock v. Clayton Co. concluded that all gender identity and sexual orientation discrimination is a form of sex discrimination, nearly all health plans cannot discriminate against LGBTQ+ people.

GLAD Law is currently challenging a New Hampshire employer’s decision to exclude transition-related healthcare from its self-funded employee health benefits plan on the basis of the business owner’s religious beliefs. Read more about that case.

New Hampshire Law

RSA 415:15 prohibits “discrimination on the basis of gender identity with respect to the availability of any covered services, medications, supplies, or durable medical equipment.” 

RSA 417:4, VIII(b) prohibits “discrimination on the basis of gender identity with respect to the availability of any covered services, medications, supplies, or durable medical equipment.”

The Patient’s Bill of Rights (RSA 151:21 XVI) protects the rights of patients admitted to hospitals in New Hampshire and states: 

“The patient shall not be denied appropriate care on the basis of age, sex, gender identity, sexual orientation, race, color, marital status, familial status, disability, religion, national origin, source of income, source of payment, or profession.” 

New Hampshire Insurance Department

Based on the above laws, in 2020 the New Hampshire Insurance Department issued a bulletin which stated in part: 

“. . .insurers are prohibited from denying, excluding, or otherwise limiting coverage for medically necessary services, based on an individual’s gender identity. Any offered services, medications, supplies, or durable medical equipment in a health insurance policy or contract must be provided to all individuals for whom a medical provider, in consultation with the individual patient, has determined that the services are medically necessary… Insurers should base coverage decisions on medical necessity rather than a person’s gender identity. The Department considers any blanket policy exclusions for health care services related to gender transition or any other form of gender dysphoria treatment as a violation of RSA 417:4, VIII(b) and RSA 415:15 in that such exclusions discriminate on the basis of gender identity.”

New Hampshire Medicaid

In 2017, the New Hampshire Department of Health and Human Services amended its rules to end the discriminatory exclusion from Medicaid coverage of gender-affirming surgeries.

New Hampshire Medicaid coverage includes the following gender-affirming services, providing there is documentation of medical necessity: 

• Mastectomy 
• Breast augmentation
• Hysterectomy 
• Salpingectomy
• Oophorectomy 
• Genital reconstructive surgery

Yes. Medicare and employer health plans that are self-funded (also known as self-insured) are governed by federal law.

GLAD Law is currently challenging a New Hampshire employer’s decision to exclude transition-related healthcare from its self-funded employee health benefits plan on the basis of the business owner’s religious beliefs. Read more about that case.

Medicare

In 2013, Medicare removed the ban on coverage for treatment of gender dysphoria because it was “experimental” and began to cover medically necessary treatment for gender dysphoria.

Section 1557 of the Affordable Care Act (ACA)

Section 1557 makes it unlawful for any health care provider that receives funding from the Federal government to refuse to treat an individual—or to otherwise discriminate against the individual—based on sex (as well as race, color, national origin, age or disability). Section 1557 imposes similar requirements on health insurance issuers that receive federal financial assistance. Health care providers and insurers are barred, among other things, from excluding or adversely treating an individual on any of these prohibited bases. The Section 1557 final rule applies to recipients of financial assistance from the Department of Health and Human Services (HHS), the Health Insurance Marketplaces and health programs administered by HHS.

Section 1557 generally does not apply to self-funded group health plans under ERISA or short-term limited duration plans because the entities offering the plans are typically not principally engaged in the business of providing health care, nor do they receive federal financial assistance.

Title VII

For employers with 15 or more employees, Title VII bans discrimination on the basis of race, color, religion, sex and national origin in hiring, firing, compensation, and other terms, conditions or privileges of employment. Employment terms and conditions include employer-sponsored healthcare benefits. The Supreme Court decision in Bostock v. Clayton Co. made it clear that sexual orientation and gender identity discrimination are forms of sex discrimination. Although the decision is about wrongful employment termination, it has implications for employer-sponsored health plans and other benefits.

There are some limited circumstances where religious employers are exempted from the requirements of Title VII. Typically, these exceptions are limited to those employees who truly perform religious duties (such as a priest or religious instructor) and do not allow employers to discriminate against an employee, such as a janitor at a religious school, who is only present in the building outside of school hours and is not responsible for transmitting the faith.

1. First check to see if your health plan provides coverage for the type of treatment that you want by getting a copy of the plan’s “Summary of Benefits and Coverage.”
2. Most insurance plans, both public and private, have detailed requirements that must be met in order to obtain coverage. This is particularly true if you are trying to obtain coverage for transition-related surgery. So, contact your health plan and request a copy of the requirements for the treatment you are seeking. 
3. Work with your therapists and doctors to make sure that you satisfy all the health plan’s requirements. Documentation from your therapists and doctors is the most critical factor in determining whether your treatment request will be approved. 
4. Check what treatment requires preapproval. In most cases, any surgery will require preapproval, and the plan may only pay if you use a surgeon that takes their plan. 
5. If your treatment request is denied, find out the reasons for the denial, and, if you still think that you qualify for the treatment, follow the plan’s appeal process. Usually there will first be an internal appeals process, and, if you are not successful there, you can sometimes appeal to an outside agency. Make sure that you adhere to the deadlines—failure to meet a deadline can automatically end your ability to appeal. 
6. Keep GLAD Law informed if you are denied treatment. GLAD Law may be able to offer suggestions that can help you win your appeal. You can contact GLAD Law Answers by filling out the form at GLAD Law Answers or by phone at 800-455-GLAD (4523). 
7. Although more health plans now cover treatment for gender dysphoria, the process for obtaining treatment, particularly for transition-related surgery, can be time consuming and frustrating. A great deal of documentation is required and finding a surgeon that does the type of surgery, and who is also acceptable to the health plan, can be difficult. 
8. Don’t be afraid to be persistent and to refile if you are denied. 

More and more surgeons who perform sex reassignment surgeries take health insurance. You should research surgeons carefully to find one who is a good fit for you. You can look at the list of in-network providers provided by your plan to see if they are included or if it includes any surgeons in your area, and if not, you can contact the surgeon’s office to determine if they accept your insurance. Most health insurance plans require that you use a medical provider in your network, but if your network does not include a surgeon who performs the services you need, you may be able to go out of network if you seek prior authorization from your plan.

If you are being discriminated against by a health care facility or provider, you can file a discrimination complaint with the New Hampshire Commission for Human Rights. See the “Discrimination” Issue Area for detailed information about how to do this.

If you have a health care plan that is regulated by the New Hampshire Department of Insurance, you can file a complaint with that agency: New Hampshire Insurance Department – Complaint Filing.

If you have a health care plan that is governed by Section 1557 of the ACA, you can file a complaint with the federal Department of Health and Human Services Office of Civil Rights. For more information, see: How to File a Civil Rights Complaint. 

If you have a self-funded health care plan through an employer with at least 15 employees, you can file a discrimination complaint with the federal Equal Employment Opportunity Commission (EEOC). For more information, see the “Discrimination” Issue Area.