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. concluiu que toda discriminação de identidade de gênero e orientação sexual é uma forma de discriminação sexual; quase todos os planos de saúde não podem discriminar pessoas LGBTQ+.

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

Sim. O Medicare e os planos de saúde do empregador que são autofinanciados (também conhecidos como auto-assegurados) são regidos pela lei federal.

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

Em 2013, o Medicare removeu a proibição de cobertura para tratamento de disforia de gênero porque era "experimental" e começou a cobrir tratamento clinicamente necessário para disforia de gênero.

Seção 1557 da Lei de Assistência Médica Acessível (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.

A Seção 1557 geralmente não se aplica a planos de saúde coletivos autofinanciados sob ERISA ou planos de duração limitada de curto prazo porque as entidades que oferecem os planos normalmente não estão envolvidas principalmente no negócio de fornecer assistência médica, nem recebem assistência financeira federal.

Título 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. A maioria dos planos de saúde, tanto públicos quanto privados, possui requisitos detalhados que devem ser atendidos para obter cobertura. Isso é particularmente verdadeiro se você estiver tentando obter cobertura para uma cirurgia relacionada à transição. Portanto, entre em contato com seu plano de saúde e solicite uma cópia dos requisitos para o tratamento que você está buscando. 
3. Trabalhe com seus terapeutas e médicos para garantir que você atenda a todos os requisitos do plano de saúde. A documentação dos seus terapeutas e médicos é o fator mais crítico para determinar se sua solicitação de tratamento será aprovada. 
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. Se o seu pedido de tratamento for negado, descubra os motivos da recusa e, se ainda achar que se qualifica para o tratamento, siga o processo de apelação do plano. Normalmente, haverá primeiro um processo interno de apelação e, se você não for bem-sucedido, às vezes poderá recorrer a uma agência externa. Certifique-se de cumprir os prazos — o não cumprimento de um prazo pode encerrar automaticamente sua possibilidade de recorrer. 
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 Respostas da Lei GLAD ou por telefone em 800-455-GLAD (4523). 
7. Embora mais planos de saúde agora cubram o tratamento para disforia de gênero, o processo de obtenção de tratamento, especialmente para cirurgias relacionadas à transição, pode ser demorado e frustrante. É necessária muita documentação, e encontrar um cirurgião que realize o tipo de cirurgia e que também seja aceito pelo plano de saúde pode ser difícil. 
8. Não tenha medo de ser persistente e de reapresentar o pedido caso ele seja negado. 

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 “Discriminação” 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.

Se você possui um plano de saúde regido pela Seção 1557 da ACA, pode registrar uma reclamação junto ao Escritório de Direitos Civis do Departamento de Saúde e Serviços Humanos do governo federal. Para mais informações, consulte: Como registrar uma queixa de direitos civis. 

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 “Discriminação” Issue Area.