Access to Gender-Affirming Care and Transgender Mental Health : Evidence from Medicaid Coverage

Using variation in the coverage of gender-affirming care under Medicaid, we pro- vide the first evidence of increasing access to gender-affirming care on the mental health of transgender people. We use data from the 2014-2020 Behavioral Risk Factors Surveillance Systems paired with a triple-difference design that leverages state-level differences in timing and availability of Medicaid coverage for gender-affirming care and income-based Medicaid eligibility thresholds. Results demonstrate that Medicaid cover- age of gender-affirming care meaningfully improves the mental health of transgender people. We also provide suggestive evidence that this is driven by increased uptake of gender-affirming care