This bill amends existing law (RCW 74.09.675) to change how gender-affirming treatment is handled in programs purchased or contracted for by "the authority" and by managed care plans. It prohibits discrimination in delivery of gender-affirming care based on gender identity or expression and, beginning January 1, 2022, bars the authority and managed care plans from using categorical cosmetic or blanket exclusions for gender-affirming treatment. The text defines "gender-affirming treatment" as a provider-prescribed service or product to support and affirm an individual's gender identity and expressly lists examples such as facial gender-affirming procedures and chest/breast procedures when prescribed as gender-affirming treatment. The bill makes procedural and coverage changes: an adverse benefit determination that denies or limits access to gender-affirming treatment may not be issued unless a health care provider experienced in prescribing or delivering gender-affirming treatment has reviewed and confirmed the appropriateness of that determination. If an authority or managed care plan lacks an adequate network, it must ensure timely and geographically accessible medically necessary gender-affirming treatment, including arranging out-of-network options and case management, and must ensure enrollees do not pay more cost sharing than they would for in-network providers. The authority is also required to adopt any rules necessary to implement these provisions. The bill also creates a coverage limitation for minors by prohibiting the authority from purchasing or contracting for certain services for individuals under 18, even if diagnosed with gender dysphoria: breast augmentation procedures (including reductions and implants), sex reassignment or confirmation surgery, puberty suppression therapy, and hormone therapy (including presurgical and postsurgical hormone therapy). The section states it does not require coverage of services that are not medically necessary. The text repeatedly refers to "the authority" and "programs under this chapter" without defining which agency or chapter is meant; no overall effective date for the bill is provided in the extracted facts. The bill is Senate Bill 6191 (S-3842.1), was read for the first time 01/16/26, and was referred to the Senate Committee on Health & Long-Term Care.

If enacted, the law would make programs run by "the authority" and their managed care plans stop using blanket cosmetic exclusions for gender-affirming care and require timely, geographically accessible, medically necessary gender-affirming treatments for covered people without higher cost-sharing when plans lack an adequate network. Managed care plans and the authority would need to arrange and pay for out-of-network options and provide case management so enrollees can access care, and any denial or limitation of gender-affirming treatment would have to be reviewed and confirmed by a provider experienced in such care. Practically, adult enrollees who are two-spirit, transgender, nonbinary, or gender diverse are likely to face fewer arbitrary denials and lower out-of-pocket barriers, while plans and the authority will face higher administrative responsibilities and potentially greater costs to secure out-of-network providers and specialist reviews. At the same time, the authority would be barred from purchasing or contracting for several gender-related services for people under 18 (including breast augmentation or reduction, sex reassignment surgery, puberty suppression, and hormone therapy), so minors would effectively lose access to those services through these programs. The text does not specify which agency "the authority" is, whether other parts of the bill change coverage more broadly, or provide an overall effective date beyond the January 1, 2022 applicability noted for some provisions, so how and when these changes would be implemented is unclear.