More state Medicaid programs cover menopause, but progress is slow

When states pass menopause insurance mandates, the headlines usually focus on private health plans. But roughly one in five American women between 50 and 64 rely on Medicaid, and until recently, most state Medicaid programs had no explicit obligation to cover menopause treatment.  

A small but growing number of states are now changing that.

Louisiana, Illinois, and New Jersey have written menopause coverage into their Medicaid programs alongside their private insurance mandates, making them the first states to treat menopause as a Medicaid issue as well as an insurance one. In addition, New Mexico’s Medicaid program, called Turquoise Care, covers varied medical services for menopause care, including hormonal and non-hormonal therapies.

For a woman in one of these states, the practical impact is meaningful. A covered hormone prescription means not having to choose between medication and other household expenses. It means a provider can prescribe the clinically appropriate treatment rather than working around a formulary. It means not being sent away with a denial letter and told to try a cheaper drug for months before the prescribed one will be considered.

Why It Matters

Medicaid covers nearly one in five American women between the ages of 50 and 64, when perimenopause and menopause are most likely to occur. That is a substantial population, and it skews heavily toward women who already face compounding barriers to care: lower incomes, fewer providers who accept Medicaid, and less flexibility to take time off work for medical appointments.

For these women, the out-of-pocket cost of hormone therapy — which runs $500 to $1,000 a year without coverage — is not just an inconvenience, it is unaffordable.

The equity dimension compounds the urgency. More than 60 percent of Medicaid beneficiaries identify as Black, Hispanic, Asian American, or another non-white race or ethnicity. These are also the populations that research consistently shows experience menopause earlier, more severely, and with less access to treatment. A 2022 study of more than 200,000 women found that Black and Hispanic women were 26% and 32 % percent less likely, respectively, to be prescribed hormone therapy compared to white women.

At age 65, women on Medicaid transition to Medicare, the federal health insurance program for Americans after age 64. Importantly, there is no federal Medicare standard requiring hormone therapy coverage, just as there is no federal Medicaid standard.

Medicare is confusing in the best of times, but navigating menopause coverage involves understanding how the different parts of Medicare apply to specific treatments: Original Medicare (Parts A and B) does not cover hormone therapy prescriptions taken at home, since these are self-administered medications rather than clinical procedures. Part B does cover office visits, lab work, and hormone-level testing related to menopause care. For prescription coverage, women must purchase and enroll in a private Medicare Part D drug plan or a Medicare Advantage plan that includes drug benefits. Even then, whether a specific hormone therapy is covered depends on that plan’s individual formulary.

Medicare Advantage plans (similar to HMOs) often provide broader coverage than original Medicare, but the variation across plans is significant and the responsibility for navigating it falls entirely on the patient.

Background

Medicaid is a joint federal-state program: The federal government sets minimum requirements, states decide what to add. Menopause care has never been a federal Medicaid requirement, which left it entirely to state discretion. For decades, most states said nothing about it at all. The result was a patchwork even messier than the one that existed for private insurance.

A woman on Medicaid in one state might find her hormone prescription covered without issue. The same woman in a neighboring state might be denied, told to try a cheaper drug first, or simply unable to find a Medicaid-accepting provider knowledgeable about menopause. Physicians in Louisiana reported exactly this problem before their state’s 2024 law: they could not get hormone replacement therapy covered by Medicaid for patients who needed it. Estrogen and progesterone prescriptions were among the most commonly rejected.

States That Have Acted

Louisiana was the first state to explicitly mandate Medicaid coverage for menopause care as part of its 2024 insurance law. The law directed the Louisiana Department of Health to make coverage available for women experiencing menopausal or perimenopausal symptoms.

Notably, the initial version of the bill was drafted specifically because Medicaid coverage was failing: the doctor who prompted the legislation had been unable to get hormone prescriptions approved for her Medicaid patients. The law banned prior authorization and step therapy requirements for hormone therapy under private insurance, but similar administrative barriers in Medicaid remain subject to federal waiver rules.

Illinois took a parallel approach through House Bill 5295, effective Jan. 1, 2026. Alongside its mandate for private insurers, the law added a new section to the Illinois Public Aid Code requiring the state Medicaid program to cover hormone therapy for women with menopause induced by a hysterectomy. This is a narrower Medicaid provision than Louisiana’s, but it establishes the principle that Medicaid has an obligation in this space, and lays groundwork for future expansion. Rep. Lilian Jimenez, who co-sponsored the bill, framed the Medicaid component explicitly as an equity measure: "By expanding coverage, it allows women to have equitable access, including Black and Brown women. Nearly half do not have access to private insurance. So this lifts all women."

New Jersey’s Menopause Coverage Act, signed in January 2026, extends the state’s comprehensive menopause coverage mandate to NJ FamilyCare, the state’s Medicaid and Children’s Health Insurance Program (CHIP) program. That means the full range of covered services—hormonal and non-hormonal therapies, pelvic floor physical therapy, bone health screenings, and behavioral health care—applies to low-income women enrolled in public coverage, not just those with private insurance.

New Mexico does not offer a standalone Medicaid menopause program per se, but covers medical services for menopause care based on medically necessity through the state’s managed care organizations. Coverage is provided on a case-by-case basis to manage specific, recognized symptoms or health risks associated with the menopause transition.

Difficulties Remain

The limits in Medicaid coverage in general are impactful.  States cannot unilaterally override federal Medicaid rules — some changes require federal waivers, which take time and may not be approved. Medicaid managed care plans, which cover most beneficiaries, have their own formularies and prior authorization processes that may not align with a new state mandate automatically.

And a coverage mandate does nothing about the provider access problem: a woman who cannot find a menopause-literate physician who accepts her plan gets little benefit from a law that says her plan must cover the visit.

For states that have not acted on Medicaid menopause coverage, the default remains what it has always been: discretionary, inconsistent, and largely invisible. The women most affected by that default are the ones with the fewest alternatives.

Related WRDI Reporting

From whispered complaint to public priority: Menopause is finally a policy issue (June 26)
How five states are creating insurance models for menopause treatment (June 26)

Resources

Georgetown Center for Children and Families - Women Depend on Medicaid Across the Lifespan
McDermott Will & Emery - New Illinois Law Provides Coverage for HRT for Menopause
NJ Governor’s Office - Governor Murphy Signs the New Jersey Menopause Coverage Act
Women’s Media Center - Menopause Is Finally Getting Attention From Lawmakers
Healthline - What to Know About Racial Disparities in Menopause
The Flow Space - State-by-State Guide to Menopause Insurance Options
News From The States - Menopause Coverage Bills Meet Mixed Fates