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Available Now: Gender-Affirming Care Self-Identification Provider Form

June 21, 2022

In September 2021, MassHealth launched its Gender-Affirming Care for MassHealth Members web page, providing information and resources about MassHealth coverage for gender-affirming care and other resources about health care for transgender and gender-diverse members.

Furthering this initiative, and through the Gender-Affirming Care Provider Self-Identification form that follows, MassHealth is collecting information from MassHealth providers who want to self-identify as providers of gender-affirming care. This form is intended to capture self-reported provider information for the purpose of informing MassHealth members of self-identified gender-affirming care providers participating in the MassHealth program, and the services they provide. Using the information collected, MassHealth may create a publicly available MassHealth gender-affirming care provider directory on our gender-affirming-care web page at

If you are an active MassHealth provider who provides gender-affirming care and would like to self-identify as a provider of gender-affirming care, please fill out the form at

Please note that this information is self-reported only. MassHealth reserves the right to verify any information submitted, but assumes no obligation to do so. Any providers completing this form must report to MassHealth any changes to their status as self-reported providers of specified gender-affirming care (e.g., change of address, new services offered, etc.).

For more information about gender-affirming surgeries and hair removal as a treatment for gender dysphoria, see MassHealth’s Guidelines for Medical Necessity Determination for Gender-Affirming Surgery and Guidelines for Medical Necessity Determination for Hair Removal, found at

If possible, it would be helpful to receive a response within 90 days, by September 20, 2022, although providers may complete the form at any time.

If you have questions about this form, email with the subject line, “gender-affirming care provider form."