Idaho Gov. Little signed HB 345 barring Medicaid coverage of gender-affirming care for transgender residents

On March 19, 2025, Idaho Governor Brad Little signed House Bill 345, the Medicaid Reform and Cost Containment Act, into law, enacting it immediately as Session Law Chapter 118. While the bill primarily restructured Idaho's Medicaid program — moving it toward managed care and adding work requirements — it also contained a provision prohibiting the state Medicaid program from paying for gender-transition surgeries or hormone treatments for both minors and adults. The exclusion extended Idaho's existing prohibition on the use of public funds for gender-affirming care into the Medicaid context, denying transgender Idahoans coverage on the basis of gender identity.

HB 345 moved through the Idaho Legislature during the 2025 session under lead sponsor Rep. Jordan Redman of Coeur d'Alene, clearing the House 61-9 and the Senate 29-6 before reaching the governor's desk. The gender-affirming-care coverage exclusion built on Idaho's 2024 public-funding ban and functioned independently of the bill's broader managed-care and cost-containment measures. Because it took effect on signing, the coverage denial applied immediately to transgender Medicaid enrollees.

The measure was part of a wider set of Idaho laws enacted in 2025 that narrowed the legal and practical position of transgender residents. By writing the coverage denial into the state's Medicaid statute, the law placed medically recognized care out of reach for transgender enrollees of any age while leaving comparable care available to others, tying access to a public health benefit to gender identity.