Trans Resource Navigator

Gender-affirming care in North Carolina

Care for adults
Limited
Care for people under 18
Banned
NC Medicaid pays for hormones
Unclear
NC Medicaid pays for surgery
Not covered
Private plans must cover care
No state rule

Adults can legally get hormone therapy and surgery in North Carolina, but state money cannot pay for transition surgery at any age, the State Health Plan exclusion is back in force, and a 2025 law extends malpractice claims to 10 years. Puberty blockers, hormones, and surgery for anyone under 18 have been banned since August 2023, except for minors already in treatment on August 1, 2023. There is no shield law and no state insurance protection.

Draft from official sources, September 24, 2026. Not yet checked by a person. How we verify

On this page
  1. If you are under 18, or a parent
  2. Rules for adults
  3. Health centers near you
  4. Hormones by telehealth
  5. Clinics, programs, and funds
  6. Paying for care
  7. Laws and court cases
  8. Sources

If you are under 18, or a parent

Since August 16, 2023 (HB 808, S.L. 2023-111; G.S. 90-21.151), medical professionals may not perform surgical gender transition procedures on anyone under 18 or prescribe, provide, or dispense puberty blockers or cross-sex hormones to them. Exception: a minor whose course of treatment began before August 1, 2023 and was still active that day may continue if the provider finds it in the minor's best interest and the parents consent (G.S. 90-21.152(b)). Mental health care is not banned. Providers who violate the law face professional discipline and civil lawsuits. The federal challenge (Voe v. Mansfield) closed in June 2026, and the law remains in force.

Families can get navigation and travel grants to reach care in other states through the Campaign for Southern Equality's Trans Youth Emergency Project.

[1][2][14]

Rules for adults

No law bans care for adults. Hormone therapy is available from Planned Parenthood, community health centers, private practices, and telehealth services, many on an informed-consent basis. Restrictions that affect adults:

  • No state funds for surgery. G.S. 143C-6-5.6 bars State funds, directly or indirectly, from paying for surgical gender transition procedures. This affects Medicaid and other state-funded programs.
  • State Health Plan (teachers and state employees): the court order in Kadel v. Folwell that required coverage no longer applies (the case was dismissed with prejudice on June 22, 2026), and the statute's carve-out for the Plan expired November 14, 2025.
  • People in state prison or DAC custody cannot receive state-funded hormones or surgery (G.S. 143C-6-5.6(b1)).
  • Malpractice: HB 805 lets adults sue over transition care up to 10 years after discovering an injury and voids liability waivers (G.S. 90-21.175). Some providers may become more cautious.

If you have no insurance and little money:

  1. Go to a community health center (findahealthcenter.hrsa.gov); they charge on a sliding scale and many prescribe hormones.
  2. Check Charlotte Trans Health's provider list and Access to Care assistance, and the Trans in the South directory.
  3. Point of Pride's HRT Access Fund pays for telehealth hormone care (applications each May).
  4. Generic estradiol and spironolactone cost a few dollars to about $35 a month with discount coupons.
[3][4][5][6][7][15][12][13][16]

Community health centers near you

These federally funded centers must see you whether or not you have insurance, and charge based on income. Many, but not all, prescribe hormone therapy. Call and ask for "gender-affirming care" or "hormone therapy."

Sorting by distance uses your location only on this device. It is never sent anywhere.

Hormones by telehealth

These services prescribe hormones through video visits for people in this state. Point of Pride pays for a year and a half of care with several of them each spring.

  • Plume

    PaidNo Medicaid18+

    Trans-led telehealth service providing informed-consent hormone therapy, lab orders, prescriptions, and letters for surgery and documents, by app and video visit. Self-pay only since January 2026. A Point of Pride HRT Access Fund partner.

    About $99 per month ($90 in NY and NJ), which includes visits, messaging, prescriptions, and document letters. Labs and medications are billed separately and are often cheap with GoodRx or at a community pharmacy. Free for 18 months if you win a Point of Pride HRT Access Fund grant.

  • FOLX Health

    InsuranceTakes insuranceNo Medicaid18+

    LGBTQ-focused telehealth offering hormone therapy, PrEP, primary care, and mental health visits. Accepts major commercial insurance (Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare) but not Medicaid or Medicare. A Point of Pride HRT Access Fund partner.

    In-network with many commercial plans; self-pay membership about $69 to $98 per month all-inclusive.

  • Planned Parenthood

    Sliding scaleTakes insurance

    Many Planned Parenthood affiliates provide informed-consent gender-affirming hormone therapy alongside sexual and reproductive health care, on a sliding scale and with Medicaid. Most affiliates see adults 18 and older; a few see 16- and 17-year-olds with parental consent and a readiness letter. Many start hormone care by telehealth. Self-pay initial consults typically run about $120 to $250 before sliding-scale discounts.

Clinics, programs, and funds

Paying for care

Medicaid (NC Medicaid)[3][8][9]

G.S. 143C-6-5.6 bars State funds from paying for surgical gender transition procedures at any age and for puberty blockers or hormones for minors, so NC Medicaid does not cover transition surgery. The same statute does not bar hormone therapy for adults, but NC Medicaid's current written coverage policy for adult hormone therapy could not be confirmed; ask your Medicaid health plan or pharmacy before relying on coverage.

NC expanded Medicaid in December 2023, so many adults with low incomes qualify. Apply through ePASS or your county Department of Social Services.

Apply for coverage

Private insurance[8][10][18]

North Carolina has no state law barring private insurers from excluding gender-affirming care. Whether your plan covers it depends on the plan. If a plan denies care, appeal with the plan first; for state-regulated plans you can then ask the NC Department of Insurance's Health Insurance Smart NC program for help with appeals and external review. Self-funded employer plans are federally regulated; the Trans Health Project has appeal templates.

File an insurance complaint

The rules in detail

Laws and court cases1 court case, 3 laws

Kadel v. Folwell, No. 1:19-cv-00272 (M.D.N.C.)

No court order requires the State Health Plan to cover gender-affirming care. Under G.S. 143C-6-5.6, the Plan's carve-out expired November 14, 2025.[5][6][3]

Challenge to the State Health Plan's exclusion of gender-affirming care. The Fourth Circuit (en banc, 2024) upheld an injunction requiring coverage, but the Supreme Court vacated that decision in June 2025 after Skrmetti. On remand the case was stayed, and the parties dismissed it with prejudice on June 22, 2026. Last update 2026-06-22.

Sources

18 sources. Numbers in the text, like [1], point here.Show all
  1. G.S. 90-21.151, Limitations on gender transition proceduresNorth Carolina General Assembly, Law. accessed
    “It shall be unlawful for a medical professional to perform a surgical gender transition procedure on a minor or to prescribe, provide, or dispense puberty-blocking drugs or cross-sex hormones to a minor.”
  2. G.S. 90-21.152, When certain procedures are permittedNorth Carolina General Assembly, Law. accessed
    “The course of treatment commenced prior to August 1, 2023, and was still active as of that date.”
  3. G.S. 143C-6-5.6, Limitation on use of State funds for gender transition proceduresNorth Carolina General Assembly, Law. accessed
    “No State funds may be used, directly or indirectly, for the performance of or in furtherance of surgical gender transition procedures”
  4. HB 805 (2025), ratified, S.L. 2025-84North Carolina General Assembly, Law. accessed
    “Subsection (c) of G.S. 143C-6-5.6 expires 30 days after the Memorandum and Order, dated June 10, 2022, or the permanent injunction ordered therein in Kadel v. Folwell, 1:19CV272 is vacated, overturned, or is no longer in force.”
  5. Kadel v. Folwell, Stipulation for Voluntary Dismissal (Doc. 306, June 22, 2026)US District Court, M.D.N.C. (via CourtListener), Court. accessed
    “all parties hereby stipulate that this action be voluntarily dismissed with prejudice”
  6. Anderson v. Crouch, No. 22-1927 (4th Cir. Mar. 10, 2026)US Court of Appeals for the Fourth Circuit, Court. accessed
    “On remand from the Supreme Court, Kadel v. Folwell was remanded to the district court for further consideration in light of Skrmetti.”
  7. HB805 Anti-Trans Bill FAQACLU of North Carolina, Organization. accessed
    “there is no provision of the law that explicitly bans gender affirming care or requires health professionals to stop providing it.”
  8. North Carolina equality profileMovement Advancement Project, Organization. accessed
  9. NC MedicaidNC Department of Health and Human Services, Official page. accessed
  10. Health insurance consumer helpNC Department of Insurance, Official page. accessed
  11. Planned Parenthood South AtlanticOrganization. accessed
  12. Access To CareCharlotte Trans Health, Organization. accessed
  13. Trans in the South GuideCampaign for Southern Equality, Organization. accessed
  14. Trans Youth Emergency ProjectCampaign for Southern Equality, Organization. accessed
  15. Find a Health CenterHealth Resources and Services Administration, Official page. accessed
  16. Point of PrideOrganization. accessed
  17. GenderbandsOrganization. accessed
  18. Trans Health ProjectAdvocates for Trans Equality, Organization. accessed