Trans Resource Navigator

Gender-affirming care in North Dakota

Care for adults
Allowed
Care for people under 18
Banned
ND Medicaid pays for hormones
Covered
ND Medicaid pays for surgery
Covered
Private plans must cover care
No state rule

Adults (18 and older) can legally get hormone therapy and surgery in North Dakota, and ND Medicaid covers hormones and many surgeries. For anyone under 18, puberty blockers, hormones, and surgery for gender transition are a crime for providers; the North Dakota Supreme Court upheld the ban in September 2026. There is no shield law and no state protection against insurance exclusions.

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. Health centers near you
  3. Hormones by telehealth
  4. Clinics, programs, and funds
  5. Paying for care
  6. Rules for adults
  7. Laws and court cases
  8. Sources

If you are under 18, or a parent

Since April 21, 2023, N.D.C.C. chapter 12.1-36.1 (HB 1254) bars health care providers from giving anyone under 18 (including emancipated minors) the following to change or affirm their gender:

  • puberty blockers, or testosterone or estrogen at supraphysiologic doses (a class A misdemeanor for the provider);
  • surgeries including mastectomy, hysterectomy, vaginoplasty, phalloplasty, and others (a class B felony).

Exceptions: minors with a medically verifiable disorder of sex development, and treatment that began before April 21, 2023. Prosecutions can be brought up to three years after the offense or after it is reported.

Families challenged the law in state court (T.D. v. Wrigley). The district court upheld it in October 2025, and the North Dakota Supreme Court affirmed on September 17, 2026, so the ban is fully in effect.

Counseling and social transition are not banned. Families who seek medical care usually travel to Minnesota, which has a shield law, or other states. Minors can still change their name through a parent's petition (see the name change guide).

[1][2][3][4]

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.

  • 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

  • ND Medicaid[6][5]

    State Medicaid program; covers hormone therapy and many surgeries for adults under its gender-affirming care policy. Apply online or through your county human service zone.

    • Free

    Serves: Statewide

  • Planned Parenthood Moorhead Health Center (MN)[9]

    Across the river from Fargo. Lists gender-affirming care, STI testing, HIV services, and birth control; in-person and telehealth visits; fees based on income. Minimum age for hormones not confirmed.

    • Sliding scale
    • Telehealth
    218-236-7145803 Belsly Boulevard, Moorhead, MN 56560

  • Fargo Cass Public Health clinic[11]

    Public health clinic offering rapid HIV and hepatitis C testing, PrEP, and STI testing and treatment. Call 701-241-1383 for an appointment.

    • Sliding scale
    701-241-13831240 25th Street South, Fargo, ND 58103

  • Family HealthCare[12]

    Federally qualified health center in Fargo-Moorhead with a sliding fee scale and free interpreters. Its website does not mention gender-affirming care; ask whether a provider prescribes hormones.

    • Sliding scale
    • Sees uninsured patients
    701-271-3344301 NP Avenue, Fargo, ND 58102

  • Point of Pride[13]

    National nonprofit with an HRT Access Fund and other funds for trans people who cannot afford care.

    • Free

  • Genderbands[14]

    National nonprofit that offers grants toward gender-affirming surgery and other transition costs.

    • Free

  • Trans Health Project (A4TE)[15]

    Advocates for Trans Equality program that helps people appeal insurance denials for gender-affirming care.

    • Free

  • HRSA Find a Health Center[16]

    Federal search tool for community health centers that charge on a sliding scale, including in rural North Dakota.

    • Free

Paying for care

Medicaid (ND Medicaid)[5][6]

ND Medicaid's Gender Affirming Care and Services policy (updated July 2026) covers medically necessary care for members with a diagnosis of gender dysphoria who give informed consent. Hormone therapy is covered, with behavioral health counseling required for the first 12 months. Surgery requires age 18+, 12 continuous months living in your gender and on hormones (unless contraindicated), a recent behavioral health evaluation, and prior authorization; covered procedures include mastectomy, hysterectomy, orchiectomy, vaginoplasty, phalloplasty, and others (breast augmentation after 24 months of hormones). Facial feminization, tracheal shave, most hair removal, and fertility preservation are not covered. Care for minors is limited by the state criminal ban regardless of this policy.

Apply for coverage

Private insurance[7][8]

North Dakota has no state law barring private health plans from excluding gender-affirming care. Check your plan's exclusions list. If a claim is denied, you can appeal with the plan and file a complaint with the North Dakota Insurance Department; the Trans Health Project can help with appeals.

File an insurance complaint

The rules in detail

Rules for adultsNorth Dakota law does not restrict gender-affirming care for adults 18 and older.

North Dakota law does not restrict gender-affirming care for adults 18 and older.

If you have little money, in rough order of what to try:

  1. Apply for ND Medicaid. It covers medically necessary gender-affirming care with a diagnosis of gender dysphoria, including hormone therapy, and many surgeries for people 18 and older with prior authorization. Its policy requires behavioral health counseling during your first 12 months on hormones.
  2. Go to a community health center (FQHC) such as Family HealthCare in Fargo. They charge on a sliding scale; ask whether a provider there prescribes hormones.
  3. Planned Parenthood North Central States lists gender-affirming care at its Moorhead, Minnesota health center, just across the river from Fargo. There are no Planned Parenthood health centers in North Dakota.
  4. Telehealth: Plume serves North Dakota. Point of Pride's HRT Access Fund pays for telehealth hormone care for some applicants each year.
[5][9][10][12]
Laws and court cases1 court case, 1 law

T.D. v. Wrigley

The ban on puberty blockers, hormones, and surgery for minors is fully in effect.[4][3]

A pediatric endocrinologist and families challenged HB 1254 under the North Dakota Constitution. After trial, the district court upheld the law on October 8, 2025. The North Dakota Supreme Court affirmed on September 17, 2026. Last update 2026-09-17.

Sources

16 sources. Numbers in the text, like [1], point here.Show all
  1. N.D.C.C. ch. 12.1-36.1, Minor Sex Change TreatmentNorth Dakota Legislative Branch, Law. accessed
    “If performance or administration of the medical procedure on the minor began before April 21, 2023.”
  2. HB 1254 (2023), prohibition of certain practices against a minorNorth Dakota Legislative Branch, Law. accessed
    “Current Status Governor signed Last Official Action Filed with Secretary Of State 04/21”
  3. Judge upholds North Dakota's ban on trans health care for teens (Oct. 9, 2025)Gender Justice, Organization. accessed
  4. North Dakota Supreme Court upholds ban on gender-affirming health care for trans young people (Sept. 17, 2026)Gender Justice, Organization. accessed
    “Today, the North Dakota Supreme Court upheld the district court's ruling in T.D. v. Wrigley”
  5. ND Medicaid Billing and Policy Manual: Gender Affirming Care and Services (updated July 2026)North Dakota Health and Human Services, Official page. accessed
    “ND Medicaid covers medically necessary gender affirming care and services provided to members with a qualifying diagnosis.”
  6. Apply for MedicaidNorth Dakota Health and Human Services, Official page. accessed
  7. North Dakota equality profileMovement Advancement Project, Organization. accessed
  8. File a ComplaintNorth Dakota Insurance Department, Official page. accessed
  9. Moorhead Health CenterPlanned Parenthood North Central States, Organization. accessed
  10. Planned Parenthood health centers in North DakotaPlanned Parenthood, Organization. accessed
  11. Fargo Cass Public Health Clinic ServicesCity of Fargo, Official page. accessed
    “Rapid HIV and Hepatitis C Testing-results available in 20 minutes PrEP Sexually Transmitted Infection counseling, testing and treatment”
  12. Family HealthCareOrganization. accessed
  13. Point of PrideOrganization. accessed
  14. GenderbandsOrganization. accessed
  15. Trans Health ProjectAdvocates for Trans Equality, Organization. accessed
  16. Find a Health CenterHealth Resources and Services Administration, Official page. accessed