The short answer
CHAMPVA's regulation, 38 CFR 17.272, excludes several reproductive and sexual health services, including IVF and artificial insemination, sterilization reversal, most over-the-counter birth control, paternity and fetal-sex testing, sex therapy, gender dysphoria-related care, and abortion unless a physician certifies the mother's life is at risk. Many nearby services are covered.
Why this page exists
These rules are scattered across one long regulation, and some changed recently. This page lists them in one place, in plain language, so you can check before relying on coverage. It describes the rules. It doesn't take a position on them.
The rules are in 38 CFR 17.272. Some of the regulation's wording is older terminology.
What the regulation excludes
| Paragraph | What's excluded | Exceptions in the text |
|---|---|---|
| (a)(23) | Services and supplies related to gender dysphoria and similar conditions, including surgery and psychotherapy | Ambiguous genitalia documented at birth |
| (a)(24) | Sex therapy, sexual counseling, and supplies for treating sexual dysfunction | None |
| (a)(26) | Reversing a voluntary sterilization | None |
| (a)(27) | Artificial insemination, IVF, GIFT, and other noncoital reproductive technology | None |
| (a)(28) | Over-the-counter contraceptives | Emergency contraception |
| (a)(29) | Paternity tests and tests to learn a baby's sex | None |
| (a)(58) | Abortion | When a physician certifies the mother's life would be endangered if the pregnancy continued |
| (a)(72) | Penile implants and testicular prostheses for psychological impotence | Limited to that purpose |
| (a)(78) | Abortion counseling | None |
What changed in 2026?
A VA final rule published December 31, 2025, and effective January 30, 2026, revised the abortion rule and added the abortion counseling exclusion. The only remaining abortion exception is a physician's certification that the mother's life is endangered. The earlier exceptions for rape, incest, and the mother's health were removed.
The rule says the treating physician makes the certification. It also says the counseling exclusion doesn't block information needed for informed consent during covered care, and doesn't stop VA from providing mental health care.
VA's December 2025 implementation memo says the change doesn't prohibit care for miscarriage or ectopic pregnancy.
Why does the Guidebook say something different?
The CHAMPVA Guidebook VA links still has older abortion language that mentions rape and incest. That text predates the 2026 rule. For abortion and abortion counseling, the current regulation controls. The rest of the Guidebook is still useful for other topics.
What's still covered nearby?
- Prescription birth control, IUDs, implants, and emergency contraception, at no cost. More here: CHAMPVA birth control.
- Vasectomy and tubal ligation.
- Testing and treatment for the cause of infertility. More here: CHAMPVA infertility treatment.
- Medically necessary genetic testing and counseling.
- Prenatal care, delivery, postpartum care, and care for miscarriage and other complications. More here: CHAMPVA pregnancy coverage.
- Mental health care in general. The sex therapy exclusion is narrow. More here: CHAMPVA mental health coverage.
Before relying on coverage
- Name the exact service and its medical purpose.
- Find the paragraph that might apply.
- For abortion-related questions, use the current regulation, not the older Guidebook.
- If it's unclear, ask CHAMPVA at 800-733-8387 before treatment.