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All Californians deserve to be able to put food on the table, pay the rent, and meet their basic needs. In short, no Californian should ever live in poverty.

Our state should aspire to be a place where no child or adult struggles to afford their basic needs, and there’s proof that it can be a reality. Recent data released by the US Census Bureau show that poverty — especially for children — significantly dropped nationally and in California in 2021, and would have been much higher if not for public supports.

That’s good news that may be unexpected as the effects of the pandemic and inflation are still very real for California children, adults, and families struggling to make ends meet. So many may be wondering: How did poverty rates drop across the US and California? And amid the pandemic no less.

The answer is simple: Poverty is a policy choice. When we choose to provide the basic support families and individuals need to thrive — as policymakers did via tax credits and other support — it really works.

What is the Supplemental Poverty Measure? And why is it important?

Public policies work best when they are crafted with reliable data and provide positive and measurable results at both the macro level and personal level for our communities.

To measure poverty in California and the success of poverty reduction strategies, we rely on data from the US Census Bureau which routinely surveys households across the country. Each September the Census releases new data that show what share of the population experienced poverty in the prior year — under the official poverty measure and the Supplemental Poverty Measure — for California and states across the country, as well as the United States as a whole.

The Supplemental Poverty Measure (SPM) is vital because it provides a more accurate picture of poverty by accounting for local differences in the cost of housing and accounting for expenses that families must pay like health care and child care. The SPM also accounts for a wide variety of safety net supports, including those that are not direct cash payments — including tax credits, food assistance, and housing subsidies. The official poverty measure does not adjust for differences in the costs of living and ignores non-cash benefits. This makes the official poverty measure less useful to evaluate poverty in California as well as the effectiveness of poverty reduction measures.

Bottom line: The SPM captures how much it costs to pay for basic needs and the resources people have available to pay for them.

Want to learn more about poverty measures?

Check out the Budget Center’s guide to understanding poverty measures in California.

Poverty dropped from 2020 to 2021 nationally and in California — what’s behind the drop in poverty, especially for kids?

Multiple factors likely contributed to the drop in poverty year over year, including the improving job market. Data show too that strong public policies played an especially key role in the low poverty rates seen in 2021. To combat the uncertainties of the pandemic and our economy, state and federal governments provided additional support directly to people, and this made the difference for many families in having the resources to pay for food, housing, diapers, and other basic necessities.

Refundable tax credits were especially effective in boosting family resources in 2021, particularly because of temporary expansions of federal credits last year. Without these credits, overall poverty would have been significantly higher in 2021.

Unfortunately, the temporary expansion to the federal Child Tax Credit that lifted nearly 3 million children out of poverty nationally last year has now expired due to Congress’ failure to permanently expand the credit. The temporary expansion of the federal Earned Income Tax Credit (EITC) for workers without dependent children has also expired. But the evidence is clear — federal policymakers can significantly lower poverty by permanently expanding the Child Tax Credit and the EITC and state policymakers can build on the success of California’s refundable tax credits, the CalEITC and Young Child Tax Credit.

How did housing costs affect California’s poverty rate?

There is no question safe, stable housing is the foundation to families’ basic needs being met, yet the cost of housing is a challenge in many parts of the state — and high housing costs directly affect California’s SPM poverty rate.

California’s poverty rate in 2021 was higher under the Supplemental Poverty Measure than under the official poverty measure — and this has been true in every year that SPM poverty data have been available, going back more than 10 years. This is mainly because, as previously noted, the SPM accounts for local differences in housing costs, so that families need more resources to be categorized as above the SPM poverty threshold (and not experiencing poverty) in places where housing is expensive, which include many parts of California. These data point to another way policymakers can effectively reduce poverty — by addressing California’s housing affordability challenges, through boosting the supply of affordable housing, protecting tenants, and providing direct support to help people afford housing costs.

Why does it matter for everyday Californians that the poverty rate dropped?

The lower 2021 poverty rate shows that our economy and safety net can work better for everyday Californians when good policy and investment come together to help people meet their basic needs. It reveals how many people can meet basic expenses like housing, food, child care, and other necessities — and it also reveals where our public policies are sorely failing.

A lower poverty rate under the Supplemental Poverty Measure means fewer families worrying about where their next meal comes from or wondering if they can keep the lights on. And while the encouraging Census data does not diminish the fact that the high cost of housing and recent high inflation have made it even more difficult for families to flourish in California communities, it does help us understand how we can build on public policies that work to help families now and in the future.

Poverty data from 2021 show that when increased state and federal support was provided, more people were able to count on having enough resources to make ends meet.

What were the primary forms of assistance people received to help meet their basic needs?

Safety net programs that help people pay for food, health care, housing, child care, and other basic needs are essential to the well-being of our people and state.

Current safety net programs — including those used to successfully lower poverty rates in 2021 — are a combination of state and federal supports aimed at helping individuals and families pay for basic needs. These programs can be divided into three categories including cash supports, tax credits, and non-cash benefits.

  • Cash support through tax credits: Federal Child Tax Credit and EITC, state CalEITC and Young Child Tax Credit, as well as child and dependent care tax credits and pandemic stimulus payments.
  • Other cash supports: Social Security, TANF (known as CalWORKs in California), Supplemental Security Income/State Supplementary Payment (SSI/SSP), Unemployment Insurance.
  • Non-cash benefits: SNAP food assistance (known as CalFresh in California), Supplemental Nutrition Program for Women, Infants, and Children (WIC), school meals, energy assistance, and housing subsidies like federal Housing Choice Vouchers.

Together, these programs significantly reduced poverty, particularly child poverty, in California in 2021.

Additional programs that help reduce the out-of-pocket costs people must pay for necessary expenses — particularly Medi-Cal health coverage and subsidized child care — also reduced the number of Californians experiencing poverty last year.

It’s important to remember that each program has unique and sometimes burdensome processes to receive assistance. Moving forward, policymakers should streamline and strengthen existing programs in order to further reduce poverty every year.

What can policymakers learn from the latest poverty data?

First and foremost, the latest Census data show us that poverty is a policy choice — we can choose to provide support needed so that families and individuals can thrive.

Federal and state governments have effective tools — like refundable tax credits — for getting cash to people and rapidly reducing poverty. When we prioritize the health and well-being of everyday people regardless of their race, age, or immigration status the result will be a country where far fewer people experience poverty and its devastating consequences.

State and federal policymakers should boost investment in the policies and tools we know are effective in helping families and individuals meet their basic needs to end poverty in California and across the country.

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Every year, California’s 58 counties adopt local budgets that provide a framework and funding for critical public services and systems — from health care and safety net services to elections and the justice system.

But county budgets are about more than dollars and cents.

A county budget expresses our values and priorities as residents of that county and as Californians. At its best, a county budget should reflect our collective efforts to expand opportunities, promote well-being, and improve the lives of Californians who are denied the chance to share in our state’s wealth and who deserve the dignity and support to lead thriving lives.

Because county budgets touch so many services and our everyday lives, it is critical for Californians to understand and participate in the annual county budget process.

Because county budgets touch so many services and our everyday lives, it is critical for Californians to understand and participate in the annual county budget process to ensure that county leaders are making the strategic choices needed to allow every Californian — from different races, backgrounds, and places — to thrive and share in our state’s economic and social life.

This guide sheds light on county budgets and the county budget process with the goal of giving Californians the tools they need to effectively engage local decision makers and advocate for fair and just policy choices.

Key Takeaways

State Budget Terms Defined

What’s the difference between a trailer bill and a policy bill? A surplus and an operating surplus? Special funds and the General Fund? And what exactly is a “Budget Bill Jr.”? Our Glossary of State Budget Terms answers that and more.

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As we begin the 2022-23 fiscal year, state leaders have reached a “nearly final” California state budget agreement, though some details still remain to be finalized and additional budget-related bills will be acted upon in August and beyond. According to legislative summaries, the budget framework includes approximately $235 billion in General Fund spending for 2022-23, a significant increase over the 2021-22 General Fund budget of $196 billion. The agreement assumes a total reserve balance of more than $37 billion across the state’s four budget reserves: the Budget Stabilization Account, the Public School System Stabilization Account, the Special Fund for Economic Uncertainties, and the Safety Net Reserve. The framework contains actions to prevent the budget from exceeding the state’s constitutional spending cap (the “Gann Limit”) over the two-year period that ends June 30, 2022 and for the 2022-23 fiscal year.

This report highlights selected elements of the budget framework that represent significant advancements to improve the lives of Californians with low and middle incomes — including women, immigrants, and American Indian, Asian, Black, Latinx, and Pacific Islander Californians and other Californians of color. We also highlight areas where the budget framework misses opportunities and there is work still to be done by policymakers to ensure that all Californians are able to not only survive but thrive in their communities.


What’s included in the 2022-23 California state budget: The budget agreement provides one-time payments, tiered by income level, for Californians who filed a tax return for 2020. Filers will receive the following rebate amounts for themselves, their spouse if filing jointly, and up to one dependent.

  • $350 for filers with incomes below $75,000 ($150,000 for joint filers); 
  • $250 for filers with incomes between $75,000 and $125,000 ($150,000 – $250,000 for joint filers);
  • $200 for filers with incomes between $125,000 and $250,000 ($250,000 – $500,000 for joint filers).

Relative to earlier rebate proposals from the governor and legislators, the agreement would provide more support to small families with low incomes, but less support to larger families with low incomes.

State leaders can further support Californians by: expanding ongoing supports — such as the CalEITC, Young Child Tax Credit, and CalWORKs — for households with low incomes who have long struggled to afford their basic needs to help them achieve lasting economic security.

Tax Credits

What’s included in the 2022-23 California state budget: California families without work earnings who have children under age 6 will now qualify for the $1,000 Young Child Tax Credit (YCTC), and the YCTC will be adjusted annually for inflation so it keeps up with rising prices. In addition, former foster youth ages 18 to 25 who qualify for the CalEITC will be eligible for a new $1,000 Foster Youth Tax Credit modeled after the YCTC. Also, beginning on or after tax year 2024, the controller will no longer be permitted to intercept tax refunds for debt payments of Californians who receive the CalEITC or YCTC, with the exception of debt related to child or family support. This will ensure that more Californians receive the full tax refunds they are counting on. Finally, the state will provide $20 million for two years, and $10 million annually thereafter, to support community-based efforts to raise tax credit awareness and connect Californians with free tax preparation services. 

State leaders can better support Californians by: establishing a larger, more meaningful minimum CalEITC, increasing the YCTC and extending it to families with older children, and continuing to expand investments in free tax prep services.

Safety Net 

What’s included in the 2022-23 California state budget: Monthly CalWORKs grants are based on the number of eligible people in the household. Reasons for ineligibility include exceeding the time limit for assistance, not meeting work requirements, or immigration status. The budget agreement includes a two-year 21% grant increase effective October 1, 2022, raising grants above the deep poverty threshold (50% of the federal poverty line) for all cases with at least four eligible people, even where there is also an excluded member. The budget agreement also passes-through to former CalWORKs families outstanding child support debt that currently is claimed as “reimbursement” for programmatic costs. Funding is appropriated for a 100% pass-through for current CalWORKs families, subject to future legislative action for the 2024-25 fiscal year.

State leaders can further support Californians with low incomes by: ensuring that grants are above the deep poverty threshold for all CalWORKs families. Additionally, state leaders should commit to ending the work participation rate penalty for counties, an outdated racist and sexist policy that hinders helping parents address barriers.

Paid Time Off

What was not included in the 2022-23 California state budget: The final budget agreement fails to strengthen key programs that are critically necessary for workers in balancing work, their own health, and family obligations. Specifically, the final budget agreement does not update payment rates for the state’s paid family leave and disability insurance programs, leaving in place a barrier to utilizing these programs for workers paid low wages. And, despite providing tax credits for businesses to cover the expense of COVID-19 supplemental paid sick days, the budget agreement fails to extend this pandemic safeguard beyond the current sunset date of September 30, 2022. This will leave many workers with just three paid sick days per year.

State leaders can better support California workers by: ensuring all workers in California are able to take paid time off, particularly workers paid low wages who are disproportionately women, Black, and Latinx Californians. Policymakers can do this by boosting payment rates for the state’s paid family leave and disability insurance programs to ensure that workers do not face difficult choices about paying the bills or caring for themselves or family. Policymakers should also extend COVID-19 supplemental paid sick leave, and, after the pandemic, require employers to provide additional paid sick days for all to maintain the health of workers and communities.

Child Care

What was included in the 2022-23 California state budget: Policymakers extended certain pandemic protections for families and subsidized child care and state preschool program providers, including the waiver of family fees and provider payments based on student enrollment, not attendance. The final budget agreement also invests $100 million in one-time federal funds for child care facilities. Finally, the 2022-23 budget provides $100 million for health care benefits for certain subsidized child care providers, but it does not update provider payment rates, leaving many struggling to keep pace with the rising statewide minimum wage and increasing price of food and supplies.

State leaders can better support California working parents, families, and communities by: providing reimbursement rates for subsidized child care providers that allow for fair and just wages that reflect the critical value of early educators’ profession. Providers, children, and working parents suffer when child care is limited in their communities because of policymakers’ lack of investment.

Rotunda California Capital building in Sacramento

See our report Dollars and Democracy: A Guide to the California State Budget Process to learn more about the state budget and budget process.


What’s included in the 2022-23 California state budget: Comprehensive Medi-Cal coverage is expanded to low-income undocumented Californians ages 26 to 49, the last group explicitly excluded from eligibility due to their immigration status and age. By January 1, 2024, all qualifying Californians will have access to comprehensive Medi-Cal coverage. This move effectively builds on previous coverage steps the state has already taken and ends the racist and exclusionary policy that blocks Californians from accessing vital health services. To provide Medi-Cal for adults age 26 and over, the state is estimated to allocate:

  • $67 million total funds ($53 million General Fund) in 2021-22 and $745 million total funds ($628 General Fund) in 2022-23 for older adults.
  • $834 million total funds ($625 million General Fund) in 2023-24 for adults age 26-49.
  • $2.6 billion total funds ($2.1 billion General Fund) in on-going out-year costs, including In-Home Supportive Services.

State leaders can further support Californians by: moving up the comprehensive Medi-Cal coverage start date. Californians who have been barred from consistent health care coverage need timely access to critical services and care to have the ability to live a healthy life.

Public Health

What’s included in the 2022-23 California state budget: $300 million ongoing General Fund to improve public health infrastructure, with about $200 million earmarked for local health jurisdictions and about $100 million for state-level operations. Under this proposal, local health jurisdictions would receive a minimum base allocation to support workforce expansion, data collection and integration, and partnerships with health care delivery systems and community-based organizations. At the state level, this funding would establish a new Office of Policy and Planning to assess current and emerging public health threats as well as support other core functions, including emergency preparedness and public health communications. This much-needed investment will strengthen public health departments’ ability to protect and promote the health and well-being of communities across the state.

State leaders can further support Californians by: establishing dedicated funding to support community-based organizations, clinics, and tribal organizations in their efforts to address health disparities and advance racial justice, given that structural racism continues to have a profound impact on communities across the state.

Health Workforce

What’s included in the 2022-23 California state budget: significant investment in the health workforce in order to increase access to timely and culturally competent care for Californians. Specifically, the budget includes $532.5 million one-time over four years to bolster the behavioral health workforce, the public health workforce, and the primary care and reproductive health workforce. The also budget includes $296.5 million in 2022-23, $370.5 million in 2023-24 and in 2024-25 for the Workforce for a Healthy California for All Program, which aims to expand the following professions:

  • Community health workers, who are trained health educators and are trusted members of the community they serve;
  • Nurses, including registered nurses and certified nurse midwives;
  • Social workers;
  • Behavioral health providers, such as psychiatrists and psychologists; and
  • Multilingual health care professionals.

State leaders can further support Californians by: promoting LGBTQ+-affirming training for health providers to better serve their communities. Policymakers can also invest in efforts to make sure that the health workforce better reflects the diversity of all Californians, including their gender identities and sexual orientations.

Reproductive Health

What’s included in the 2022-23 California state budget: over $200 million to protect and increase access to reproductive health care services, particularly in response to the Supreme Court’s recent decision to end a constitutional right to an abortion as well as states’ actions to ban or restrict access to abortion care — both of which severely undermine the health and economic security of pregnant people. Funding in the budget agreement includes:

  • $40 million to establish an uncompensated care fund for Californians with low incomes; 
  • $20 million to support abortion training for clinicians and health care professionals;
  • $20 million to establish the Los Angeles County Abortion Access Safe Haven Pilot Program; and 
  • $20 million to assist patients in overcoming barriers to abortion care.

State leaders can further support Californians by: ensuring that all Californians have access to reproductive health care, especially Californians in rural areas and those with low incomes, given the possible influx in out-of-state patients seeking health care.


What’s included in the 2022-23 California state budget: New funds in the budget agreement focus on encampments, with $300 million in 2022-23 (and $400 million in 2023-24) for local governments for encampment “resolution.” Equitable and effective use of these funds should prioritize the housing and service needs of Californians living in encampments, not just clearing streets. The budget agreement also boosts current-year investment in Homekey by $150 million, and includes intent to continue the annual $1 billion investment in flexible local funding to address homelessness for another year in 2023-24. Also included are $1 billion in 2022-23 — and $500 million in 2023-24 — for bridge housing for people  experiencing homelessness with serious mental illness, as proposed by the governor in January. Policy negotiations continue for the CARE Court proposal.

State leaders can better support Californians experiencing homelessness by: increasing flexible local funds to address local service gaps and opportunities, and providing these funds on an ongoing basis to enable long-term planning. Also boosting investment in affordable permanent housing, which is necessary to end homelessness.

California Capitol Building in Sacramento

California Budget

The California budget is the pathway to building a just and equitable state. By ensuring Californians have access to engage in meaningful conversations and strategic decisions, our budget and policies can better reflect Californians’ values and aspirations.

Affordable Housing

What’s included in the 2022-23 California state budget: There are increased funds to expand California’s supply of affordable housing, including for multi-family housing ($100 million in 2022-23 and $225 million in 2023-24), shovel-ready projects through the Housing Accelerator Program ($250 million), adaptive reuse of underutilized commercial space ($410 million over two years), and infrastructure for infill housing ($200 million in 2022-23 and $225 million in 2023-24). Significant new funds are also allocated to assist first-time homebuyers and homeowners with moderate and low incomes, through existing ($350 million over two years) and new ($500 million) programs. These programs could help address the racial wealth gap — but they are unlikely to benefit renters with the lowest incomes, who face the greatest housing affordability challenges and risk of homelessness.

State leaders can better support Californians’ housing needs by: increasing investment in affordable housing production and preservation to a scale that matches the need. A stable, affordable home is the most basic foundation for health and well-being, and addressing the severe affordable housing shortfall is vital for California’s long-term prosperity.

K-12 Education

What’s included in the 2022-23 California state budget: K-12 schools will receive significant funding increases including:

  • $7.9 billion for a one-time discretionary block grant allocated based on the percentage of enrolled students in K-12 districts who are English learners, students from low-income families, or foster youth — a more equitable method than proposed in the May Revision.
  • $7.9 billion for the Local Control Funding Formula (LCFF), which includes $2.8 billion for LCFF grant costs using a three-year average of average daily attendance.
  • $4 billion in ongoing funding for the Expanded Learning Opportunities Program, which provides additional learning time for students before or after school, and outside of the traditional school year. 
  • $3.6 billion for a one-time per-pupil block grant that can be used for many purposes such as arts and music.

State leaders can better support Californians by: providing additional resources to leverage the language assets of more than 40% of the state’s K-12 students who live in a home where a language other than English is spoken.

Higher Education

What’s included in the 2022-23 California state budget: The 2022-23 budget makes progress in making higher education more affordable by: 

  • Increasing total ongoing funding for the Student Success Completion Grant (SSCG) to nearly $413 million. The SSCG supports community college students by encouraging full-time enrollment. 
  • Providing an additional $227 million one time in 2023-24 for the Middle Class Scholarship, which supports students at the UCs and CSUs. 
  • Initiating reforms to the Cal Grant program to expand access to more students, but major changes to the program would not be implemented until 2024-25 if there are dollars available.

The budget agreement also includes ongoing base increases for all higher education segments to support operational costs and provides $1.4 billion in grants for the construction of affordable student housing.

State leaders can further support Californians by: providing additional emergency financial assistance to students from low-income households that recently abandoned their educational plans. Education expenses are a major reason why students, especially those from low-income households, canceled their higher education plans in the most recent academic year.

Gann Limit

What’s included in the 2022-23 California state budget: The budget package keeps state spending under the disco-era Gann Limit during both the 2022-23 fiscal year, which began on July 1, and the two-year period that ended June 30, 2022. To achieve this outcome, state leaders used the limited flexibility provided by the Gann Limit to allocate a large share of state dollars toward purposes that are excluded from the limit. For example, policymakers substantially increased spending on infrastructure, tax refunds, and emergency response — none of which counts toward the Gann Limit. The budget package also changed state law so that significantly more state funding for local governments (“subventions”) will count against local governments’ own spending limits rather than against the state’s limit, creating Gann Limit “room” at the state level.

State leaders can further address the Gann Limit’s impact by: laying the groundwork for meaningful Gann Limit reform. The Gann Limit is a roadblock to creating a more equitable California. Failure to repeal or revise the spending cap could soon jeopardize California’s ability to adequately fund public services.

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Mental health is an essential part of overall health and well-being for Californians no matter one’s age, zip code, gender identity, or sexual orientation. Everyone should have the opportunity to be healthy and thrive, yet LGBTQ+ people disproportionately experience mental health challenges compared to non-LGBTQ+ people.1The acronym “LGBTQ+” is a collective acronym for lesbian, gay, bisexual, transgender, queer or questioning, and other sexual and gender identities. The addition of the “+” indicates inclusion of other identities not encompassed by “LGBTQ,” including but not limited to those who identify as intersex, nonbinary, and asexual. For more information about terminology used in this report, see GLAAD Media Reference Guide, This was true even before the pandemic, when many Californians experienced stress, grief, isolation, depression, and other hardships.

Many LGBTQ+ Californians Reported Poor Mental Health During the Pandemic

Over the past several months, LGBTQ+ Californians have experienced more mental health hardship than cisgender and straight Californians, according to data from the US Census Bureau Household Pulse Survey collected between July 2021 and March 2022.2A cisgender person is a person whose gender identity aligns with the sex they were assigned at birth. Data reflect the period between July 21, 2021 and March 14, 2022. While the US Census Bureau began administering the Household Pulse Survey in April 2020, it only began including questions about sexual orientation and gender identity in July 2021. Overall, about half of LGBTQ+ Californians reported poor mental health during the pandemic, which is defined as symptoms of depression, anxiety, or both. Mental health hardship was particularly pronounced among transgender Californians, with about two-thirds experiencing symptoms of poor mental health. In addition, about 6 in 10 bisexual Californians and more than 4 in 10 gay or lesbian Californians experienced poor mental health, compared to less than one-third of straight Californians.

Bar Chart: Transgender Californians have experienced more mental health hardship compared to cisgender people.

The Household Pulse Survey includes relatively detailed information on gender identity and sexual orientation, which is significant because US Census Bureau surveys generally fail to capture this information, making it impossible to compare outcomes between LGBTQ+ and non-LGBTQ+ communities. However, the Household Pulse Survey data still do not fully reflect the complexity, nuance, and full spectrum of identities.

Bar Chart: Bisexual, gay, and lesbian Californians have experienced more mental health hardship compared to straight people.

Many LGBTQ+ Californians Did Not Receive Mental Health Care When Needed

More than 1 in 5 LGBTQ+ Californians reported that they needed mental health services but did not receive them, compared to about 1 in 10 straight, cisgender people. LGBTQ+ people have unique barriers in accessing care, such as discrimination or fears of discrimination as well as a lack of competent providers and gender-affirming care.3Susan H. Babey et al., Gaps in Health Care Access and Health Insurance Among LGBT Populations in California (UCLA Center for Health Policy Research, February 2022) See also Jennifer Kates et el., Health and Access to Care and Coverage for Lesbian, Gay, Bisexual, and Transgender (LGBT) Individuals in the U.S. (Kaiser Family Foundation, May 3, 2018) For example, providers may refuse to use the names and pronouns that correspond with an individual’s gender identity, question an individual’s stated sexual orientation, or fail to acknowledge someone’s relationship as legitimate.4Rory P. O’Brien et al., Mapping the Road to Equity: The Annual State of LGBTQ Communities (#Out4MentalHealth Project, 2018), 70-82,

LGBTQ+ People Face Multiple Stressors That Are Harmful to Health

Even before the pandemic, Californians who reported their gender as transgender or gender nonconforming as well as those who identified as gay, lesbian, or bisexual were much more likely to report serious psychological distress compared to cisgender and straight Californians, respectively.5Serious psychological distress is an estimate of adults who have serious, diagnosable mental health disorders that warrant mental health treatment. See D. Imelda Padilla-Frausto et al., Serious Psychological Distress on the Rise Among Adults in California (UCLA Center for Health Policy Research, September 2020), 4-5, Experiences with discrimination, family or social rejection, and internalized oppression that many LGBTQ+ people face likely contribute to these higher rates of distress. For example, in a nationally representative sample of adults, including 489 adults identifying as LGBTQ, more than half of the LGBTQ respondents reported having experienced or having a LGBTQ friend or family member who had experienced personal discrimination such as slurs, harassment, violence, or threats of violence.6Harvard T.H. Chan School of Public Health, Robert Wood Johnson Foundation, and National Public Radio, Discrimination in America: Experiences and Views of LGBTQ Americans (November 2017), 1, For more background on the factors that may contribute to higher rates of mental health challenges for specific LGBTQ+ populations, including LGBTQ+ people of color, see Pasha Mikalson Walker et al., Surveying the Road to Equity: The Annual State of LGBTQ Communities (#Out4MentalHealth Project, 2019), About 1 in 5 reported having experienced discrimination in employment or housing.7Discrimination in America.

Economic Challenges May Worsen Mental Health for LGBTQ+ Communities

In addition to creating psychological distress, discrimination faced by LGBTQ+ individuals may lead to economic challenges such as poverty and homelessness, putting them at further risk of experiencing poor mental health outcomes. Between July 2021 and October 2021, people who identify as LGBT nationally were more likely to report difficulty paying for household expenses, such as food, rent, mortgage, and car payments than non-LGBT people, according to a report from the Williams Institute.8Kerith J. Conron et al., Food Insufficiency Among LGBT Adults During the COVID-19 Pandemic (The Williams Institute, April 2022), 4,

Californians who are LGBTQ+ and have low incomes have experienced an especially high rate of poor mental health during the pandemic. About 6 in 10 LGBTQ+ Californians in households with incomes less than $50,000 experienced poor mental health between July 2021 and March 2022, according to the Household Pulse Survey data. In contrast, about 4 in 10 non-LGBTQ+ Californians in households with incomes under $50,000 had poor mental health symptoms.

Income, cost of living, and socioeconomic status all impact people’s health. Research shows that low levels of household income and mental health conditions are related.9Jitender Sareen et al., “Relationship Between Household Income and Mental Disorders: Findings From a Population-Based Longitudinal Study,” Archives of General Psychiatry 68 (April 2011): 419–427, doi:10.1001/archgenpsychiatry.2011.15. Adults living in poverty are about three times more likely to report feeling nervous all or most of the time and four times more likely to report feeling sad all or most of the time compared to adults with higher incomes.10“Adults living in poverty” refers to adults who live in families with incomes below the poverty threshold. “Adults with higher incomes” refers to adults who live in families with incomes that are 200% of the poverty threshold or greater. “Interactive Summary Health Statistics for Adults,” National Center for Health Statistics (webpage), 2018 National Health Interview Survey, accessed April 18, 2022, Having a low income makes it difficult to afford health care, quality housing, and retirement savings — all of these stressors negatively impact both physical and mental health.

LGBTQ+ people with low incomes must navigate multiple and compounding stressors related to their economic situation as well as their gender identity and/or sexual orientation, which can be especially harmful to their mental health.

State Leaders Should Address the Mental Health Needs of LGBTQ+ Californians

State policymakers should address the unique needs of LGBTQ+ Californians as they work to increase access to mental health services and bolster the state’s mental health workforce. For instance, state leaders can promote LGBTQ+-affirming training for behavioral health providers to better serve Californians receiving health services through Medi-Cal, as some advocates have proposed. Policymakers can also invest in efforts to make sure that the behavioral health workforce better reflects the diversity of all Californians, including their gender identities and sexual orientations.

Information About the US Census Bureau Household Pulse Survey Data:

The US Census Bureau Household Pulse Survey measures how the COVID-19 pandemic has impacted households across the country from a social and economic perspective. In July 2021, the survey began collecting information on current gender identity, sex assigned at birth, and sexual orientation. For the gender identity dimension, the possible responses are 1) male, 2) female, 3) transgender, and 4) none of these. The possible responses for the sexual orientation question are 1) gay or lesbian, 2) straight, that is not gay or lesbian, 3) bisexual, 4) something else, and 5) I don’t know.

Because some transgender individuals select male or female as their primary gender identity, the data presented for transgender Californians in this report also include respondents identifying as male or female whose current gender identity is different than their sex assigned at birth.

Data Displayed in this Report:

This report does not display results for respondents who selected “none of these” on the gender identity question or those who selected “something else” or “I don’t know” to the sexual orientation question — unless the respondents were categorized as gay or lesbian, bisexual, or transgender based on other survey responses. Previous research suggests that people selecting these options may or may not identify as LGBTQ+.11Conron et al., Food Insufficiency, 17. Given the inconclusiveness of these data, it may not be appropriate to assume that people selecting these responses are LGBTQ+. However, excluding these responses means that the data do not fully represent the experiences of some groups of LGBTQ+ Californians. These groups include but are not limited to: those who identify as nonbinary, genderqueer, gender fluid, two-spirit, or another gender identity; those identifying as pansexual, asexual, or another sexual orientation; and those questioning their sexual orientation or gender identity.

Why Inclusive Information Matters for California Policy:

In order to better understand the experiences and needs of various LGBTQ+ populations, it is crucial that future federal, state, local, and nongovernmental surveys both include questions about gender identity and sexual orientation and also refine these questions to more accurately reflect the diversity of LGBTQ+ communities. Policymakers can advance health and economic equity for LGBTQ+ individuals by ensuring that publicly funded data efforts include comprehensive and inclusive information about gender identities and sexual orientations.

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