key takeaway
Protecting Medi-Cal’s funding and access to gender-affirming care is essential to safeguard the health, mental well-being, and dignity of California’s low-income transgender, gender-expansive, and intersex communities. However, this is currently threatened by federal budget cuts and policy proposals that would exacerbate existing disparities and costs.
Every Californian should be able to make decisions about their own medical care. This is especially important for transgender, gender expansive, and intersex (TGI) people who rely on gender-affirming care to ensure that they can access treatments that align with their gender identity without unnecessary restrictions or interference from others. For the 36,000 TGI Californians with low incomes who qualify for Medi-Cal, California’s Medicaid program serves as a lifeline that provides them with free or low-cost health coverage. Policymakers should protect Medi-Cal and access to gender-affirming care so that all Californians are able to access life saving care, have better mental health outcomes, and live with dignity.
What Are Current Threats to Medicaid and Gender-Affirming Care?
Congressional Republicans are actively pushing federal budget and policy proposals that threaten the ability of TGI people on Medicaid to access crucial gender-affirming care. Gender-affirming care improves mental and physical health outcomes, reduces disparities, and helps provide better health care access for TGI people. Denying access to this care can lead to untreated mental health issues, substance abuse, and other health issues that will only increase costs for the state and health care systems in the long run.
Federal budget proposals would cut funding for Medicaid in favor of tax breaks for the wealthy. Congressional Republicans are also pursuing policy proposals that would prevent Medicaid funding from being used for gender-affirming care. Such cuts and proposals would be harmful for all Californians, as gender-affirming care supports procedures like breast reduction surgery and IUDs. For TGI people, who are already facing significant health disparities due to historic and ongoing discrimination, these proposed cuts would be devastating.
For many, Medi-Cal is the only way to access vital health services, from gender-affirming care to mental health supports. Out-of-pocket costs for gender-affirming care can range from $72 to $3,792 per year, meaning that without Medi-Cal, many TGI Californians would be unable to afford out-of-pocket expenses for this critical care.
Cutting funding for Medi-Cal means taking critical care away from people who already face long-standing barriers to care, such as:
- Lack of health coverage,
- Limited access to treatments that align with gender identity,
- Limited health care resources,
- Lack of culturally competent and linguistically appropriate care, or
- Other forms of discrimination.
These barriers to care are rooted in systemic transphobia and racism that TGI people face in health care and in society, which have systematically denied TGI people equitable access to quality care and resources. Cutting funding for Medicaid and enacting discriminatory policy proposals would reinforce systemic transphobia and put the health and well-being of our trans, non-binary, and intersex neighbors at risk.
Key Terms
Transgender and Gender Expansive Californians Are Already Facing Increased Risks
Mental health is essential for overall health and well-being. Yet, half of TGI Californians experienced serious psychological distress in the past year. That is much higher than the rate for cisgender people (14%). Experiences with health care stigma, family or social rejection, and internalized oppression that many TGI people face contribute to worse mental health outcomes.
TGI people are not only facing disparities in mental health, they are also enduring worse health outcomes overall. A history of discrimination and stigma in health care faced by TGI people have resulted in inequitable health outcomes. Approximately 1 in 4 TGI people in California are in fair or poor health, which is significantly higher than cisgender Californians (16%).
It is critical that everyone, especially TGI Californians, has access to timely and equitable health care that aligns with their gender identity without unnecessary restrictions. However, TGI people in California are delaying medical care or getting prescriptions at high rates. Over 40% of TGI people in the state delayed receiving medical care between 2019 and 2023, which is significantly higher than the average for cisgender people in the state (18%).
Forgoing preventive care or treatment for health conditions is harmful to health and well-being. Avoiding or delaying care also threatens the ability of people to thrive in the state. However, TGI people face unique barriers in accessing care, such as discrimination or fears of discrimination as well as a lack of competent providers and gender-affirming care. For example, providers may refuse to use the names and pronouns that correspond with an individual’s gender identity. Cutting funding for Medicaid and preventing Medicaid recipients from accessing gender-affirming care would increase the cost of health care for millions of Californians, and TGI people are already unable to afford out-of-pocket expenses due to employment discrimination and harassment or being unhoused. Increased costs would cause even more TGI people to delay receiving critical care.
Gender-affirming care saves lives. Policymakers should protect Medi-Cal to ensure all Californians — regardless of their income or gender identity — have access to affordable, quality, and affirming health care. Cutting Medi-Cal would take critical care away from some of our most vulnerable neighbors who rely on Medi-Cal to stay healthy and access care that allows them to survive.
Rather than cementing discriminatory policies and deepening inequities, state and federal policymakers should strengthen Medi-Cal to better meet the needs of TGI people and ensure that they can receive the care they need.
