The Trump administration announced in August that the federal government will stop paying its share of medical costs for transgender youths on Oct. 13. State lawmakers responded last week, authorizing funds in the budget for some of the state’s most vulnerable children.
The final rule from the Centers for Medicare & Medicaid Services ends federal Medicaid and Children’s Health Insurance Program funding for puberty blockers, hormone therapy and surgery for transgender minors. In California, about 1,500 children on Medi-Cal, the state’s Medicaid program, would lose care they receive now.
Medi-Cal reimbursed providers $7.4 million last year for gender-affirming services for Californians younger than 18. That is 0.0004% of Medi-Cal’s $194.4 billion budget. It’s a rounding error. The Trump administration estimates it will save all of $138 million over 10 years.
This was never about the money. The administration calls the care “sex-rejecting procedures,” a phrase invented to demean children. California’s own health agency told CMS plainly that the term is “new and misleading.” It is a slur with a Federal Register number from an administration that would never say the words gender-affirming care.
The care is not experimental. It is not casually applied. The American Academy of Pediatrics and the American Psychological Association support youth access to gender-affirming care. Doctors, parents and patients work together to decide what is best for each child. Research links hormone therapy to lower rates of depression and suicidal thoughts among transgender adolescents.
The federal rule does not change the legality of gender-affirming care in California. It remains legal, and state law requires health plans to cover it. Local governments agree. In July, the Sonoma County Board of Supervisors unanimously approved a resolution endorsing access to gender-affirming care.
What changes is who can afford it. Teenagers insured under a parent’s work coverage keep their endocrinologists. Teenagers from low-income families or with disabled parents lose access to new treatment on Oct. 13, and those already receiving hormone therapy will enter a six-month tapering period.
The Legislature therefore approved $10 million for care of youth who will no longer qualify for federal matching funds. As of Thursday, Gov. Gavin Newsom had not signed the budget bill containing the funding. He has until the end of the month to do so or veto it. He should not delay. Families are making decisions about October now.
Yet this funding is just a bridge. It is a one-time pot of money that does not go directly to Medi-Cal. Rather, it goes to the Department of Health Care Access and Information, which is encouraged to coordinate with Medi-Cal. That might hold for a year, but the funding needs greater security to ensure that young people continue to receive care.
The permanent solution is a Medi-Cal billing pathway, a way for the state to pay providers with its own dollars separate from federal money. Advocates had asked for that eight months ago, but they did not get it. It should be a priority early in the next legislative session.
Lawmakers backed the LGBTQ+ community this year with real money. In addition to the last-minute $10 million, they provided $26 million to protect access to transition-related care and the providers who deliver it. They also approved $30 million for uncompensated care covering both reproductive health and transition-related services.
The children affected by the Trump administration’s cruelty were an easy target because they are few, poor and politically defenseless. California declared that they still matter.
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