Trump administration cuts healthcare coverage for some transgender youth in California

The latest political battleground between California and the Trump administration over transgender youth is a few million dollars annually for gender-affirming care.

Upcoming cuts to federal funding for gender-affirming health care will apply to a small fraction of transgender kids and teens in California. The impact will be far short of U.S. Health Secretary Robert F. Kennedy Jr.’s original plan last year to block that care for youth nationwide.

But California medical associations and LGBTQ+ advocates say the pared-back policy remains a “cruel” attack on a vulnerable population for whom gender-affirming care can be lifesaving. They have asked Gov. Gavin Newsom and state lawmakers to approve millions of dollars in emergency funding to maintain payments to providers.

Medi-Cal and the Children’s Health Insurance Program, subject to the cuts, are “lifelines for thousands of transgender Californians and their families, and the devastating impacts of these cuts cannot be understated,” more than 50 organizations wrote to Gov. Gavin Newsom last week.

A spokesperson for Newsom’s office did not comment on the funding ask by advocates and providers.

The Centers for Medicare & Medicaid Services, part of the Trump administration, approved a final rule this month that ends federal funding for healthcare when some low-income youth explore their gender or decide to transition. It goes into effect in October. In California, the rule targets youth and some young adults whose healthcare is covered by Medi-Cal, the state version of Medicaid.

Relatively few transgender youth on Medi-Cal receive gender-affirming care. In 2025, the program reimbursed providers for doctor visits, surgeries, counseling, speech therapy and other services for about 1,500 members under 18 years old, according to the California Department of Health Care Services. That’s a small slice of the estimated 85,000 transgender youth in the state.

That care is also a tiny portion of Medi-Cal’s budget. Those reimbursements totaled $7.4 million — about 0.0004% of the program’s $194.4 billion budget last fiscal year, Anthony Cava, a spokesperson for the state health agency, said in an email.

For those transgender youth, however, Medi-Cal is a vital source of healthcare, said Jorge Reyes Salinas, a spokesperson for Equality California.

“We’re talking about affecting a very vulnerable population at this moment of time,” he said.

When the rule goes into effect this fall, federal funds will no longer cover common therapies including puberty blockers — hormone analogues that delay the onset of puberty — and hormone treatments, which patients use to align their bodies with their gender identities. Also restricted is funding for surgical procedures, which are rarely recommended for youth.

“We are ending federal taxpayer funding for sex-rejecting procedures on children,” U.S. Department of Health and Human Services Secretary Robert F. Kennedy Jr. said in a statement earlier this month. “These interventions carry serious risks and can cause irreversible harm.”

Medi-Cal’s budget is split between the federal government and the state, and the new rule championed by Kennedy still allows states like California to pay for gender-affirming care themselves. The advocacy groups and some medical providers, including the California Primary Care Association, which represents community health centers, and Planned Parenthood Affiliates of California, sent a letter to Newsom last week asking for an emergency appropriation of $10 million.

That would fund direct reimbursements to providers for care, Reyes Salinas said.

The Trump administration views gender-affirming care as an untested science that is dangerous for minors. Dr. Mehmet Oz, the celebrity doctor and administrator of the Centers for Medicare & Medicaid Services, has expressed skepticism that the care process benefits youth. In December, he said children with gender dysphoria — a psychiatric diagnosis of inner conflict between a person’s gender identity and the sex they were assigned at birth — are “confused, lost and need help.”

That’s at odds with many major medical associations in the U.S., including the American Academy of Pediatrics and the American Psychological Association, which support access to gender-affirming care for youth. Medical societies have opposed the Trump administration’s efforts to block access, including its unfulfilled proposal last year to strip federal funding from hospitals providing that care to minors.

However, the American Society of Plastic Surgeons recommended in February to delay gender-related surgeries until a patient is “at least 19 years old.” The society cited low certainty of evidence about mental health outcomes and “emerging concerns about potential long-term harms and the irreversible nature of surgical interventions in a developmentally vulnerable population.”

However, global health authorities have taken a more cautious approach toward such treatments for youths. The World Health Organization, in a process to develop transgender care guidelines, said in 2024 that it will focus only on care for adults because “the evidence base for children and adolescents is limited and variable regarding the longer-term outcomes of gender affirming care for children.”

California’s 2026-27 budget already includes $10 million for general grants to gender-affirming care providers, plus $8 million each in the next two budget years. The budget also puts $30 million into a fund for uncompensated abortion and gender-affirming care for Californians.

In their letter, the advocates and providers said tapping those funds to cover direct reimbursements for providers would spread the funding too thin between different programs, threatening the availability of gender-affirming care for youth.

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