As of January 1, 2023, a new law protects the right of Transgender, Gender Diverse, and Intersex (TGI) Californians to access Gender-Affirming Care. Senate Bill 923, authored by California Senator Scott Weiner, is known as the TGI Inclusive Care Act, and was signed into law by Governor Newsom last fall.
Unfortunately, many TGI Californians currently encounter discrimination and difficulty accessing the health care they need. TGI Californians report experiencing a range of discrimination in health care, including having to teach their providers about the transgender community in order to receive appropriate care, treatment refusals, verbal harassment, and physical and sexual assault.
In addition, TGI people report experiencing significant administrative barriers to accessing care. For example, it is often difficult for TGI people to determine which providers in their plan’s network can deliver the Gender-Affirming Care they need. As a result, TGI people too-often spend hours calling providers to try to identify one who offers the particular services they need, with each call increasing the risk that they will be subjected to harm, whether in the form of a provider’s office inadvertently using incorrect pronouns or in the form of a provider’s office staff member harassing the person over the phone based on their gender identity. Many people give up and go without the care they need, while others experience significant delays. The resulting harm to TGI people’s physical and mental health, is significant.
The TGI Inclusive Care Act aims to address this harm and reduce discrimination by creating a more inclusive and culturally competent healthcare system for TGI people in California. It will do so by taking several concrete steps to make Gender-Affirming Care more accessible in California, while also ensuring that health care providers and insurance plan staff have the training they need to provide culturally competent information and care to TGI people.
Specifically, under the new law in California:
- Physician Continuing Medical Education (CME) will include evidence-based culturally competent curriculum to help physicians provide inclusive care for TGI people;
- The California Health and Human Services Agency will, by March 2024, issue enforceable quality standards for treating TGI patients and recommend a training curriculum, working collaboratively with state Departments, providers, TGI people, and TGI-serving organizations;
- Health plans and insurance companies will provide TGI cultural competency training for their staff and delegated entities who are in direct contact with patients by March, 2025;
- Health plans and insurance companies will, by March 2025, in their network directories, include a list of in-network providers who offer gender-affirming services, so that TGI people know where to go for specialized care; and
- The relevant oversight agencies will track and monitor complaints relating to TGI-inclusive care and publicly post findings in their annual reports or website.
During a time when many states are actively passing bills that attack the TGI community and attempting to make it harder for people to access the care they need, California’s work towards protecting TGI people is important and commendable. While there is significant work ahead to implement the TGI Inclusive Care Act, it marks an enormous, first-in-the-nation, step toward ensuring that TGI Californians are able to access the care they need. Advocates in other states should consider working with their state policymakers to ensure TGI people in their states have access to timely, appropriate, and culturally competent Gender-Affirming Care.
SB 923 was co-sponsored by Break The Binary LLC, California LGBTQ Health and Human Services Network, California TRANScends, Equality California, Gender Justice LA, National Health Law Program, Orange County TransLatinas, Queer Works, Rainbow Pride Youth Alliance, San Francisco Office of Transgender Initiatives, The TransPower Project, TransCanWork, Trans Community Project, TransFamily Support Services, Transgender Health and Wellness Center, Tranz of Anarchii INC, Unique Woman’s Coalition (UWC), Unity Hope, and Western Center on Law & Poverty.