California law prohibits health plans from denying health care or discriminating against individuals because of the individual’s gender, including gender identity or gender expression. In 2023, California implemented the Transgender, Gender Diverse, and Intersex (TGI) Inclusive Care Act which protects the right of Californians to access Gender-Affirming health care services.
TGI Health Care FAQs
What is Trans-Inclusive Care?
Trans-Inclusive Care is defined in state law as “comprehensive health care that is consistent with the standards of care for individuals who identify as TGI, honors an individual’s personal bodily autonomy, does not make assumptions about an individual’s gender, accepts gender fluidity and nontraditional gender presentation, and treats everyone with compassion, understanding, and respect.”
What is Gender Affirming Care?
The World Health Organization defines Gender Affirming Care as a range of social, psychological, behavioral, and medical interventions “designed to support and affirm an individual’s gender identity.”
Does my health plan cover Gender Affirming Care?
Yes, health plans licensed by the California Department of Managed Health Care (DMHC) and insurers licensed by the California Department of Insurance (CDI) are required by California law to provide health plan enrollees who identify as transgender, gender diverse, or intersex (TGI) with medically necessary Gender Affirming Care.
How do I access Gender Affirming Care through my health plan?
While every experience will be unique, most people begin with their primary care doctor who can assess an initial gender dysphoria diagnosis and provide referrals to specialty doctors to access hormone treatment, surgical interventions or other Gender Affirming Care. If you do not have an existing relationship with a doctor or your doctor is unable to help you, please contact your health plan directly.
What are the range of services I can access through my health plan?
Working with your doctor(s), you should find a wide variety of medical and surgical interventions available for you. Please see the lists below for types of gender affirming services typically covered by health plans. Please note, this list is not exhaustive nor a guarantee of services your health plan will cover. Each individual service will be assessed, and the services will need to be deemed medically necessary before you receive care.
- Hormone therapy
- Puberty blockers
- Primary care and specialist doctor visits
- Mental health therapy
- Lab work
- Speech therapy
- Hair removal/electrolysis
- Medical tattooing (nipple-areola)
- Gender affirming facial surgery (including facial feminization surgery)
- Mastectomy and chest reconstruction
- Breast augmentation
- Tracheal shaves
- Phalloplasty and metoidioplasty
- Vaginoplasty and vulvoplasty
- Hysterectomy
- Oophorectomy
- Orchiectomy
- Penectomy
- Urethroplasty
- Vaginectomy
- Uterine transplantation
- Penile transplantation
- Body Contouring Services (Liposuction)
What do I do if my health plan denies gender affirming services?
If your health plan denies a service or treatment, they must provide you with a reason for the denial and how to file a grievance with your health plan to appeal the denial.
Where can I get more information and additional assistance with services?
We encourage you to review your individual policy/Evidence of Coverage. You can request a copy from your health plan by calling the Member Services number on your health plan ID card or asking your employer. If you need any additional help, please contact your health plan or visit the DMHC Help Center (see below).
DMHC Help Center
The DMHC Help Center assists all enrollees with understanding their health care rights, benefits and to resolve health plan issues. If you are having issues with your health plan, you should file a grievance with your plan. If you are not satisfied with your health plan’s resolution of the grievance or have been in your plan’s grievance system for 30 days for non-urgent issues, you should contact the DMHC Help Center for assistance. If your issue is urgent, you should contact the DMHC Help Center immediately.
The DMHC Help Center provides help in all languages, and all services are provided at no cost to the enrollee. All information shared with the DMHC Help Center is confidential. Help is available by calling 1-888-466-2219 or by visiting DMHC Help Center.
For more information, please visit the following links:
Your Health Care Rights
In California, all health plan enrollees in commercial and Medi-Cal managed care health plans regulated by the DMHC have many health care rights, including the following rights:
- Coverage and access to basic health care services
- The ability to choose your primary doctor
- An appointment when you need one (timely access to care)
- To see a specialist when medically necessary
- Get a doctor’s second opinion
- Receive treatment for all medically necessary mental health and substance use conditions
- Understand your health problems and treatments
- Know why your health plan denies a service or treatment
- Keep your medical information private
- File a Complaint and ask for an Independent Medical Review (an external appeal of your plan’s denial of services or treatment)
Common Terms and Definitions
- Types of Coverage: Explore the different types of health plan coverage in California
- Cost Sharing
- Deductible: The amount you must pay for covered health services each year before your health plan starts to pay.
- Copayment: A fee you pay each time you see a doctor, receive other health care services, or fill a prescription.
- Coinsurance: The set percentage you must pay for health services.
- Evidence of Coverage: A written guide to the services your health plan covers and does not cover and what you pay for services.
- Monthly premium: A monthly fee your health plan charges for your health insurance. You may pay part of the premium and your employer or union may pay the rest.
- Network/Provider Network: All the doctors, labs, hospitals, and other providers that have contracts with a health plan to provide health care services to the plan's members.
- Prior Authorization: The process of getting approval from your health plan or medical group before you receive services (also called approval or prior approval).
Additional health care terms and definitions
Fact Sheets
Health care can be confusing. To help you understand how to use your health care coverage and your health care rights, we have compiled information and resources in the Fact Sheets below to help you.
Statewide Initiatives
The DMHC convened the Transgender, Gender Diverse, or Intersex (TGI) Health Care Quality Standards and Training Curriculum Working Group to make recommendations to the Department, as required by Senate Bill (SB) 923 (2022). The Working Group’s purpose was to develop a quality standard for patient experience to measure cultural competency related to the TGI community and recommend a trans-inclusive training curriculum to be used by health care plan staff who are in direct contact with enrollees in the delivery of health care services.
To learn more, please visit TGI Working Group and TGI Working Groups Recommendations Report.
Now Available: SB 923 Guidance
Additional State Resources
California Department of Health Care Services
The California Department of Health Care Services (DHCS) is the single state agency responsible for financing and administering the state's Medicaid program, Medi-Cal, which provides health care services to low-income persons and families who meet defined eligibility requirements. Medi-Cal is authorized and funded through a federal-state partnership. Medi-Cal programs cover physical health, mental health, substance use disorder, services, pharmacy, dental, and long-term services and support.
The current DHCS guidance related to services is detailed in APL 20-018 Ensuring Access to Transgender Services. The Model Member Handbook includes transgender services and specifies that Medi-Cal Managed Care Plans cover transgender services (gender-affirming services) when they are medically necessary or when the services meet the rules for reconstructive surgery.
Coming soon: SB 923 DHCS Guidance
For more information or enrollment assistance, please visit: Medi-Cal
If you do not have health care coverage or recently lost your employer-sponsored health care coverage, you can find more information on financial assistance available through Medi-Cal and Covered CA here.
California Department of Public Health
The California Department of Public Health (CDPH) works to protect the public's health in the Golden State and helps shape positive health outcomes for individuals, families and communities. CDPH's fundamental responsibilities are comprehensive in scope and include infectious disease control and prevention, food safety, environmental health, laboratory services, patient safety, emergency preparedness, chronic disease prevention and health promotion, family health, health equity and vital records and statistics.
For more information on TGI resources, please visit:
Transgender Community Health in California
LGBTQ+ Health
AIDS Drug Assistance Program
Long Term Care Facilities Rights of residents including Transgender persons in California
Chestfeeding: Hospital breastfeeding policy resource inclusive of information & information about TGI people and parental resources
California Department of Social Services
The California Department of Social Services (CDSS) administers or oversees a wide variety of safety net and social services programs that provide cash assistance, nutrition assistance, children and family services, case management and navigation, in-home supportive services, housing and homelessness programs, and more. All of these programs are available to eligible Californians, including Transgender, Gender Diverse, or Intersex Californians. Additional information can be found at https://www.cdss.ca.gov/.
For more information on current guidance, please visit:
Screening Tool and List of Gender Affirming Providers in California for Assisting Transgender and Gender-Nonconforming (TGNC) Minor and Nonminor Dependents in Foster Care
ACL 19-27: Gender Affirming Care For Minor And Nonminor Dependents In Foster Care
ACL 16-82: Reproductive And Sexual Health Care And Related Rights For Youth And Non-Minor Dependents (NMD) In Foster Care
ACL 19-92: SOGIE Awareness During Child Welfare Intake
For more information on the Civil Rights Department, please visit: CA Civil Rights
For information on how to update your gender marker or sex identifier on your identity documents, please visit: Gender Marker Changes
To learn more about the Stop the Hate program, please visit: Stop the Hate Program Webpage
Federal Protections
On April 26, 2024, the federal Department of Health and Human Services (HHS) Office for Civil Rights (OCR) issued a final rule under Section 1557 of the Affordable Care Act (ACA) advancing protections against discrimination in health care. This codifies that Section 1557’s prohibition against discrimination based on sex includes LGTBQI+ patients. For more information, please visit: Nondiscrimination in Health Programs and Activities
Federal Resources
Health and Human Services Agency: Federal LGBTQI+ Health & Well-Being
Center for Disease Control and Prevention: Transgender Person’s Health at the CDC
Publications and Reports
WPATH Standards of Care for the Health of Transgender and Gender Diverse People V.8
California Health Care Almanac
UCSF Guidelines for Primary and Gender-Affirming Care of Transgender and Gender-Nonbinary People
California LGBTQ Health & Human Services Network