california law on gender reassignment surgery

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New California law on transgender youths doesn’t remove a parent’s custody

If your time is short.

• A new California law provides legal protections for parents fleeing states that have banned gender-affirming health care for youths.  
• The law clarifies that California courts have jurisdiction over any custody cases that may arise from parents taking their children to the state for care.   
• It doesn’t give the state permission to take custody of a child if one parent disagrees with a child’s decision to seek gender-affirming health care. ​

California Gov. Gavin Newsom recently signed into law a measure that aims to strengthen protections for transgender youths and their families.

Senate Bill 107 contains an array of safeguards for families who arrive in California from states where their children have been denied gender-affirming health care.

It bans courts from enforcing subpoenas from other states regarding minors seeking that care. It prohibits health care providers from releasing medical information. And it clarifies that California courts have jurisdiction over any child custody cases arising from parents taking their children to the state for care.

But a Sept. 29 Facebook post went further to suggest the law says something else: 

"Gov. Gavin Newsom signed Senate Bill 107 into law. In the state of California, your child can now be taken from your custody if you do not affirm gender-reassignment surgery."

The post, shared by the American Council, is a screenshot of a tweet by the group’s founder, Tanner DiBella. The American Council describes itself as an organization dedicated to increasing voter turnout among Christian evangelicals . 

The post was flagged as part of Facebook’s efforts to combat false news and misinformation on its News Feed. (Read more about our partnership with Facebook .)

DiBella told PolitiFact the California Legislative Counsel’s summary of the law backs up his reasoning. He pointed specifically to a passage of the summary at the top of bill’s text that reads, "The bill would authorize a court to take temporary jurisdiction because a child has been unable to obtain gender-affirming health care."

But experts we spoke to said that doesn’t mean the state would take custody of the child — it clarifies that California courts would assume jurisdiction of the legal matter. Current law allows California courts to decline jurisdiction in multistate custody matters in certain circumstances.

Courtney Joslin, a Martin Luther King Jr. professor of law at the University of California, Davis School of Law, said the law has nothing to do with who gets custody of a child during a dispute and makes no mention of allowing the court to take custody.

"It’s just describing which courts have jurisdiction in those multi-state (custody disputes)," she said. "There’s no possibility that this bill could be interpreted to do what this person is claiming."

Asaf Orr, a senior staff attorney and Transgender Youth Project director at the National Center for Lesbian Rights, said the bill doesn’t give California carte blanche to remove a child from a parent’s custody. 

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If parents disagree over whether their child should receive gender-affirming care in California, a state court would hear that case and rule based on evidence provided by both parents, Orr said. Out-of-state laws would not apply to the court’s determination. 

Orr said this isn't a new thing, as a state already has jurisdiction over court cases related to children who recently entered that state, for reasons such as escaping from domestic violence. 

"It just ensures that, in situations like this, the court recognizes they have jurisdiction to hear these cases and that they’re going to decide them based on the evidence," he said. "Both parties, as in any court case, will have the opportunity to present evidence and it’s going to be individualized for that young person."

Wendy Seiden, a visiting professor at Chapman University’s Fowler School of Law, said there is nothing in the law that would allow California to take custody of a child. But it does allow California to resist another state’s attempt to remove a parent’s custody if the proposed removal is based on that parent’s efforts to get gender-affirming care for their child.

California state Sen. Scott Wiener, D-San Francisco, an attorney and Senate Bill 170’s author, described DiBella’s interpretation of the text as "categorically false."

"It doesn’t change custody laws in any way," Wiener said. "It just means that, rather than having to go back to Texas or Alabama, they can do it in court here." 

Weiner said he authored the bill in response to proposed legislation in other states involving transgender youth. It provides guidance, he said, for California courts concerning custody hearings involving transgender youths and it helps protect parents who decide to bring their children to the state.

"This bill literally protects parents’ ability to make decisions about children's health care without having to be thrown in prison," Wiener said.

At least 24 states have proposed bills since Jan. 1 targeting transgender or nonbinary youths’ ability to receive gender-affirming care.  

In Texas, Republican Gov. Greg Abbott issued a directive earlier this year that ordered state officials to launch child abuse investigations of parents suspected of allowing their child to receive gender-affirming care. 

Alabama Gov. Kay Ivey signed a law in April that makes providing gender-affirming care for youths a felony, punishable by up to 10 years in prison.

A Facebook post claims that a recently signed California law dealing with gender-affirming care for transgender youth will allow that state to take custody of a child from a parent. 

Experts said that’s not so. The bill clarifies that California courts have jurisdiction to hear any custody cases related to a child being taken to the state to seek gender-affirming health care. It does not say that the courts can take custody of a child. 

We rate this claim False.  

Our Sources

Facebook post ( archive ), Sept. 29, 2022

Twitter post ( archive ), Sept. 29, 2022

Office of California Gov. Gavin Newsom, SB 107 Signing , Sept. 29, 2022

California Legislature, Senate Bill No. 107 , Oct. 3, 2022

The American Council, About , accessed Oct. 3, 2022

Email with Tanner DiBella, Oct. 3, 2022

Phone interview with Courtney Joslin, Oct. 10, 2022

Phone interview with Asaf Orr, Oct. 3, 2022

Email with Wendy Seiden, Oct. 8, 2022

Phone interview with California State Sen. Scott Wiener, Oct. 3, 2022

The Los Angeles Times, "Newsom signs bill protecting transgender youths and families fleeing red-state policies," Sept. 29, 2022

Bloomberg Law, "Transgender Health Care Becomes Target for Wide GOP-Led Rollback," Sept. 20, 2022

The Texas Tribune, "Transgender Texas kids are terrified after governor orders that parents be investigated for child abuse," Feb. 28, 2022

NBC News, "Alabama ban on gender-affirming care for transgender youth takes effect," May 9, 2022

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Newsom Signs Bill Making California ‘Sanctuary’ for Child Gender Transition

• Oops! Something went wrong. Please try again later. More content below

On Thursday, California governor Gavin Newsom signed legislation that would facilitate child gender-transition tourism from other states.

The bill, spearheaded by Democratic state senator Scott Wiener, aims to make California a “sanctuary state” for out-of-state children to receive so-called gender-affirming surgery and hormone therapy without the knowledge or consent of their parents. The bill includes a number of provisions designed to insulate residents of red states that have banned child gender-transition from prosecution.

It prohibits California courts and lawyers from enforcing subpoenas imposed by other states demanding that healthcare providers disclose when they perform such medical procedures on minors.

Wiener has been behind multiple lawmaking efforts in the state to undermine parental rights. In January, he pitched a bill that would allow minors to be vaccinated without parental permission .

Under the gender-transition law, California courts will have “temporary emergency jurisdiction” over any child and the person who accompanied the child to California to obtain the invasive medical interventions.

California’s law enforcement vows to treat any potential out-of-state arrest warrant issued for violating laws against child gender transitioning with “the lowest law enforcement priority,” according to the bill.

“California law enforcement agencies shall not knowingly make or participate in the arrest or participate in any extradition of an individual pursuant to an out-of-state arrest warrant for violation of another state’s law against providing, receiving, or allowing a child to receive gender-affirming health care and gender-affirming mental health care in this state, if that care is lawful under the laws of this state, to the fullest extent permitted by federal law,” the law reads.

In his signing message, Newsom claimed the legislation would empower parents by giving them “choice” rather than effectively strip custody from them, as many Republicans have alleged.

“In California we believe in equality and acceptance. We believe that no one should be prosecuted or persecuted for getting the care they need — including gender-affirming care,” Newsom said. “Parents know what’s best for their kids, and they should be able to make decisions around the health of their children without fear. We must take a stand for parental choice.” He also claimed that Republican-controlled states that have limited or outlawed sex-change surgeries for children in order “demonize” people who identify as LGBT.

A severability clause, which would allow the remainder of the bill to apply even if some provisions are held to be illegal or otherwise unenforceable, was included in an amendment at the last minute, according to the Los Angeles Times ,  because of doubts about the bill’s constitutionality.

Wiener admitted to the publication that proponents of the bill aimed to push the bounds of what is permissible under the Constitution, adding that California should not serve as “an arm of law enforcement of the states of Texas or Alabama.”

“We may have limits under the U.S. Constitution, but we are going to go right up to the edge of what we’re able to do to protect them and say, ‘Unless we are absolutely forced to send you back, we are not going to send you back,’” he said of child arrivals to California, and their guardians, seeking transition ‘treatment.’

More from National Review

Newsom Blasts Book Banning in K-12: ‘Education Is under Assault’

California School Board May Open Planned Parenthood Clinic at LA High School

Moms for Liberty Locked Out of Twitter after Criticizing California Gender-Transition Bill

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California governor signs bill offering legal refuge to transgender youths 

California Gov. Gavin Newsom signed a bill Thursday that aims to legally protect transgender youths and their parents if they flee conservative states that have restricted access to gender-affirming care. 

The bill seeks to “offer refuge” to trans minors and their families “if they’re being criminalized in their home states,” state Sen. Scott Wiener, who introduced the bill, said on Twitter after Newsom signed it.

Wiener said states like Texas and Alabama “are seeking to tear these families apart,” referring to efforts in both states to bar parents from providing their trans children with medical care like puberty blockers and hormone therapy.

In February, Texas Gov. Greg Abbott called on the state’s Department of Family and Protective Services to “conduct a prompt and thorough investigation” of any reported instances of minors undergoing “elective procedures for gender transitioning.” He also encouraged anyone who works with children in the state and regular citizens to report parents providing such care. 

Following the directive, the department confirmed that it opened at least nine investigations , but state courts have since blocked most of those investigations .

In Alabama, Gov. Kay Ivey signed a bill that makes it a felony for medical professionals to provide gender-affirming medical care to people under 19. 

“We should especially protect our children from these radical, life-altering drugs and surgeries when they are at such a vulnerable stage in life,” Ivey said in a statement at the time.

A judge partially blocked enforcement of that law in May.

Tennessee also passed a law prohibiting gender-affirming care for prepubertal youth , though advocates said at the time that there were no doctors in the state who provided transition care to children prior to puberty.

As a result of the policies, some families of transgender minors have decided to leave their home states so they can continue to access gender-affirming care, which is supported by accredited medical groups — including the American Medical Association , American Academy of Pediatrics and American Psychological Association .

The bill Newsom signed is intended to protect families and children like those from prosecution in their home states if they travel to California for gender-affirming care or if they move to California after already receiving transition-related care elsewhere. 

“We believe that no one should be prosecuted or persecuted for getting the care they need — including gender-affirming care,” Newsom said in a statement after signing the measure. “With the signing of this bill, California will ensure that these kids and their families can seek and obtain the medical and mental health care that they need.”

The legislation includes a variety of provisions that are meant to help protect families and trans kids. It prohibits California health care providers from releasing medical information in relation to other states’ laws prohibiting gender-affirming care for minors. It also prohibits the enforcement of a court order “based on another state’s law authorizing a child to be removed from their parent or guardian based on that parent or guardian allowing their child to receive gender-affirming health care or gender-affirming mental health care.”

The bill also authorizes a California court to take temporary emergency jurisdiction when a child hasn’t been able to receive gender-affirming health care elsewhere, which some on social media interpreted to mean that California courts will be able to take custody of children if they flee their home states because their parents don’t want to provide them with gender-affirming care. 

But that isn’t accurate, according to Asaf Orr, a senior staff attorney and Transgender Youth Project director at the National Center for Lesbian Rights. Orr said that portion of the bill is related to a court’s jurisdiction in custody matters. 

“State courts around the country have the authority to consider whether to retain jurisdiction over a custody matter involving a child who recently came into the state,” Orr told Reuters . “This typically occurs in instances of domestic violence or other crisis situations. This law simply clarifies that courts should retain jurisdiction in situations where a parent brings their child to California so that they can obtain medical treatment for gender dysphoria.” Gender dysphoria is a medical condition that involves a conflict between an individual’s sex assigned at birth and their gender identity. 

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Jo Yurcaba is a reporter for NBC Out.

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A new law in California protects transgender youth who come for medical care

Lesley McClurg

California is now a sanctuary for transgender youth who come for medical care. A new law protects families traveling from places where there are efforts to criminalize gender-affirming care.

AILSA CHANG, HOST:

A new California law protects families who travel to the state seeking medical care for transgender youth. It's a response to growing efforts in red states against trans rights. Lesley McClurg from member station KQED has more.

LESLEY MCCLURG, BYLINE: After decades of building a life in Texas, a mother suddenly worried she might be investigated for child abuse.

UNIDENTIFIED PERSON: We were stunned that it was no longer safe for us to be there.

MCCLURG: She requested we not use her name because earlier this year, Texas Governor Greg Abbott ordered Family Protective Services to investigate parents with transgender kids. The mother started hearing stories about children who were pulled out of classrooms and interrogated.

UNIDENTIFIED PERSON: With their parents not being there. And these are children that have only socially transitioned. All they asked for was to be called a different pronoun. That's terrifying.

MCCLURG: Her own 12-year-old daughter socially transitioned three years ago, when she asked her family and friends to use feminine pronouns.

UNIDENTIFIED PERSON: And so we sat down and talked to our kid. We gave her a little card to go to school with that listed her rights and told her what to do if somebody came to investigate us.

MCCLURG: But the family could not relax. They sold their home, and this fall they packed up all their belongings and moved to Southern California.

UNIDENTIFIED PERSON: It feels very good to not feel like you're in danger, you know, on that really critical place of, like, our family being ripped apart.

MCCLURG: They feel safe under a new law authored by State Senator Scott Wiener. It ensures families can access hormones or puberty blockers in California. And it shields families from investigations in other states.

SCOTT WIENER: We are going to provide them with refuge, and we're not going to send them back, and we're not going to honor subpoenas. And our law enforcement is not going to enforce the laws of Texas and Alabama criminalizing these families.

MCCLURG: Leaders in 21 states are pushing laws that would restrict medical care for transgender youth. Many of these efforts are tied up in court. Nevertheless, families are panicking because kids who are already on hormones or puberty blockers may lose access to their medication.

GREG BURT: We want these treatments to not be happening on minors because they're permanent.

MCCLURG: Greg Burt is with the conservative Christian California Family Council. He worries kids will regret transitioning.

BURT: We do not assume that your body is the problem. We think it's much more logical to encourage young people to try and get their minds to match their bodies.

MCCLURG: Yet the standard of care for kids who are really distressed and diagnosed with gender dysphoria does include medical interventions. But it's not just the content of the new California law that Burt opposes. He also argues that it violates the Constitution.

JESSICA LEVINSON: There could be litigation both with respect to abortion and with respect to gender-affirming care.

MCCLURG: Jessica Levinson is a professor at Loyola Law School in Los Angeles.

LEVINSON: But I think the weight of the law indicates that states are separate sovereigns. If and until there is a national standard that indicates, nobody can obtain gender-affirming care or nobody can obtain an abortion, the law allows for that patchwork.

MCCLURG: That patchwork is crucial to Kathie Moehlig's work. She is the executive director of Trans Family Support Services in San Diego.

KATHIE MOEHLIG: The politicians should not be making medical decisions for anybody, nor should they be making parental decisions for anybody.

MCCLURG: A survey from the Trevor Project, a suicide prevention organization, found that 45% of transgender youth have considered killing themselves in the last year. About a decade ago, Moehlig helped her 11-year-old access puberty blockers.

MOEHLIG: My son would not still be alive if we waited to 18. He already was in so much distress and so completely miserable. His body was becoming something that he knew he was not.

MCCLURG: Today, she says her son is thriving in college, studying theology. Yet there's little to no data on whether youth who transition regret that decision later. For the Moehlig family, their only regret is waiting as long as they did. For NPR News, I'm Lesley McClurg.

(SOUNDBITE OF OLIVIA RODRIGO SONG, "GOOD 4 U")

Copyright © 2022 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

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California set to become a refuge for transgender health care

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Lawmakers approved a bill to protect those receiving or providing transgender health care in California from prosecution under a wave of legislation in other states. But the proposal drew intense opposition from the California Family Council. Gov. Gavin Newsom signed the bill.

Lea este artículo en español .

Update: Gov. Gavin Newsom announced Sept. 29 he signed the bill, issuing a statement that said in part: “In California we believe in equality and acceptance. We believe that no one should be prosecuted or persecuted for getting the care they need — including gender-affirming care.”

When Kathie Moehlig’s 11-year-old son decided to transition in 2012, she says not one doctor in San Diego was willing to treat him. “When I called to make appointments, they kept telling me: ‘We don’t treat kids like that here,’” Moehlig said.

But she continued making calls, eventually breaking through at Rady Children’s Hospital. Her efforts drew attention from other families of transgender kids, many of whom began asking her for help. 

She decided she “couldn’t just be a family friend,” so eight years ago she started TransFamily Support Services , a nonprofit that offers a multitude of services to hundreds of families of transgender individuals across the country, including support groups, assistance navigating the medical system, and — most recently — political advocacy. 

Now, TransFamily Support Services is a co-sponsor of Senate Bill 107 , designed to protect from prosecution patients who travel to California for what supporters call gender-affirming care and doctors who provide that care.

The Assembly gave its final approval to the bill in a 60-19 vote . The Senate went along on a 30-9 vote, sending the bill to Gov. Gavin Newsom, who signed it Sept. 29.

The bill will make California a refuge for minors seeking gender-affirming care , similar to how Assembly Bill 1666 , which Newsom signed into law in June , made the state a refuge for those seeking abortions.

“It will send a very clear message that trans kids and their families, if they don’t feel safe in their state, they can come here and we’ll do everything in our power to protect them from prosecution,” state Sen. Scott Wiener, a San Francisco Democrat and the bill’s author, told CalMatters.

But state Sen. Melissa Melendez, a Lake Elsinore Republican, said the bill interferes with the relationship between parents and their transgender children.

“I don’t disagree that we should make sure that kids in this category are protected, and not bullied, and not harassed, and provided some understanding and certainly any medical attention mental-health-wise that they may need,” she said during the floor debate. “But I don’t think the state of California should be stepping in and facilitating that. That’s not our place.”

In a statement in response to the bill signing, Jonathan Keller, president of the California Family Council, said: “By signing this extreme bill, Gavin Newsom is telling all parents across the country that he knows what’s best for their children.”

But Tony Hoang, executive director of Equality California, countered in a statement: “While small, hateful men like Greg Abbott and Ron DeSantis attack trans children and their families, Governor Newsom today made clear that California will welcome them with open arms. SB 107 officially makes California a state of refuge for trans kids and their families.”

A national wave   

The bill, perhaps the highest profile of several LGBTQ-related proposals also signed by Newsom, responds to a recent wave of legislation: At least 40 bills in 20 states would restrict access to gender-affirming medical care for transgender youth. These proposals vary from an Idaho bill to criminalize gender-affirming medical procedures to a Florida law banning their insurance coverage . In Texas, state social workers are reportedly rebelling — or even threatening to quit — rather than carry out an order by Gov. Greg Abbott to investigate parents who allow transgender health care.

Proponents of the bill say it is California’s responsibility to intervene.

“There are efforts all across the country…to go after trans kids and their families. California has a role to play in providing a safe, welcoming environment for trans kids and their families to get the care they need,” said Samuel Garrett-Pate, managing director of external affairs for Equality California, which supports the bill and says it’s the nation’s largest LGBTQ civil rights group.  

SB 107 would: 

• Prohibit law enforcement participation and the arrest or extradition of an individual for allowing a person to receive or provide gender-affirming care when that care is legal under California and federal law. 
• Declare arrest warrants for individuals who allowed their child to receive gender affirming health care the lowest law enforcement priority.
• Ban the enforcement of another state’s law authorizing a state agency to remove a child from their parent or guardian because they allowed their child to receive gender-affirming care.
• Bar compliance with subpoenas seeking medical information related to gender-affirming care that interferes with a person’s right to allow a child to receive that care.

“As it stands, transgender youth and their parents in these states are under a constant threat of being reported by anyone around them, while foregoing life-saving treatment,” said Assemblymember Lori Wilson, a Suisun City Democrat and parent of a trans person, in presenting the bill on the Assembly floor. “In doing so, they are targeting our most vulnerable population — children — as well as their parents and doctors who support them.”

Learn more about legislators mentioned in this story

Scott Wiener

State Senate, District 11 (San Francisco)

Time in office

2016—present

Member, Board of Supervisors

Email Legislator

Race/Ethnicity

Voter Registration

Sen. Scott Wiener has taken at least $834,000 from the Finance, Insurance & Real Estate sector since he was elected to the legislature. That represents 14% of his total campaign contributions.

Lori Wilson

State Assembly, District 11 (Suisun City)

2022—present

Mayor / Finance Director

Asm. Lori Wilson has taken at least $379,000 from the Labor sector since she was elected to the legislature. That represents 24% of her total campaign contributions.

Foes raise concerns

By leaning into the national debate around transgender issues, the bill has generated intense opposition. 

Opponents say that children often misunderstand their gender identity and are likely to regret their decision to get irreversible treatments such as hormone replacement therapy and gender-affirming surgery.

“A lot of kids don’t quite comprehend the implications of taking puberty blockers, cross-sex hormones and even some of the surgeries; don’t comprehend the long-term nature and the damaging effect it would have on their on their bodies when they were minors,” said Greg Burt, a spokesperson for the California Family Council .

Burt cited testimony from Chloe Cole before the Assembly Public Safety Committee on June 28. 

“SB 107 is circumventing states’ laws and that have needed safeguards in place so my story’s not repeated. Children cannot consent,” said Cole, a 17-year-old from the Central Valley, who medically transitioned from age 13 to 15 with puberty blockers, male hormones and a mastectomy. 

Given this, Burt said the religious nonprofit “would be against any kind of drugs or surgeries to try and match a person’s body to their feelings below the age of 18,” regardless of parental consent.

“We don’t let parents sterilize their kids, even if parents consent to it, and we think this is in the same category,” Burt said. “You can’t harm your child permanently, even if you believe the harm is somehow justified.”

However, Sen. Richard Pan, a Sacramento Democrat who is also a pediatrician, said the medical profession does not recommend surgery for transgender individuals under the age of 18. During the floor debate on Wednesday, he cited research showing that the majority of children who question their gender identity do not change their minds and that the majority of treatments provided to transgender youth are reversible.

Opponents also highlight a clause in the bill that they say could take custody rights away from an out-of-state parent who disagrees with the other on their child’s gender-affirming care.

Erin Friday, a San Francisco attorney and parent of a child who once wanted to transition, said that the clause “pits parents against parents” by allowing an out-of-state parent to refile for full medical custody of their child in California and eclipse the consent of the non-affirming parent.

“It makes it easier for the one parent who wants to harm their child to harm their child, and it’s an enticement for kids to run away. There’s no two ways about it,” she said.

Wiener’s office disputes that this is the bill’s intent .

“The point of the bill is not to remove kids from their parents’ custody — not when parents come here with their kids to prevent states like Texas from removing them from their custody,” he said.

Helping families, one at a time

As the political debate rages on, Moehlig and her staff of 10 continue their work, helping families across America figure out the best doctor and how to get insurance coverage, and providing support groups for people from elementary school to age 30. She says her group has assisted 3,000 families in its lifetime.

That work convinces her of the importance of the bill. She said it’s “ludicrous” for politicians to assert that they know better than the parents of transgender children and their doctors about what medical care and treatment is best.     

As of now, every law that criminalizes gender-affirming care in other states has been delayed by legal challenges. Moehlig, however, said it’s only a matter of time before one of these bills becomes law.

And she’s already seeing the impact: She said she has multiple clients who have moved to California because of the laws in other states. One of her clients in Texas said his doctor canceled his female-to-male top surgery because they were no longer comfortable treating transgender youth.

“I think that protecting the rights of these parents to make these medical choices and get this treatment for these kids without having to worry about any of the ramifications of prosecutions is super important,” Moehlig said.

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Ariel Gans was a political reporting intern focusing on the 2022 election cycle. She recently got her master’s of journalism from Northwestern University, where she specialized in politics, policy, and... More by Ariel Gans

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A.G. File No. 2023-020

Pursuant to Elections Code Section 9005, we have reviewed the proposed measure (A.G. File No. 23-0020, Amendment #1) related to certain gender-affirming medical procedures for individuals under the age of 18 years.

Some Children Are Transgender. Sex generally refers to a person being biologically male, female, or intersex. The attitudes, feelings, and behaviors that a given culture associates with these biological designations are generally known as gender. Gender identity generally refers to an individual’s internal sense of being male, female, or something else. For example, transgender individuals have gender identities that differ from the sex assigned to them at birth.

Transgender Children Are a Small Share of California’s Population. Data on transgender individuals are limited. That said, research suggests that transgender individuals comprise a small share of children. For example, one recent study by the Williams Institute at the University of California, Los Angeles estimates that nearly 50,000 individuals (around 2 percent) of individuals between the age of 13 to 17 years identify as transgender in California.

Some Transgender Children Receive Health Care Services to Affirm Their Gender Identity. Some transgender individuals experience distress from having a gender identity that is different from their sex assigned to them at birth. Transgender individuals experiencing distress can receive certain health care services, including mental health services and medical treatments. These treatments can be a part of what is referred to as “gender affirming care.” Medical treatments can include prescription drugs to postpone the development of puberty (known as “puberty blockers”), hormone therapies, and surgeries. For transgender children, decisions around which treatment to provide and when to provide the treatment are made jointly by the physician and parent of the child, generally following professionally recognized standards.

California Law Protects Access to Gender-Affirming Care. A number of laws in California protect access to gender-affirming care for transgender individuals. For example, California law prohibits health insurance plans from discriminating against transgender patients, including by denying patients access to gender-affirming treatments when the treatments are medically necessary.

California Helps Pay for Health Care for Many Individuals, Including Gender Affirming Care. State and local governments help certain Californians pay for health care through a number of different programs. For example, Medicaid, known as “Medi-Cal” in California, provides health coverage to eligible low-income California residents. It is funded from a mix of federal, state, and local funds. Health care services covered by Medi-Cal include gender affirming care for transgender individuals, generally when considered to be medically necessary.

California Licenses Health Care Providers. California law requires health insurance plans, health care providers, and health care facilities to be licensed to provide health care services. Several departments are responsible for licensing health care entities in California. For example, the Department of Consumer Affairs includes numerous licensing boards that license health care providers, such as physicians, nurses, and pharmacists, among others. These departments and boards generally cover the cost to license providers and investigate complaints by charging affected providers fees and fines.

Prohibits Providing Certain Medical Treatments That Affirm a Different Gender Than Biological Sex for Youth. The measure would prohibit health care providers (such as a physician or a nurse) from providing patients under the age of 18 certain medical treatments that affirm a gender identity different than the patient’s biological sex. The initiative specifically would prohibit prescribing or administering puberty blockers, hormones or hormone antagonists, and surgery or medical procedures. The measure defines biological sex as either male or female, based on specified physiological and genetic attributes.

Excludes Three Kinds of Services From Prohibitions. The measure would exclude from these prohibitions the following: (1) services medically necessary to treat a minor born with a medically verifiable genetic disorder of sexual development; (2) services to return a child who previously received gender-affirming procedures back to his or her biological sex; and (3) services to children who began gender-affirming procedures prior to when the measure becomes law or January 1, 2025, whichever is earlier.

Enacts Consequences to Providers for Providing Services. Except for the exclusions described in the previous paragraph, providing a prohibited medical service under the measure would be considered unprofessional conduct and subject to discipline and a hearing process by the provider’s licensing entity. The measure specifies that such discipline would include revoking of the health care provider’s license or certification.

Fiscal Effect

Impact Depends on Court Rulings Related to Gender-Affirming Health Care. In recent years, several states have enacted prohibitions on health care providers from providing certain gender-affirming medical treatments, including treatments that would be prohibited under this measure. Many of these laws are being litigated in the federal court system to determine whether they conflict with the United States Constitution. At the time of this analysis, the courts have allowed bans in some states to take effect, while bans in other states have not been allowed to go into effect. If a court were to rule this measure could not go into effect, it would have no fiscal effect. Alternatively, were the measure to withstand legal challenges, there would be fiscal effects, described below.

If Measure Becomes Law, Possible Minor Savings From No Longer Covering Prohibited Treatments… Were the measure to become law, state and local government health programs that pay for gender-affirming puberty blockers, hormone therapies, and surgeries for youth could no longer do so. Although comprehensive data on state and local government spending for these services is not available, it could be as much as in the millions of dollars annually. This represents a very small share of overall state and local spending, with the state General Fund providing $37.5 billion to Medi-Cal in 2023-24, for example.

…Could Be Impacted by Other Long-Term Effects. The savings from no longer paying for health care services could be increased, reduced, or even offset by other health-related impacts. For example, some Medi-Cal enrollees under the age of 18 who otherwise would have received prohibited services may choose to receive some of these services when they are adults. In these cases, some of the spending associated with prohibited services would still occur, but at a later time for the individual. In other cases, individuals who are eligible for Medi-Cal as children may earn too much income to qualify for Medi-Cal as adults or forgo these services altogether. These effects are difficult to project. Also adding to the fiscal uncertainty, the long-term effects on mental and physical health of providing gender-affirming care to transgender youth are actively being studied. Depending on these long-term impacts, prohibiting certain gender-affirming medical treatments on individuals under the age of 18 could affect the use of health care services, with corresponding fiscal impacts

Potential, but Unknown, Cost Pressure Related to Federal Anti-Discrimination Laws. Federal law prohibits health care providers that receive federal funding for health programs (such as Medicaid) from discriminating against patients on the basis of race, sex, and other factors. Federal courts currently are assessing whether these nondiscrimination provisions extend to gender identity and the provision of gender-affirming care. Depending on the decisions in these court cases and any resulting federal actions, California providers could face a number of potential consequences, including revoked federal funding. Such actions also could place pressure on state and local governments to backfill lost federal funding. Whether action is taken and the magnitude of such action is unknown, but the impact could be significant.

Summary of Fiscal Effects. We estimate the measure would have the following fiscal effects:

• To the extent the measure can be legally implemented, potentially relatively minor savings up to the millions of dollars annually from no longer paying for prohibited services for individuals under the age of 18. These savings could be affected by many other impacts, such as individuals seeking treatment later in life.
• Potential, but unknown, cost pressure to state and local governments related to federal fiscal penalties if the measure results in providers being deemed out of compliance with federal law.

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California Becomes First Sanctuary State for Transgender Youth Seeking Medical Care

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California is the first state in the nation to create a sanctuary for transgender youth seeking gender-affirming medical care. Gov. Gavin Newsom signed a new law in September that ensures transgender kids from elsewhere can safely access hormones or puberty blockers here. The legislation also shields families from child abuse investigations or from being criminally prosecuted for seeking gender-affirming care.

“In California we believe in equality and acceptance. We believe that no one should be prosecuted or persecuted for getting the care they need — including gender-affirming care,” Newsom said in a signing message . “Parents know what’s best for their kids, and they should be able to make decisions around the health of their children without fear. We must take a stand for parental choice.”

This year a wave of bills in states ranging from New Hampshire to Arizona have attempted to limit, ban or criminalize access to medical care for transgender and nonbinary youth. An Alabama law passed in February not only banned medication for transgender youth, but ruled that doctors who break it could face up to 10 years in prison.

“You don’t disfigure 10-, 12-, 13-year-old kids based on gender dysphoria,” Florida Gov. Ron DeSantis said at an August press conference . “I think these doctors need to get sued for what’s happening.”

Most of these laws are in legal limbo as they are challenged in court . Meanwhile, families are panicking.

Scared out of Texas

After decades of building a life in Texas, a mother of a 12-year-old suddenly worried she might be investigated for child abuse, after Gov. Greg Abbott ordered the Texas Department of Family Protective Services to investigate parents who are providing gender-affirming care to their kids last February.

“We were stunned that it was no longer safe for us to be there,” said the mother, who asked that KQED not use her name to protect her identity and that of her child.

Even after a Texas judge temporarily stayed such investigations , Texas Attorney General Ken Paxton insisted that they were legal and would continue .

Media reports soon detailed experiences where state investigators pulled trans youth out of classrooms for interrogations.

“With their parents not being there,” said the Texas mother, adding that she heard similar stories from family friends. “And these are children that have only socially transitioned. All they asked for was to be called a different pronoun. That's terrifying.”

Three years ago, her own 12-year-old daughter asked her friends and family to use feminine pronouns.

“And so we sat down and talked to our kid,” she said. “We gave her a little card to go to school with that listed her rights and told her what to do if somebody came to investigate us.”

But the family could not relax. They said they had no choice but to sell their home. This fall they packed up all of their belongings and moved to Southern California.

“It feels very good to not feel like you're in danger — in that really critical place of our family being ripped apart,” said the mother.

Providing refuge

They feel safe under a new law authored by state Senator Scott Wiener (D-San Francisco), which declares that any potential out-of-state arrest warrant for violating laws related to such care will be given “the lowest law enforcement priority.”

“We are going to provide them with refuge and we're not going to send them back and we're not going to honor subpoenas,” said Sen. Wiener. “And our law enforcement is not going to enforce the laws of Texas and Alabama criminalizing these families.”

High stakes

Mental health therapists say puberty blockers and hormone therapy can save lives . A recent survey found that nearly 1 in 5 transgender 13- to 24-year-olds have attempted suicide in the past year.

The World Health Organization defines gender-affirming care as a variety of “social, psychological, behavioral and medical interventions designed to support and affirm an individual’s gender identity.”

These interventions can be nonmedical — called social transitioning — like when a child adopts a chosen name and/or new pronouns or dresses in alignment with their gender identity. Research suggests changing one's name may reduce depression and suicide ideation.

Also, beginning in early adolescence, doctors may prescribe medical interventions. The World Professional Association for Transgender Health recommends waiting until youth are 15 years old for surgical procedures, according to their new guidance released over the summer.

Constitutional questions

The new California law faces fierce opposition. Forty-five organizations, including the Alliance Defending Freedom and  The Heritage Foundation , penned a letter to Newsom urging him to veto Wiener’s bill.

“We want these treatments to not be happening on minors because they're permanent,” said Greg Burt, director of capitol engagement for the California Family Council , a Christian faith-based organization. “We do not assume that your body is the problem. We think it's much more logical to encourage young people to try and get their minds to match their bodies.”

Yet the standard of care for kids who are really distressed and diagnosed with gender dysphoria does include medical interventions.

California is also acting as a sanctuary for those individuals seeking abortions from other states after the U.S. Supreme Court overturned Roe v. Wade, the historic 1973 ruling that granted a legal right to the procedure. But conservatives, including Burt, argue that California’s “sanctuary” laws on abortion and gender-affirming care violate the Constitution.

“There's going to be a constitutional crisis if states don't honor each other's civil judgments,” Burt said.

Jessica Levinson, professor at Loyola Law School in Los Angeles, said there “could be litigation both with respect to abortion and with respect to gender-affirming care.”

But she and other legal experts are not convinced by conservative critiques that the new California laws violate the Constitution’s full faith and credit clause .

“I think the weight of the law indicates that states are separate sovereigns. If and until there is a national standard that indicates nobody can obtain gender-affirming care or nobody can obtain an abortion, the law allows for a patchwork,” Levinson said.

That patchwork is crucial to the families seeking help at Trans Family Support Services in San Diego.

“The politicians should not be making medical decisions for anybody, nor should they be making parental decisions for anybody,” said Kathie Moehlig, the organization’s executive director.

About a decade ago, Moehlig helped her 11-year-old access puberty blockers.

“My son would not still be alive if we waited until 18,” she said. “He already was in so much distress and so completely miserable that his body was becoming something that he knew he was not.”

Today she says her son is thriving in college, studying theology. He has never regretted transitioning.

There is no solid data on how many kids remain satisfied with medical interventions, or feel remorse about gender-affirming transitions. A recent report from Reuters highlights the lack of solid evidence on the long-term effects of gender-affirming care . For example, there is very little known about how transitioning affects fertility or cognitive development. Puberty blockers and sex hormones do not have FDA approval for children’s gender care, and the National Institutes of Health has said that clinical trials have not yet determined whether there are any short- or long-term health risks for teens.

For the Moehlig family, their only regret is that they waited as long as they did to transition their son.

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California Pride: Medi-Cal Coverage of Gender-Affirming Care Has Come a Long Way

By: Abigail Coursolle

What is gender-affirming care?

Transgender and non-binary people may be diagnosed with gender dysphoria , a condition that manifests as significant distress when people experience conflict between their assigned gender and the gender with which they identify. Some transgender and non-binary people experience a conflict between their assigned gender and gender identity without distress. But when people do experience clinically significant distress, they may require treatment to alleviate the distress. The standards of care for treating gender dysphoria involve a range of options depending on the needs and desires of the person seeking treatment. Together, these interventions are known as gender-affirming care. Gender-affirming health care interventions may include hormone therapy, surgical interventions, speech and language interventions, and behavioral health services. Not all transgender or non-binary people seek all health care interventions, and some may seek none. When people seek these interventions to treat gender dysphoria, they are considered medically necessary when treatment is consistent with the standard of care.

A short history of Medi-Cal coverage of gender-affirming care

In 1974, California’s Medi-Cal agency promulgated a bulletin that prohibited Medi-Cal payment for interventions related to surgical treatments for gender dysphoria. The case was challenged by two transgender individuals – G.B. , and J.D. – whose cases reached the California Court of Appeal in 1978. The Court ruled that G.B. and J.D. were entitled to have the gender-affirming surgical treatments they sought covered by Medi-Cal, since they were medically necessary to treat the individuals’ Gender Dysphoria, and were not cosmetic for that purpose. In the years that followed, however, Medi-Cal continued to exclude coverage of many gender-affirming treatments. Finally, in 2001, a California judge ordered the Medi-Cal agency to rescind its policy that automatically denied coverage for gender-affirming surgical procedures, and to instead review all requests on a case-by-case basis. Doe v. Bonta , Sacramento Superior Court of the State of California (case no. 00CS00954, January 29, 2001).

Even after the court’s decision in Bonta , many transgender and non-binary Medi-Cal beneficiaries found accessing the gender-affirming services they needed difficult. In 2013, after years of advocacy by LGBTQ and health equity advocates, including the Health Consumer Alliance , of which National Health Law Program is part, California’s Medi-Cal agency released guidance to providers and managed care plans, clarifying the scope of Medi-Cal’s coverage of treatments for gender dysphoria. The guidance was updated and further clarified in 2016 to include a discussion of the ACA’s non-discrimination provision (Sec. 1557), which was defined in regulations to prohibit categorical exclusions of gender-affirming treatments. Today, transgender and non-binary Medi-Cal beneficiaries can access myriad medical interventions to treat gender dysphoria, including behavioral health services, hormone therapy, and a variety of surgical procedures.

Looking ahead: Ensuring California continues to provide full access to treatment for transgender people in Medi-Cal

California has come a long way to make sure that transgender and non-binary Medi-Cal beneficiaries have full-access to the medical services they need. That is particularly important today, when LGBTQ rights, and in particular the right of transgender and non-binary people to access health care, are under attack by federal agencies , in the federal courts , and by other states . But there is still more work to be done in California. First, there are not enough health care providers in the state to meet the demand for certain interventions including some gender-affirming surgeries. Second, managed care plans sometimes deny medically necessary treatments for gender dysphoria as cosmetic. Third, transgender and non-binary people still face high incidence of discrimination and refusals in health care settings in the state. So as we celebrate Pride this year in California, and we commend the state for taking important steps forward to ensure that transgender and non-binary people in the state have access to the health care services they need, we must continue the work to end discrimination and remove enduring barriers that prevent access to care.

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Newsom signs bill protecting transgender youths and families fleeing red-state policies

Gov. Gavin Newsom signed a bill that will protect transgender youths fleeing laws in red states that ban gender-affirming care.

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Again heralding California as a refuge from discriminatory policies in conservative states, Gov. Gavin Newsom on Thursday signed into law a bill that aims to protect transgender youths and their families from bans against gender-affirming care.

Senate Bill 107 by state Sen. Scott Wiener (D-San Francisco) provides for a range of safeguards meant to block out-of-state attempts to penalize families that come to California seeking medical treatment for transgender children and teens or that move to the state to avoid consequences for already seeking that treatment elsewhere.

In a signing message, Newsom said that state laws attempting to ban medical care for transgender people younger than 18 “demonize” the community and are an act of hate.

“In California we believe in equality and acceptance. We believe that no one should be prosecuted or persecuted for getting the care they need — including gender-affirming care,” Newsom said. “Parents know what’s best for their kids, and they should be able to make decisions around the health of their children without fear. We must take a stand for parental choice.”

The new law prohibits California courts and attorneys from enforcing subpoenas requested by other states about gender-affirming care for minors, and healthcare providers from releasing medical information.

The bill also declares that any potential out-of-state arrest warrant for violating laws related to such care will be given “the lowest law enforcement priority.”

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“While attacks on the transgender community are not new, we are experiencing alarmingly blatant attempts to use legislation, policy and political rhetoric to restrict or eliminate the autonomy, freedom and existence of transgender people across the country,” the advocacy group Equality California said in a statement of support for the bill.

The California bill comes after more than 20 Republican-led states have introduced legislation to outlaw gender-affirming medical care for young people, and to penalize parents and healthcare providers who allow it.

The actual enactment of policies to limit that care has largely been stalled as states face legal challenges at the federal level. In August, a federal appeals court in Arkansas ruled that the state can’t enforce its ban on transgender children receiving gender-affirming medical care.

But Wiener said California cannot bank on such blockages continuing.

“We don’t know what’s going to play out in appeal or if states will find other kinds of laws they can get through to courts,” Wiener said in an interview before the bill’s passage. “It would be absolutely negligence for us to say we’re not going to do anything until one of these laws gets upheld and someone gets put in prison.”

Whether SB 107 itself will be upheld in court is also in question because of federal requirements that states must recognize out-of-state laws when residents travel.

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Last-minute amendments to the bill include a severability clause because “it is unclear whether this bill will run afoul of the Constitution,” according to a legislative analysis of the measure. Severability allows parts of a law to remain in effect even if other provisions are struck down.

Wiener acknowledged that uncertainty, and said that the bill was crafted carefully to avoid violations of the U.S. Constitution, but that California should not act as “an arm of law enforcement of the states of Texas or Alabama.”

“We may have limits under the U.S. Constitution, but we are going to go right up to the edge of what we’re able to do to protect them and say, ‘Unless we are absolutely forced to send you back, we are not going to send you back,’” he said of potential families of transgender youth that may come to California.

California has also labeled itself a “sanctuary state” for those seeking abortions , which several states have banned after the U.S. Supreme Court’s decision to overturn Roe vs. Wade, the historic 1973 ruling that granted a legal right to the procedure.

As with California’s attempt to support out-of-state residents seeking abortions, the effect of SB 107 is hard to estimate because many people in other states don’t have the option or financial wherewithal to abruptly move to California.

“We can’t solve everything in one bill. We’re making sure that people who are being criminalized have a place to go,” Wiener said. “This bill is about giving people refuge.”

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Gender-affirming care includes a range of “social, psychological, behavioral and medical interventions designed to support and affirm an individual’s gender identity,” according to the World Health Organization.

That can include hormones and puberty blockers, depending on a child’s age. The World Professional Assn. for Transgender Health recommends some surgeries for patients starting at 15 years old, according to new guidelines released in June.

Conservative groups opposed the bill. The California Family Council, which routinely opposes LGBTQ rights legislation, said that SB 107 encourages “medical child abuse.”

State Sen. Brian Dahle (R-Bieber), who is running against Newsom for governor, said that children “really don’t know what their identity is,” and that the legislation would insert the state into family custody battles.

“If one parent is for it and the other is against it, the state now will be in the middle of that decision,” Dahle said on the Senate floor before voting against the measure. “This bill is basically putting the state in your home.”

The bill’s supporters included Lt. Gov. Eleni Kounalakis, state Atty. Gen. Rob Bonta, Planned Parenthood Affiliates of California and Equality California.

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Mackenzie Mays covers state government and politics in the Los Angeles Times’ Sacramento bureau. Previously, she worked as an investigative reporter for Politico, the Fresno Bee and the Charleston Gazette-Mail. In 2019, she received the National Press Club Press Freedom Award for her political watchdog reporting. She is a graduate of West Virginia University and proud Appalachian.

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California courts may weigh affirmation of child’s gender identity in custody cases

FILE - Assemblywoman Lori Wilson, D-Suisun City, receives applause as she is introduced during an Assembly session in Sacramento, Calif., on April 7, 2022. Lawmakers on Wednesday, Sept. 6, 2023. debated legislation that would require courts to consider whether a parent affirms their child’s gender identity in custody introduced by Assemblywoman Wilson and other cases. It was one of dozens of bills that got a vote in the Legislature as lawmakers speed toward a Sept. 14 deadline. (AP Photo/Rich Pedroncelli, File)

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SACRAMENTO, Calif. (AP) — California could soon require judges to consider whether a parent affirms their child’s gender identity when making custody and visitation decisions under a bill that cleared the state Senate on Wednesday.

The vote was split almost entirely along party lines, with Democrats arguing the legislation would help to protect the well-being of LGBTQ+ children whose parents are going through a divorce. Democratic Sen. Scott Wiener, who represents San Francisco, said the bill was a proactive measure.

“This is about not having to get involved after a child has been beaten and had their arm broken, or after they’ve been kicked out,” Wiener said. “This is about trying to make sure that something terrible does not happen to them.”

Every Republican in the state Senate voted against the bill, with state Sen. Kelly Seyarto, who represents Murrieta in Southern California, arguing that lawmakers were interfering too much with how parents choose to raise their children.

“Inserting this into the mix is going to pit one parent against the other and make things worse,” Seyarto said.

The vote comes amid intense political battles across the country over transgender rights, including efforts to impose bans on gender-affirming care , bar trans athletes from girls and women’s sports, and require schools to notify parents if their children ask to use different pronouns or changes their gender identity.

The California bill would make gender affirmation one factor among many that courts already have to consider in custody proceedings, including whether a parent has been abusive and how much contact the child has with the parents. If the state Assembly agrees to amendments made to the bill, it would still have to be signed by Democratic Gov. Gavin Newsom to become law.

The bill would not require judges to prioritize whether a parent affirms their child’s gender identity over other factors. What affirmation looks like varies depending on the particular child and their age, said Assemblymember Lori Wilson, a Democrat who introduced the bill. She has an adult son who came out as transgender when he was a teenager.

Wilson said gender affirmation could include letting children play with toys associated with their gender identity, getting their nails painted or wearing their hair at a length that feels comfortable. The bill does not lay out specific requirements related to gender-affirming surgeries, which minors in California cannot undergo without a parent’s consent.

“A child whose parents are going through a divorce is going through probably one of the worst and most challenging experiences of their life (up) to that point,” said Alexis Sanchez, an advocate with the Sacramento LGBT Community Center. The bill could lead to better outcomes for those children in the future, Sanchez said.

It was one of several bills that lawmakers introduced this year aimed at protecting LGBTQ+ children. The state Senate also approved legislation Wednesday to keep documents related to a gender change petition for a minor out of the public record .

California lawmakers have fewer than two weeks to vote on hundreds of bills before adjourning for the year.

RESTRICTIONS ON GUNS

One of the longest debates of the day was over a resolution asking the Congress to change the U.S. Constitution to restrict how people can buy guns. Newsom is pushing for a 28th amendment to the Constitution to require universal background checks, and to ban assault weapons, as well as guns to anyone under 21, and to impose a waiting period on all gun purchases.

To be successful, 33 states would have to pass resolutions asking Congress to call a constitutional convention. California could be the first state to do that. The state Senate passed the resolution, and it now heads to the Assembly.

“We must go further than thoughts and prayers,” said Democratic state Sen. Aisha Wahab, who said her father was murdered by gun violence.

But Wiener, the San Francisco Democrat, voted against it, saying he is concerned a constitutional convention could lead to other, unpredictable changes to the constitution that would go beyond gun policy. He said he supports all of the proposals to restrict gun sales.

The resolution lawmakers approved on Wednesday calls for a “limited constitutional convention” that does not allow Congress to consider any amendments other than those relating to gun sales. State Sen. Shannon Grove, a Republican from Bakersfield, said she didn’t think other states would agree to that.

“This could open up a pandora’s box on the Constitution,” she said.

DECRIMINALIZING PSYCHEDELICS

California could become the next state to decriminalize the possession and use of “magic” mushrooms and other plant-based psychedelics for adults over 21 under legislation approved by the state Assembly Wednesday. Oregon and Colorado have already approved similar measures.

The bipartisan California bill would not legalize the sale of the drugs. A coalition of veterans who support the proposal say they rely on plant-based psychedelics to treat post-traumatic stress disorder.

“While pharmaceuticals certainly have a benefit to some people, it’s not having a benefit on all society,” Republican Assemblymember Bill Essayli said. “If there’s scientific data, which there is, to suggest that these could be promising therapeutics, I think people deserve an opportunity to seek those.”

The bill would require the state’s health agency to study and make recommendations on the therapeutic use of psychedelic substances.

Associated Press writers Adam Beam and Trân Nguyễn contributed.

Sophie Austin is a corps member for the Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places journalists in local newsrooms to report on undercovered issues. Follow Austin @sophieadanna

Fact check: Post distorts California bill about mental health services for children

The claim: California bill could strip custody from parents who refuse gender-affirming surgery

An April 10 Instagram post ( direct link , archived link)  shows an image of what appears to be the text of a bill.

“CA bill seeks to remove custody from parents and provide 'gender affirming' therapy to children without parental consent," reads text featured below the image of the bill.

Part of the post’s caption reads, “If the bill becomes law; children who wish to seek ‘gender affirming’ surgery who have parents that will not permit such mutilations, will be able to be removed from the custody of their parents.”

The post generated over 900 likes in less than a week. 

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Our rating: False

The California bill referenced in the bill would not change parental custody laws, according to the bill sponsor and legal experts. It also won’t change requirements for parental consent, which is currently required for gender-affirming surgery. Rather, it seeks to expand on existing laws concerning the consent of minors receiving mental health treatment and residential services.

Bill doesn't change existing parental custody laws

California lawmakers introduced Assembly Bill 665 , which seeks to allow some children between the age of 12 and 17 to receive mental health treatment without parental consent or notification, in February.

But there is nothing in the bill that allows children to be removed from their parent's custody, according to the bill's sponsor and legal experts.

"This bill makes no changes to the processes of the child welfare system in California and no changes to the processes of removal from a home," California Democratic State Rep. Wendy Carrillo , the bill's sponsor, said in an email to USA TODAY.

Joshua Jones, a legal writing professor at California Western School of Law, agreed that nothing about the proposed bill adds anything to existing child welfare laws that would allow a child to be taken from their parents.

Under California law, the removal of children from their parents' custody typically occurs when there are concerns about the child's safety and well-being, or when there is evidence of abuse, neglect or abandonment, Simona Grossi, a law professor at Loyola Law School, told USA TODAY.

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“The court must find clear and convincing evidence that there is a substantial danger to the child's physical health, safety, protection, or physical or emotional well-being, and that there are no reasonable means to protect the child without removal,” Grossi said in an email. " Cal. Welf. & Inst. Code § 366.26 provides for the procedures for conducting hearings to terminate parental rights or determine adoption, guardianship, or placement of children adjudged dependent children of juvenile court."

Scott Altman , a law professor at the University of Southern California, said that the bill does permit temporary stay in a residential shelter. But that is not the same as taking custody away from parents, which requires a showing of danger to the child, he said.

Bill doesn't allow for gender-affirming surgery without parental consent

Altman said the proposed bill allows the state to bypass parental consent for some mental health care, which might be gender-affirming, but it wouldn't allow gender-affirming surgery without consent. 

Assembly Bill   665  expands on existing laws around consent for minors regarding outpatient mental health or counseling services and shelter services, experts say. It would correct an inequity that separates the type of care available by the type of insurance used.

The bill, if passed, would allow minors between the ages of 12 and 17 to be treated by mental health professionals in outpatient services or residential shelter services without parental consent or notification if the child is deemed "mature enough to participate intelligently" and if parental involvement is determined to be "inappropriate."

The existing law, signed in 2010 by former California Gov. Arnold Schwarzenegger, allows minors ages 12 to 17  on private health insurance to consent to mental health and residential shelter services. But the law doesn't apply to recipients of  Medi-Cal, a state Medicaid program that pays for the medical services of low-income families. 

The proposed bill would ensure that Medi-Cal-insured youth have the same access to those services without the need for parental consent, according to Carrillo.

Fact check:  No, new Canadian bill won't allow prosecution of those who misgender others

USA TODAY reached out to the social media user who shared the claim for comment.

The Associated Press also debunked this claim.

Our fact-check sources:

• Scott Altman, April 17, Email exchange with USA TODAY
• Mary Persyn , April 17, Email exchange with USA TODAY
• Joshua Jones , April 17, Email exchange with USA TODAY
• Simona Grossi, April 17, Email exchange with USA TODAY
• Wendy Carrillo, April 18, Email exchange with USA TODAY
• California Legislative Information, accessed April 18,  Senate Bill No. 543
• California Legislative Information, accessed April 18, Assembly Bill 665
• California Legislative Information, accessed April 18,  WELFARE AND INSTITUTIONS CODE - WIC
• National Association of Social Workers, accessed April 19,  SENATE BILL SB 543

Thank you for supporting our journalism. You can subscribe to our print edition, ad-free app or electronic newspaper replica here .

Our fact-check work is supported in part by a grant from Facebook.

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Perspective: A reckoning is coming for California

California voters and policymakers aren’t on the same page on gender ideology.

By Valerie Hudson

California has always been in the forefront of issues concerning all things transgender. The 2019 Gender Recognition Act allows for change of gender by request on all government documentation, such as birth certificates and driver’s licenses. SB107 offers sanctuary to transgender youth fleeing states where transgender-related care, such as puberty blockers, cross-sex-hormones and sex reassignment surgery, are illegal for minors. 

Under California law , shelters are to admit individuals on the basis of gender identity and not sex, and ditto for any other facilities, such as gyms or spas or restrooms, that are single-sex: single-sex means single-gender in California. Furthermore, no documentation of gender identity, such as a driver’s license, is necessary; only an assertion of gender is required.

In California, employer-provided health plans must cover transgender-related care. Still another law allows prisoners to be housed according to gender identity, not sex. There are many other trans-related laws that could be mentioned that California has passed — more than any other state — making the state stand out in this area.

And some municipalities in California have even gone further. San Francisco offers a $1,200 per month guaranteed income to trans individuals for 18 months. The city also provides housing subsidies for them as well. Other cities such as Palm Spring and San Diego have similar initiatives underway.

All of this legislative and policy activity seems to suggest that the majority of Californians are in agreement with the direction their state government is taking on these issues. A new poll, however, seems to suggest that may not actually be the case. A November 2023 poll conducted by Spry Strategies of 1,000 likely California voters, with a margin of error of 3.1%, contains quite a few surprises. 

The sample was stratified to match overall demographic and party affiliation among California voters. So, for example, about 47% of California voters are Democrats , and the sample has 48% Democrats. About 52% of California voters are white, and that percentage was matched in the sample. Age, sex and other characteristics were also matched.

The first question of note was whether the respondent thought sex was binary — that is, male and female only.  Sixty-two percent responded in the affirmative, while only 22% did not believe sex was binary. More than 70% stated that the definition of a woman was someone who was “biologically born female.” And 72% of respondents stated that parents should be notified if their child identified as transgender in school. These are strong majorities.

Turning to single-sex activities, 59% stated that males who identify as females should not compete in women’s sports, with only 28% saying they should be allowed. Sixty-four percent stated males who identify as females should not be allowed in areas where women are changing or showering, with only 26% saying they should be allowed. Sixty percent stated that males who identify as females should not be housed in women’s prisons (rising to 68% when the perpetrator was convicted of domestic abuse or sexual assault), with 25% stating they should (declining to 16% in case of domestic abuse/sexual assault).

With regard to domestic violence shelters, 61% felt that males who identify as females should not be allowed, with 24% saying they should.  Sixty-three percent opposed all gender-affirming care (puberty blockers, cross-sex hormones, surgery) for minors, with 21% saying it should be allowed. Sixty-eight percent thought parents should not lose custody if they fail to affirm their child’s gender (as has been threatened by the state legislature), with only 12% favoring such a course of action.

Across all these survey questions, at least 2-3 times as many California voters rejected demands that biological sex be erased as a matter of law and policy, compared to the number that supported erasure. This is a robust rejection across the board, and a truly stunning result.

Furthermore, a similar survey was conducted among Californian voters three years ago with a slightly smaller sample size, with a margin of error of up to 4%. A comparison of the results shows that the percentage of California voters rejecting the erasure of biological sex has risen significantly in that short time span. Rather than becoming more acceptant, the Californian electorate has become more cautious over time.

For example, in the 2020 survey, 54% of respondents did not want males who identify as female in female changing rooms and showers; in 2023, that had increased to 64%, a jump of 10 percentage points. With regard to prison placement, in 2020 the percentage objecting was 46%; in 2023, it was 60%, a jump of 14 percentage points. For domestic violence shelters, 46% objected; in 2023 it was 61%, a jump of 15 percentage points.

That magnitude of jump, in the space of three years, is stunning. The longer Californians think about it and the more experience they have with the consequences, the less they are on board with the direction their state government is taking.

And despite its reputation as an outlier, on these issues, the Californian electorate is not out of step with the national electorate. A national Pew survey in 2022 found similar percentages opposed to the erasure of biological sex in sports (58% opposed), and asserting that sex is binary (60%), all very much in line with the thinking of Californians today. This survey too found evidence that the rejection of sex erasure was increasing over time, not decreasing.

A reckoning is coming. Whether you call this a democratic reckoning or a reckoning with common sense, candidates should beware. The political pendulum is swinging back more swiftly and with a greater degree of consensus behind it than anyone could have possibly imagined — even in California.

Valerie M. Hudson is a university distinguished professor at the Bush School of Government and Public Service at Texas A&M University and a Deseret News contributor. Her views are her own.

New & Stories

Ca legislators pass bill to take children from parent who doesn’t affirm kid’s gender identity.

• AB 957 , gender dysphoria , LGBT , parental rights , Transgender
• September 11, 2023

Last week the state legislature approved a bill to require judges to equate “affirmation of child gender transition” directly with a child’s “health, safety, and welfare” when determining custody or visitation rights.  Consequently,  parents who do not affirm the chosen gender identity of their child (of any age) risk having their child taken from them. AB 957 now heads to Governor Gavin Newsom’s desk for a final decision by October 14th, a bill he is expected to sign. (See Votes )

The legislation has drawn national attention and even become a talking point for presidential candidate Tim Scott. A ccording to Fox News , he called the bill “evil.” Tech entrepreneur and Tesla founder Elon Musk has also weighed in. In a discussion about AB 957 on X, formerly known as Twitter, Musk wrote , “ This bill is a wolf in sheep’s clothing.  What it actually means is that if you disagree with the other parent about sterilizing your child, you lose custody.  Utter madness!”

This is California State Rep. Lori Wilson, who wrote AB 957: "Parents affirm their children. Typically it happens when their gender identity matches their biological gender. But when it doesn't, the affirmation starts to wane... Our duty as parents is to affirm our children." pic.twitter.com/KP2Z9sksmp — Greg Price (@greg_price11) September 8, 2023

“It is unconscionable that state legislators are trying to take children from parents who believe the sex of their children is a matter of biology and not feelings, or because they want to protect their children from sterilizing drugs and mutilating surgeries,” said Greg Burt, Capitol Director for the California Family Council. “If Governor Gavin Newsom signs this bill, parents have every right to sue. Every parent has a God-given responsibility and a constitutionally protected right to direct the upbringing, education, and care of their own children. No one should lose custody of their children because their opinions or religious beliefs are unpopular with state politicians.”

The bill’s author, Assemblywoman Lori Wilson (D-Livermore), is the only legislator who has a child who identifies as transgender. During the Assembly Floor session debate last week, Wilson defended her bill arguing it is the duty of parents to “affirm the child’s gender identity and expression… whatever that is.” 

While California legislators seemed determined to mandate that every gender-confused child be socially and medically transitioned,  countries all over Europe  are backing away from the “gender affirmation” model of care for minors with gender dysphoria. For instance, just recently the  Norwegian Healthcare Investigation Board , (NHIB/UKOM) has deemed puberty blockers, cross-sex hormones & surgery for children & young people experimental, determining that the current “gender-affirmative” guidelines are not evidence-based and must be revised. 

Scientific literature is starting to question the studies on which “gender-affirming care” is based. For instance, the  Journal of Sex and Marital Therapy  published an article in January of 2023 titled, The Myth of “Reliable Research” in Pediatric Gender Medicine: A critical evaluation of the Dutch Studies—and research that has followed. These are the types of articles you would be mandating judges ignore when determining what is really in the best interest of a child.

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California Pays for Transgender Prisoner’s Sex Reassignment Surgery

by Joe Watson

The rights of transgender prisoners are in the throes of a major transition.

In August 2015, California’s Department of Corrections and Rehabilitation (CDCR) made the unprecedented decision to pay for sex reassignment surgery (SRS) for Shiloh Quine, 57, a transgender woman incarcerated since 1980. Seventeen months later, in January 2017, Quine became the first U.S. prisoner to receive state-funded SRS.

The decision to pay for the surgery resolved a lawsuit filed on Quine’s behalf by the Transgender Law Center, which argued that denying the procedure would violate the Eighth Amendment’s prohibition against cruel and unusual punishment.

A settlement in Quine’s lawsuit also resulted in California prison officials agreeing to provide toiletries and clothing specific to the preferences of transgender prisoners or those diagnosed with “gender dysphoria” – a recognized medical condition. See: Quine v. Beard, U.S.D.C. (N.D. Cal.), Case No. 3:14-cv-02726-JST.

The CDCR’s original position, that SRS was not medically necessary in Quine’s case, was undermined by the department’s own expert.

“[SRS] is medically necessary to prevent Ms. Quine from suffering significant illness or disability, and to alleviate severe pain caused by her gender dysphoria,” wrote Richard Carroll, a clinical psychologist at Northwestern University in Chicago.

Quine is serving life without parole for first-degree murder, kidnapping and robbery, and thus does not have the option of having SRS after her release.

Like nearly 400 other transgender prisoners in California, she received hormone therapy to aid her transition. Still, she repeatedly attempted suicide after CDCR officials denied her requests for surgery, which costs between $15,000 and $25,000.

Quine’s attorneys believe the settlement in her lawsuit sets a precedent for future cases. “This is clearly where the law is going and where the entire health industry is going,” said Ilona Turner, the Transgender Law Center’s legal director.

There are others, of course, who disagree.

“A settlement is not a precedent,” argued Kent Scheidegger, legal director for the conservative Criminal Justice Legal Foundation. “But I suppose it gives a little ammunition to the next guy to say, ‘you did this for him, why not me?’”

“The idea that the Eighth Amendment requires something for prisoners not available to the law abiding public is something a lot of people find offensive,” he added.

One of those people was Farida Baig, who had attempted to block Quine’s state-funded SRS through litigation. Baig is the daughter of Shahid Ali Baig, who was robbed and murdered by Quine and an accomplice.

While Quine’s case was the first time any state had agreed to pay for a transgender prisoner’s SRS, others have won, at least temporarily, the right to surgery.

In April 2015 another CDCR transgender prisoner, Michelle Norsworthy, was scheduled to receive SRS due to a federal court decision. But she was subsequently paroled, letting prison officials off the hook for her surgery.

And in early 2014, a panel of the First Circuit Court of Appeals ruled that Massachusetts transgender prisoner Michele Kosilek, who had repeatedly attempted suicide and self-castration, had a constitutional right to SRS. [See: PLN, Dec. 2014, p.18]. But the appellate court recalled its initial ruling, and in December 2014 the en banc court reversed and denied Kosilek’s surgery on the grounds that it would endanger prison security.

Until the completion of her SRS, Shiloh Quine was housed at the CDCR’s Mule Creek State Prison, a protective custody facility for male prisoners that also houses transgender women. After being transferred to the Central California Women’s Facility in Chowchilla, Quine said the prison was “a torture unit,” as she was isolated from other prisoners and denied basic hygiene items such as shaving razors. As a result, she began growing facial hair. According to a March 22, 2017 news report, Quine stated in a court filing that prison officials had “no legitimate penological objective but harassment” in refusing to let her shave.

California’s is not the only prison system in a state of flux where transgender issues are concerned. In August 2016, it was announced that federal Bureau of Prisons prisoner Marius Mason, serving a 22-year sentence for arson, had been approved to begin hormone treatment to transition from female to male.  

Sources: www.latimes.com, www.nytimes.com, www.courthousenews.com, www.mcclatchydc.com, www.wboc.com

More from this issue:

• PLN Interviews CIA Whistleblower John Kiriakou
• Washington Sex Offender Records Not Exempt from PRA Disclosure
• Vermont Supreme Court Adopts Prison “Mailbox Rule”
• PLN Files Censorship Suit Against Cook County, Illinois
• Ninth Circuit: “Debatable” Constitutionality Requires Qualified Immunity
• Fourth Circuit Reinstates Prisoner’s Lawsuit Over Coerced Penis Surgery , by Lonnie Burton
• Despite Past Problems, Prison Privatization in Ohio May Expand , by Lonnie Burton
• BOP Potentially Liable for Valley Fever Outbreak at Privately-run California Prison , by Lonnie Burton
• Lawsuit Claims Ohio Jail Guards Raped, Tortured Female Prisoner
• GM Hides Defect that Killed 124 People, but No One Goes to Prison , by Joe Watson
• Fee Award in Arizona Prison Healthcare Suit Helps Fund Legal Services for Immigrant Detainees, ACLU , by Joe Watson
• California Pays for Transgender Prisoner’s Sex Reassignment Surgery , by Joe Watson
• ACLU Exposes Debtors’ Prisons Across New Hampshire , by Joe Watson
• Federal Dismissals Not In Forma Pauperis Strikes in Arkansas
• Michigan County Jail Loses Appeal on Legal Mail, Settles with ACLU , by Derek Gilna
• Innocence Project Blasts Lack of Consequences from Prosecutorial Misconduct , by Derek Gilna
• Connecticut DOC Settles Five Percenters Religious Rights Suit , by Derek Gilna
• $175,000 Settlement for BOP’s Deliberate Indifference to Mentally Ill Prisoner , by Derek Gilna
• Denial of Sex Offender Treatment Nets Disabled Utah Prisoner $60,000
• Ignorance, Bureaucracy and Red Tape: U.S. Citizens Mistakenly Deported , by Christopher Zoukis
• COA Not Required for Innocence Protection Act Appeals
• Texas City Settles Suit Over Jail Prisoner’s Death for $1.25 Million , by Matthew Clarke
• Settlement in Baltimore Prison Conditions Class-Action Suit
• NY State Prisoner Settles Case Over DOC’s Denial of Hepatitis C Treatment , by Derek Gilna
• New York: $67,000 Jury Award in Rikers Island Prisoner’s Suit
• Exonerated Illinois Prisoner Wins $22 Million Verdict Against City of Chicago , by Derek Gilna
• $155,000 Settlement in Lawsuit Over California Jail’s Censorship of PLN , by Matthew Clarke
• $50,000 Jury Award in South Carolina Prisoner’s Failure to Protect Suit
• $16,650,000 Settlement in D.C. Wrongful Conviction Suit , by Matthew Clarke
• Oregon: Muslim Prison Visitor Receives $40,000 for Discrimination, Retaliation
• Two Alabama State Court Judges Disciplined , by David Reutter
• Pennsylvania: Compassionate Release Reforms Fail to Achieve Aim , by David Reutter
• Site of Gruesome Prison Riot Becomes New Mexico Tourist Attraction , by Joe Watson
• Report Presents Bleak Analysis of BOP Medical Bureaucracy , by Derek Gilna
• Stock Prices for Private Prison Firms Surge After Trump Elected President , by Derek Gilna
• State Sentencing Reforms Doing Little to Reduce Nation’s Prison Population , by Lonnie Burton
• Work Release Programs Reduce Recidivism in Louisiana – At a Cost
• Arizona DOC Invites Attorneys to Provide Execution Drugs for Their Clients
• California Prisoners Provide Cheap Labor to Fight Dangerous Wildfires , by Joe Watson
• New Treatment Regimen for Latent TB Shows Promise
• Your Kid Goes to Jail, You Get the Bill , by Eli Hager
• 28 Days in Chains , by Christie Thompson and Joseph Shapiro
• News in Brief
• New York: Contraband Convictions Vacated After Guard Admits Planting Weapon
• HRDC Supports Lawsuit Against Jailing of Immigrant Children
• HRDC Condemns CoreCivic’s Rejection of Resolution for More Oversight
• From the Editor , by Paul Wright
• Another Florida Prisoner Death, Another Cover Up? , by David Reutter
• Yale Law School Report Examines Variations in Death Row Housing Units , by Derek Gilna
• Supreme Court Reverses Criminal Conviction for Racial Bias by Juror , by Derek Gilna
• “PrisonCloud” Provides Limited Internet Access to Belgian Prisoners , by Derek Gilna
• Video Calling Services vs. In-person Visitation , by Christopher Zoukis
• Report: How Private Prison Companies Exercise Influence Over Public Officials , by Christopher Zoukis
• Privately-run Montana Jail Remains Mostly Empty Since 2007 , by Christopher Zoukis
• Arkansas Judge Charged with Trading Leniency for Sexual Favors

More from Joe Watson:

• 3 Murders in 10 Months at Oklahoma Prison Run by CCA , Jan. 3, 2018
• Missouri’s Release of Pot Dealer Doing LWOP Gives Hope to Nonviolent Drug Offenders Incarcerated Nationwide , Nov. 28, 2017
• Former Sheriff Arpaio Guilty of Criminal Contempt, Receives Presidential Pardon , Nov. 6, 2017
• IRS Audit Prompts New Mexico County to Convert Bonds Used for ICE Facility , Oct. 10, 2017
• TN Prison Counselor Suspended for Posting Insults on Facebook , Aug. 30, 2017
• Wiccan Prisoner Settles with NV DOC Over Denial of Hardbound Religious Books , Aug. 7, 2017
• Settlement for IN Man Deprived of Critical Meds While Incarcerated in County Jail , Aug. 7, 2017
• NV Prisoner with Hand Injury Settles for Used TV, Medical Evaluation and $40.70 in Copying Fees , Aug. 7, 2017
• IN Woman Settles Wrongful Arrest Lawsuit , Aug. 7, 2017
• $7,500,000 Class-Action Settlement for Illegal Strip-Searches in Camden, NJ , Aug. 7, 2017

More from these topics:

• Tennessee Private Prison Gets State’s First LGBTQ+ Group , Nov. 15, 2023. Corrections Corporation of America/CoreCivic , Advocacy , Transgender Medical Procedures .
• Seventh Circuit Sides With Muslim Prisoner, Bars Strip Search by Transgender Wisconsin Guard , March 1, 2023. Strip Searches , Religious Practices , Discrimination (Transgender) .
• Transgender Idaho Prisoner Who Won Gender Conforming Surgery Awarded Over $2.6 Million in Legal Fees , March 1, 2023. Settlements , Transgender Medical Procedures .
• Federal Judge in Pennsylvania Rules BOP Must Honor Transgender Prisoner’s Legal Name Change , Feb. 1, 2023. Name Changes , Transgender Medical Procedures , Bureau of Prisons (BOP) .
• Fourth Circuit Says Prisoners with Gender Dysphoria not Excluded from ADA Protection , Feb. 1, 2023. Americans with Disabilities Act , Transgender Medical Procedures .
• Federal Judge Calls Out BOP’s ‘Plinko’ Tactics, Orders Surgeon Found for Trans Prisoner’s Gender-Confirming Procedure , Oct. 31, 2022. Transgender Medical Procedures .
• 11th Circuit Tells Sexually Assaulted Transgender Georgia Prisoner: PREA Violations Aren’t Per Se Eighth Amendment Violations , Oct. 27, 2022. Sexual Assault , Eighth Amendment , Prison Rape Elimination Act , Discrimination (Transgender) .
• Idaho Provides Nation’s Second Gender Confirmation Surgery for Transgender Prisoner , Sept. 30, 2022. Transgender Medical Procedures .
• Seventh Circuit Reiterates That Threats and Withholding Grievance Forms Render Administrative Remedies Unavailable to Prisoner , July 15, 2022. Retaliation for Filing Grievances , Failure to Protect (General) , Eighth Amendment .
• Eighth Circuit Reinstates Arkansas Prisoner’s Claim Over DOC’s Failure to Maintain Hearing Aids , July 15, 2022. Correct Care Solutions , Hearing , Failure to Treat , Malpractice , Eighth Amendment , Americans with Disabilities Act .

TLDEF's Trans Health Project

Gender reassignment surgery.

Policy: Gender Reassignment Surgery Policy Number: BSC7.02 Last Update: 2021-04-01 Issued in: California

Body Contouring:

Additional surgeries may be proposed (i.e., body feminization or masculinization) for an individual who is planning to undergo or has undergone gender reassignment surgery. Including, but not limited to, the following surgical procedures need to be reviewed for medical necessity (see documentation needed for medical necessity determination in the Policy Guidelines section): Calf implants Gluteal and hip augmentation (implants/lipofilling) Liposuction (removal of fat in the hips, thighs, or buttocks) Pectoral implants Suction-assisted lipoplasty of the waist

Breast Reconstruction:

Additional surgeries may be proposed (i.e., body feminization or masculinization) for an individual who is planning to undergo or has undergone gender reassignment surgery. Including, but not limited to, the following surgical procedures need to be reviewed for medical necessity (see documentation needed for medical necessity determination in the Policy Guidelines section): Breast enlargement procedures, including augmentation mammoplasty, implants, and silicone injections of the breast

Facial Reconstruction:

Additional surgeries may be proposed (i.e., body feminization or masculinization) for an individual who is planning to undergo or has undergone gender reassignment surgery. Including, but not limited to, the following surgical procedures need to be reviewed for medical necessity (see documentation needed for medical necessity determination in the Policy Guidelines section): Blepharoplasty/Brow reduction/brow lift (removal of redundant skin of the upper and/or lower eyelids and protruding periorbital fat) Chin augmentation (reshaping or enhancing the size of the chin) Chin/nose/cheek implants Face lift/forehead lift (e.g., rhytidectomy) Facial reconstruction for femininization or masculinization (e.g., facial bone reduction) Forehead augmentation Hair reconstruction (hair removal/hair transplantation) Jaw/mandibular reduction or augmentation Lipofilling Lip reduction/enhancement (decreasing/enlarging lip size) Rhinoplasty (reshaping of the nose) including nose implants Trachea shave (Adam’s apple shaving)/reduction thyroid chondroplasty (reduction of the thyroid cartilage)

Permanent Hair Removal:

Additional surgeries may be proposed (i.e., body feminization or masculinization) for an individual who is planning to undergo or has undergone gender reassignment surgery. Including, but not limited to, the following surgical procedures need to be reviewed for medical necessity (see documentation needed for medical necessity determination in the Policy Guidelines section): Electrolysis or laser hair removal for facial, or body areas other than pubic region. Reevaluation by a qualified medical provider is needed if treatment exceeds 6 months or 30 hours. Pubic area electrolysis or laser hair removal may be considered medically necessary when there is a recommendation from the surgeon (with documentation in the medical record) of the need to be done related to a planned genital reconstructive surgery. This treatment can be done during the same time period as hormonal therapy and living in the preferred gender role full time. Photographic and endocrinologist documentation is not required. Re-evaluation by a qualified medical provider is needed if treatment exceeds 6 months or 30 hours.

Voice Therapy and Surgery:

Additional surgeries may be proposed (i.e., body feminization or masculinization) for an individual who is planning to undergo or has undergone gender reassignment surgery. Including, but not limited to, the following surgical procedures need to be reviewed for medical necessity (see documentation needed for medical necessity determination in the Policy Guidelines section): Cricothyroid approximation (voice modification that raises the vocal pitch by stimulating contractions of the cricothyroid muscles with sutures) Laryngoplasty (reshaping of laryngeal framework) Voice modification surgery and voice retraining (speech therapy)

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Updated on Nov 23, 2021

Idaho governor signs bill banning use of public funds for gender-affirming care

T ransgender people in Idaho will no longer be able to use Medicaid and other publicly funded programs to help cover the cost of gender-affirming medical care under a new state law set to take effect in July.

Republican Gov. Brad Little quietly signed the measure Wednesday, a day after receiving it from Idaho’s GOP-controlled Legislature. Little’s office did not immediately return a request for comment.

The law, which is set to take effect July 1, bars the use of public funds for puberty blockers, hormones, and surgeries for transgender minors and adults and prevents government-owned facilities from providing them.

Those who intentionally violate the law could face misuse of public funds charges, which carry a penalty of up to $10,000 in fines and imprisonment between one and 14 years.

Idaho joins a growing coalition of Republican-led states in banning Medicaid funding for gender-affirming care for transgender people of all ages,  according to the Movement Advancement Project , a nonprofit organization that tracks LGBTQ laws. The Medicaid policies of three states explicitly exclude transition-related care for minors.

A federal judge in June  struck down a Florida rule  excluding gender-affirming health care from Medicaid coverage, writing in a 54-page opinion that Florida had adopted the rule “for political reasons.” That same month, a federal judge in Arkansas  blocked the state’s ban  on gender-affirming care for minors, including in the state’s Medicaid program.

Little has said on several occasions that he does not believe public funds should be used for gender-affirming care. In a May letter to Idaho’s Department of Health and Welfare, Little said he was opposed to using Medicaid funds for puberty blockers, hormones and surgeries for transgender children and adults.

“Hardworking taxpayers should not be forced to pay for an adult’s sex reassignment surgery,” he wrote.

In April, Little  signed legislation making it a felony  for health care providers to administer gender-affirming care to minors in Idaho. In a letter to House leadership, Little wrote that while it is important to protect minors “from surgeries or treatments that can irreversibly damage their healthy bodies,” as lawmakers, “we should take great caution whenever we consider allowing the government to interfere with loving parents and their decisions about what is best for their children.”

A federal judge in December temporarily  blocked the state’s ban  from going into effect. In February, Idaho appealed that decision  to the Supreme Court.

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