Children's Health Insurance Program

California is assessing whether state funds can cover a gap left after the Trump administration, through the Centers for Medicare & Medicaid Services under Mehmet Oz, moved to restrict federal Medicaid funding for gender-affirming care. Medi-Cal data show youth patients filed about $1 million in claims for hormone therapy and puberty blockers in 2025, plus $6.4 million for related services like counseling and doctor visits. Gender-affirming surgeries for minors remain rare.

The new federal rule, effective October 13, targets puberty blockers, hormone therapy, and surgeries, but leaves mental health services reimbursable and allows states to fund the restricted care themselves. California has set aside a $30 million fund for gender-affirming care and abortion services and a $26 million trans healthcare trust fund, which state health officials expect to cover Medi-Cal needs for three years. Trans youth services represent a tiny fraction of Medi-Cal's roughly $200 billion budget.

Advocates and the state's LGBTQ Legislative Caucus warn of future funding pressure, while Attorney General Rob Bonta's office says it is reviewing the rule but has not announced litigation.