Health policy

A new report from Washington's state hospital and community health associations projects hospitals will lose nearly $6 billion in revenue through 2033 due to federal Medicaid cuts enacted under last year's Republican-backed tax and spending law. Sen. Maria Cantwell and healthcare leaders warned the roughly $900 billion in nationwide cuts will raise ER wait times, premiums and uncompensated care costs. About 200,000 Washingtonians are expected to lose coverage by next year, partly due to new work requirements starting January 1 and the removal of coverage for refugees and asylees. Rural hospitals, including on the Olympic Peninsula, face the steepest losses, with clinics also bracing for major reimbursement shortfalls and reduced patient visits.

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.