Know Your Rights: Attorney General Bonta Issues Guidance on Gender-Affirming Care Rights in California

OAKLAND — Amidst escalating attacks against the LGBTQ+ community and gender-affirming care, California Attorney General Rob Bonta today issued guidance outlining protections under California law for medical providers and patients seeking gender-affirming care, as well as obligations for insurers and health plans. California law prohibits healthcare providers and insurers from discriminating or denying healthcare services to a patient for being transgender, nonbinary, gender nonconforming, or intersex, or due to a diagnosis of gender dysphoria. Today’s guidance provides information regarding legal protections and obligations related to gender-affirming care under California law. 

“As the Trump Administration continues its political attacks against our transgender and LGBTQ+ communities, California remains committed to protecting and upholding everyone’s right to access healthcare free from discrimination,” said Attorney General Bonta. “It is critical that you know your rights: In California, state law protects you from discrimination and guarantees access to medically necessary care for everyone, regardless of gender identity. Insurance companies in California have a legal obligation to provide timely, safe, and equitable access to healthcare services, so you can get the support you need.”

In California, you have the right to receive medically necessary gender-affirming care or any other medically necessary healthcare without discrimination. Insurance companies and health plans cannot deny coverage or benefits based on a person’s gender identity or diagnosis of gender dysphoria. Nor can they deny coverage because of inconvenience or inadequate provider networks. If no in-network provider is available within the required time or distance, your insurer must arrange care with an out-of-network provider. Insurance companies also cannot penalize or discriminate against doctors for providing gender-affirming care.

You are Protected from Out-of-State Investigations:

California law protects individuals and families accessing gender-affirming care in our state from other state’s investigation and prosecution. You have the right to receive gender-affirming care in California without fearing that state and local law enforcement will provide your information to aid another state’s investigations into care lawfully performed in California. You have the right to institute a civil action for injunctive, monetary, or other appropriate relief against someone who engages in abusive litigation that infringes on or interferes with gender-affirming care legally performed in California.

Healthcare Practitioners in California are Protected for Providing Lawful, Medically Necessary Gender-Affirming Care: 

Medical boards that certify health professionals cannot deny applications for licensure, or suspend, revoke, or otherwise discipline providers based on the performance, recommendation, or provision of gender-affirming care. Staff privileges cannot be denied or restricted based on any out-of-state action against a healthcare practitioner for providing gender-affirming care. 

Additional Protections:

• California’s Lesbian, Gay, Bisexual, and Transgender Long-Term Care Facility Residents Bill of Rights prohibits discrimination against individuals in long-term care facilities based on their actual or perceived sexual orientation, gender identity, gender expression, or HIV status.
• California requires that foster youth, including transgender, nonbinary, intersex, and gender expansive youth in foster care, have access to medically necessary gender-affirming care, including gender-affirming mental healthcare, based on the prevailing standards of care.
• Transgender and intersex youth detained in California juvenile facilities have the right to access medical and behavioral health providers qualified to provide care and treatment to transgender and intersex youth.

Obligations of Insurers and Healthcare Plans:

• Insurers and healthcare plans covered by California law are prohibited from denying an individual a plan contract, health insurance policy, or coverage for a benefit included in the contract or policy, based on a person’s sex. This includes medically necessary gender-affirming care for treating gender dysphoria.
• Insurers and healthcare plans must also cover medically necessary treatment for gender dysphoria as part of the requirement to cover behavioral health conditions under California law.
• If an in-network provider is unavailable to provide services according to the geographic and timely access standards, the insurer must arrange for an out-of-network provider to provide the services.
• An insurance company shall not terminate or refuse to issue or renew professional liability insurance or increase the premium or deductible for healthcare providers based solely on their provision of gender-affirming care, including based on any legal action taken against the provider by another state for providing such care. 

RESOURCES 

California has a number of resources for transgender people and the broader LGBTQ+ community: 

• California Department of Justice’s Health Equity and Civil Rights webpage
• California Department of Justice’s LGBTQ+ Discrimination Rights webpage
• Transgender, Gender Diverse, and Intersex (TGI) Inclusive Care Act
• California Department of Health Care Services’ Medi-Cal State Inmate Program and Medi-Cal County Inmate Program webpage
• California Civil Rights Department’s The Rights of Employees Who Are Transgender or Gender Nonconforming fact sheet
• California Department of Insurance’s Equal Access to Health Insurance: Coverage for Transgender Californians webpage
• California Department of Managed Health Care’s TGI Care webpage  

If you believe your rights are being violated, you can file a complaint with the California Attorney General’s Office here or with the California Civil Rights Department here. 

A copy of the Know Your Rights guidance is available here.