California will fund gender-affirming care for youth on Medicaid after the Trump administration cuts off federal funding next month, a victory for patient advocates who had lobbied state lawmakers and Gov. Gavin Newsom to step in.

However, some advocates are concerned that state health officials have moved too slowly to prevent interruptions in care for those youth.

The California Department of Health Care Services, a branch of Newsom’s administration, said Friday that state dollars will be used to reimburse providers of gender-affirming care for youth covered by Medi-Cal, the state version of Medicaid, after new federal restrictions kick in October 13.

A rule by the federal Centers for Medicare & Medicaid Services prohibits federal reimbursement for surgeries, puberty blockers and hormone therapies for minors’ gender transition. It also applies to patients 18 and younger on the Children’s Health Insurance Program for families who can’t afford private insurance. The California Medical Association, which represents 50,000 doctors, wrote that the rule “threatens access to medically necessary, evidence-based care for transgender youth.”

State health agencies told physicians at hospitals and clinics to continue booking those appointments, and to expect reimbursement with state funds via a new grant program for gender-affirming and reproductive care.

“California is unwavering in its commitment to transgender and gender-diverse youth,” Department of Health Care Services spokesperson Anthony Cava told the Bay Area News Group. “Gender-affirming care improves health and well-being, and California will continue standing with young people, their families, and the providers who care for them.”

About 1,500 transgender youth in California are covered by Medi-Cal — a small slice of the state’s estimated 85,000 transgender kids and teens. In a lobbying campaign this summer, advocates said providers would stop offering gender-affirming care to those youth without state funding, jeopardizing their health and well-being.

Now, those youth and their families will be “much better off” than those in states where officials are not backfilling the federal cuts, said Andrew Ortiz, senior policy attorney at the Oakland-based Transgender Law Center. Elsewhere, Massachusetts and New York are also funding that care for youth, Ortiz said.

California lawmakers have set aside $66 million for abortion, gender-affirming care and other “uncompensated care” that cannot be paid for with federal dollars, as the Trump administration slashes health spending. To spend the funds, the state Department of Health Care Access and Information is setting up a new grant program to pay providers of gender-affirming care.

But Arne Johnson, a Berkeley father of a transgender child and organizer with Rainbow Families Action, said health officials have moved too slowly.

“California was completely unprepared for something that’s been developing basically since the moment that Trump was elected,” Johnson said.

The federal Centers for Medicare & Medicaid Services began planning its spending prohibition on gender-affirming care in December 2025. In response, the state Department of Health Care Access and Information posted a request for proposal last week to find a partner organization able to administer the grant program.

Johnson’s child is not a Medi-Cal recipient, but the advocate said families who are covered by the government insurance program have been bracing for trouble keeping their doctors or finding new ones.

Others are concerned that could still be the case. It could take months or longer for state health authorities to actually deliver the funding to providers, said Ortiz of the Transgender Law Center.

A spokesperson for the agency, Andrew DiLuccia, said officials are “in close contact with providers, advocates and community members to ensure timely and responsive use of funds.” It set a deadline of September 29 for organizations to apply.

Gender-affirming care includes medical treatments that help align a person’s physical characteristics with their gender identity. Care typically begins with therapy and may progress to puberty-blocking medicine and hormone treatments, and in rare cases for adolescents, surgeries.

Writ large, even nonsurgical treatments are rare for U.S. youth. A medical journal study in 2025 found fewer than one in 1,000 U.S. teens with commercial insurance took puberty blockers or hormone treatments in a five-year period.

Most major medical associations endorse the treatments as beneficial medical care for youth struggling with their gender identity, and a global professional association has developed standards of care to guide providers. But not all professional associations are in lockstep. The American Society of Plastic Surgeons recommends delaying gender-related surgeries until adulthood, citing “emerging concerns about potential long-term harms and the irreversible nature of surgical interventions in a developmentally vulnerable population.”

Centers for Medicare & Medicaid Services Administrator Mehmet Oz has also said the practices cause “irreversible harm” for youth and their families and rely on shaky science, and the Trump administration has pressured hospitals to shutter gender clinics since early 2025.

Advocates in the Bay Area also said they’re uneasy this month as the Trump administration notches victories in its national campaign to restrict access to gender-affirming care for youth.

In September, two East Coast hospitals struck deals with the U.S. Department of Justice to no longer provide gender-affirming care to minors, and fund “detransition” treatments for patients seeking to reverse the effects of gender-affirming care. In exchange, the department agreed to drop investigations into “potential violations of federal law arising from their provision of sex-rejecting procedures on children,” U.S. Attorney General Todd Blanche said in a statement. The Justice Department had already reached similar agreements with four other hospitals in Ohio, New York, Texas and Connecticut.

No hospital in California has signed a similar agreement with the federal government. But the federal pressure has reduced access to gender-affirming care in the Bay Area: Last year, Stanford Medicine announced it would stop providing surgeries to youth in the course of gender-affirming care, citing “actions and directives from the federal government.”

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