The Senate Health Committee recently moved to improve access to health care for transgender, gender nonconforming, and intersex (TGI) individuals with the passage of Senate Bill 923, sponsored by Sen. Scott Wiener (D–San Francisco), Asm. Cristina Garcia (D–Bell Gardens), Sabrina Cervantes (D–Corona), Alex Lee (D–San Jose), and Evan Low (D–San Jose).
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The bill would require a Medi-Cal managed care plan or a health care service plan to require its staff and contracted providers to complete evidence-based cultural competency training, which will be incorporated into continuing medical education (CME) for providers, for the purpose of providing trans-inclusive health care for patients who identify as TGI.
The bill would also require health plans to include a list of in-network providers who offer and have provided gender-affirming services, and would require the public websites of those health plans to display this directory without any restrictions or limitations.
The bill would require the California Department of Managed Health Care (DMHC) to impose sanctions to ensure compliance, and would also require health plans to annually and publicly report certain information related to compliance, monitoring, and any related complaints or grievances.
The bill would also require the California Health and Human Services Agency (CalHHS) to convene a working group including TGI people to develop a quality standard for TGI patient experience to ensure that providers are providing appropriate care to TGI people, and also to create appropriate training standards for providers.
Wiener said this bill will work to combat other states’ efforts to limit access to health care for TGI individuals.
“It’s absolutely terrifying what states like Texas and Idaho are doing right now to trans youth and trans people in general … We have states that are banning health care for trans children, making it illegal, criminalizing physicians, for providing that care,” he said. “The message that sends to trans people, particularly to trans youth, is horrific, and it is no wonder that rates of self harm are higher among trans kids. This bill will send a strong message to the contrary.”
He added that the bill would keep California consistent with its historical support of the LGBTQ+ community, emphasizing how TGI individuals often endure negative experiences when seeking health care, including being refused treatment entirely because of their gender identity, being verbally harassed, or having to teach the provider about transgender people in order to receive appropriate care.
Wiener also emphasized that the bill is not focused on criminalizing providers, but ensuring providers have all the resources and training they need in order to treat these individuals effectively and with compassion.
Erin Pollard, a clinician specializing in gender affirming mental health care for LGBTQ+ patients, spoke in favor of the bill. She said this cultural competency training is vital to clinicians providing appropriate care to TGI individuals.
“These trainings are often very difficult to find which results in only a small amount of properly trained clinicians. This leaves our TGI patients guessing as to where they can find competent care appropriate to their needs,” she said. “In order for care to be affirming and inclusive, the clinician needs to not only understand medical transition options, but also the complex social and emotional impact of being trans, nonbinary, or intersex in our society. Without this training, clinicians often provide misguided treatment that is in fact harmful to our TGI patients.”
Jedd Hampton, representing the California Association of Health Plans (CAHP), spoke from the organization’s “oppose unless amended” point of view. CAHP had raised concerns about the requirements on health plans and insurers to ensure that their contracted providers complete these training, which could lead to many administrative and logistical challenges that could inadvertently limit enrollee access to care. Hampton said that many of these concerns had been highlighted in ongoing discussions with the bill sponsors, and that CAHP would look forward to continuing those discussions to potentially reevaluate the organization’s position.
Sen. Melissa Melendez (R–Lake Elsinore) voiced her concerns about an unclear accreditation process in the bill for the organizations and individuals who will be conducting the cultural competency training for providers.
Sen. Richard Pan (D–Sacramento) clarified that, as the training would be encompassed into CME for providers, there would be an accreditation process involved.
Sen. Monique Limon (D–Santa Barbara) highlighted that this bill would help improve the health care system as a whole, not just for TGI individuals, due to its incorporation into CME.
“I believe that more training is the right direction to go to be inclusive of the [large amounts of] information that need to be understood to be a better provider,” she said. “We have to get training continuously, and the reason we do this is because there is always more we can learn. And if we only do it on a one time basis and not do it ongoing, we limit how helpful we can be.”
Wiener concluded with how the bill will take a stand for trans visibility.
“It’s so important for communities to have confidence in the health care system, that they’re going to be helped and not harmed,” he said. “[TGI people] are part of our community, they are real … and they need health care, and they’re not going to go get health care if they believe they are going to be treated poorly or treated by someone who doesn’t have any idea who they are or how to interact with them.”
The bill ultimately passed in an 8-2 vote, with opposing votes from Melendez and Sen. Shannon Grove (R–Bakersfield), and was rereferred to the Senate Committee on Appropriations.