Senator Wiener Introduces the Transgender Inclusive Care Act to Require Health Providers and Staff to Undergo TGI Cultural Competency Training

February 11, 2022

SACRAMENTO – Senator Scott Wiener (D-San Francisco) introduced Senate Bill 923, the TGI Inclusive Care Act. This legislation requires health providers and staff who interact with transgender, gender non-conforming, and intersex (TGI) people to undergo cultural competency training to help them provide inclusive care. These trainings must be facilitated by TGI-led organizations, and they must include the perspectives of TGI people. SB 923 also ensures that health plans’ online directories include a search feature to list providers who offer gender-affirming services. This legislation will help create a more inclusive and culturally competent healthcare system for TGI people across California. 

“It’s simple: transgender, gender non-comforming and intersex people deserve the same quality of healthcare that everyone else receives,” said Senator Wiener. “No one should go to a doctor’s appointment only to be misgendered, harassed, or even refused treatment. While many providers work hard to treat TGI people with respect, too many TGI patients aren’t treated appropriately. These traumatizing experiences keep people away from the doctor, and prevent them from receiving the care they need. The TGI Inclusive Health Care Act will ensure providers are trained and ready to give quality care to everyone, regardless of their gender identity.”

Healthcare discrimination and a lack of access to culturally competent care is a major problem that many TGI people regularly face. The National Center for Transgender Equality reports that one-third of all transgender individuals who saw a healthcare professional in 2014 had at least one negative experience related to being transgender, with even higher rates for people of color and people with disabilities. These negative experiences include being refused treatment, verbally harassed, physically or sexually assaulted, or having to teach the provider about transgender people in order to receive appropriate care.

This is especially problematic given that TGI people, compared with the general population, suffer from more chronic health conditions. TGI people experience higher rates of health problems related to HIV/AIDS, substance use, mental illness, and sexual and physical violence, as well as a higher prevalence and earlier onset of disabilities that can also lead to longterm health issues. Sadly, 23% of transgender individuals reported that fear of discrimination caused them to postpone or not receive necessary medical care.

Every person deserves to receive quality, compassionate health care from understanding, informed, and respectful providers – providers who don’t make assumptions about their gender or sexuality, and who honor their bodily autonomy. TGI people already face so many obstacles outside of the healthcare system, including higher rates of violence, workplace discrimination, ostracization from families and religious communities, and housing discrimination. Going to the doctor should not mean facing additional discrimination or unecessary hardship. 

TGI people should have access to positive healthcare experiences. This includes seeing providers who are able to give them the care they need in a non-judgmental and supportive environment, and being able to search for providers who provide gender-affirming services (gender-affirming services include but are not limited to: chest reconstruction, mastectomy, facial feminization surgery, hysterectomy, voice masculinization or feminization, hormone therapy related to gender dysphoria or intersex conditions, gender-affirming gynecological care, or voice therapy related to gender dysphoria or intersex conditions). Gender-affirming care is critically important health care, and anyone who needs it should be able to find and access it.

Finally, SB 923 requires health plans to have an accessible search function that allows patients to easily find providers who offer gender-affirming care. While all health plans are required to cover gender-affirming care, it can be difficult for TGI patients to actually find providers who routinely offer this care. This is a major impediment to TGI people accessing the care they need. 

The TGI-Inclusive Care Act will help create a healthcare system that meets the needs of TGI people, and provide a more positive patient experience. 

“Transgender, gender non-conforming and intersex Californians to this day face significantly higher rates of chronic health conditions and other health problems, compared to the general population,” said Pau Crego, Acting Director for the SF Office of Transgender Initiatives. “This happens, in large part, because health care providers lack adequate education on our communities’ unique needs, and on how to respectfully interact with us as patients. This bill will help address this by educating providers on how to provide respectful and affirming care to TGI people, and in turn, will ensure TGI people feel safe accessing a medical establishment that has historically ignored and mistreated us.” 

“Many medical students and medical providers who provide specialty care such as podiatry, cardiovascular, gastroenterology, etc. have a predetermined opinion that they will never serve the transgender, gender non-conforming and intersex community due to their specialization,” Dannie Cesena, Transgender Health Equity Manager, CA LGBTQ Health and Human Services Network. “The assumption that TGI community members will not seek specialty care is dangerous. As human-beings, we deserve comprehensive and affirming medical care for all comorbidities that we may face, and this bill will ensure that all medical providers, regardless of their expertise, are properly trained to provide that access to care.”

“Improving Gender Affirming care needs to be prioritized for TGI people.  For far too long, the TGI community has been ignored and erased.  It’s time we start prioritizing and valuing the most marginalized and disproportionately impacted population in the state of California.  According to the Transmasculine Health Justice: LA (TMHJ: LA) report, over 90% of participants delayed care, ‘Many participants said they lacked trust in health care providers, had anxiety related to bad experiences and were concerned about mistreatment due to transphobia…’” said Ezak Perez, Executive Director of Gender Justice LA.

Perez continued, “we need to start transforming health care institutions, addressing the multitude of barriers that TGI people face when trying to access quality health care.  Requiring health plans, contracted providers and staff to undergo TGI cultural humility training is a basic necessity.  Requiring provider directories to include and make searchable providers who offer gender affirming services would dramatically change health outcomes for the TGI community, followed by further prioritizing and implementing policies and practices to help improve the lives of TGI people, address health disparities and other social determinants.”

"It's unconscionable that transgender, gender-nonconforming and intersex Californians are being forced to postpone or not seek life-saving medical care because they fear harassment and discrimination in healthcare settings,” said Tami Martin, Legislative Director for Equality California. “Equality California is proud to co-sponsor this innovative legislation that will prioritize inclusive healthcare by requiring that health plans ensure contracted providers and staff undergo training regarding care for TGI people. It is the right thing to do to ensure access to quality, affirming healthcare for all LGBTQ+ people."