Senator Wiener’s Transgender Inclusive Care Act, Requiring Physicians to Undergo TGI Cultural Competency Training, Passes Senate Health Committee

April 6, 2022

SACRAMENTO – Senator Scott Wiener (D-San Francisco)’s Senate Bill 923, the TGI Inclusive Care Act passed the Senate Health Committee by a vote of 8-2. It will now head the Senate Appropriations Committee.

This first in the nation legislation requires physicians to undergo evidence-based  cultural competency education to help them provide inclusive care for transgender, gender non-conforming, and intersex (TGI) people. This legislation comes at a time when trans kids and trans people are under attack across the country by right-wing state leaders. In February, Texas Governor Greg Abbott issued an executive order making it illegal for parents to allow their trans kids to receive gender-affirming care. These parents could have their children taken away or be sent to prison, simply for allowing their children to be who they are and receive this necessary care. Abbott called gender-affirming care “child abuse.” In Florida, just this week, Governor Ron DeSantis signed the “Don’t Say Gay” law, banning discussions about gender identity and sexual orientation from public school classrooms.

“What’s happening in Texas and Florida is simply horrifying,” said Senator Wiener. “We cannot let gender-affirming care and LGTBQ rights become a politicized issue, with LGTBQ kids caught in the crosshairs. SB 923 will ensure that California providers treat patients with the culturally competent and respectful care that they deserve. This legislation will set a new standard nationwide for what truly inclusive gender-affirming care looks like.”

While LGBTQ kids are under attack in Texas and Florida, SB 923 shows a different path forward: one in which quality gender-affirming care is provided for anyone who needs it, and one in which providers treat TGI patients with the respect and care they deserve.

SB 923 specifies that the required cultural competency curriculum must be facilitated by a working group of representatives from at least three TGI-serving organizations and appointees from state agencies to develop a quality standard for patience experience. SB 923 also ensures that health plans include a list of in-network providers who offer gender-affirming services. This legislation will help create a more inclusive and culturally competent healthcare system for TGI people across California.

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.[1]

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.[2]

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 website and available call center 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.

SB 923 is sponsored by the California LGBTQ Health and Human Services Network,  Equality California, National Health Law Program Trans Community Project, TransFamily Support Services & Western Center on Law & Poverty. It is coauthored by Assemblymembers Sabrina Cervantes (D-Corona), Evan Low (D-San Jose) and Alex Lee (D-Fremont). Assemblymember Cristina Garcia (D-Bell Gardens) is principal co-author.