Resolution reaffirming San Francisco's commitment to the rights of its transgender, gender-nonconforming, intersex, and two-spirit (TGNCl2S) residents and employees to obtain gender-affirming care without discrimination; and strongly urging healthcare providers and insurance carriers operating within the city to adhere to state and local laws mandating access to medically necessary healthcare, including gender-affirming care.
Summary
San Francisco's Board of Supervisors has passed a resolution reaffirming the city's commitment to the rights of its transgender, gender-nonconforming, intersex, and two-spirit (TGNCI2S) residents and employees to access gender-affirming care (GAC) without discrimination. This resolution extends sanctuary protections to TGNCI2S children and youth, building on a previous resolution from June 2024. The city strongly urges healthcare providers and insurance carriers to adhere to existing state and local laws, such as California's Unruh Civil Rights Act and Government Code Section 11135, which mandate access to medically necessary GAC and prohibit discrimination based on gender identity.
The resolution directly condemns proposed federal rules from the Centers for Medicare & Medicaid Services (CMS), issued on December 18, 2025, which aim to restrict GAC for youth. These federal rules propose to prohibit federal Medicaid funding for "sex-rejecting procedures" (SRPs) for individuals under 18 and federal CHIP funding for SRPs for individuals under 19. Additionally, a separate proposed rule would prohibit Medicare and Medicaid certified hospitals from performing SRPs on children under 18. The federal government justifies these restrictions by citing an HHS review that found "extremely weak evidence of benefit" and "significant risks" associated with GAC for minors, and critiques existing medical guidelines (WPATH, Endocrine Society) as biased.
San Francisco's resolution highlights that California's Attorney General has confirmed GAC as a constitutional right in the state and is actively challenging federal efforts to limit it. The resolution also expresses concern over healthcare providers preemptively discontinuing or delaying GAC services for youth in anticipation of federal changes, emphasizing the potential for "real and lasting harm." The federal rules, if finalized, would reduce federal Medicaid spending by an estimated $188 million over ten years, but would allow states to use their own funds for such care, and would pre-empt conflicting state laws.
This resolution ensures that San Francisco residents, including TGNCI2S children and youth, are explicitly supported in their right to access gender-affirming care within the city, regardless of federal attempts to restrict it. It aims to protect access to medically necessary care, which could otherwise be jeopardized by federal funding prohibitions or preemptive actions by healthcare providers.
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