Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the acts requirements a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law requires health care service plans and health insurers, as specified, within 6 months after the relevant department issues specified guidance, or no later than March 1, 2025, to require all of their staff who are in direct contact with enrollees or insureds in the delivery of care or enrollee or insured services to complete evidence-based cultural competency training for the purpose of providing trans-inclusive health care for individuals who identify as transgender, gender diverse, or intersex.

This bill would prohibit a subscriber, enrollee, policyholder, or insured from being excluded from enrollment or participation in, being denied the benefits of, or being subjected to discrimination by, any health care service plan or health insurer licensed in this state, on the basis of race, color, national origin, age, disability, or sex. The bill would define discrimination on the basis of sex for those purposes to include, among other things, sex characteristics, including intersex traits, pregnancy, and gender identity. The bill would prohibit a health care service plan or health insurer from taking specified actions relating to providing access to health programs and activities, including, but not limited to, denying or limiting health care services to an individual based upon the individuals sex assigned at birth, gender identity, or gender otherwise recorded. The bill would prohibit a health care service plan or health insurer, in specified circumstances, from taking various actions, including, but not limited to, denying, canceling, limiting, or refusing to issue or renew health care service plan enrollment, health insurance coverage, or other health-related coverage, or denying or limiting coverage of a claim, or imposing additional cost sharing or other limitations or restrictions on coverage, on the basis of race, color, national origin, sex, age, disability, as specified. Because a violation of the bills requirements by a health care service plan would be a crime, the bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the acts requirements a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law requires health care service plans and health insurers, as specified, within 6 months after the relevant department issues specified guidance, or no later than March 1, 2025, to require all of their staff who are in direct contact with enrollees or insureds in the delivery of care or enrollee or insured services to complete evidence-based cultural competency training for the purpose of providing trans-inclusive health care for individuals who identify as transgender, gender diverse, or intersex.

This bill would prohibit a subscriber, enrollee, policyholder, or insured from being excluded from enrollment or participation in, being denied the benefits of, or being subjected to discrimination by, any health care service plan or health insurer licensed in this state, on the basis of race, color, national origin, age, disability, or sex. The bill would define discrimination on the basis of sex for those purposes to include, among other things, sex characteristics, including intersex traits, pregnancy, and gender identity. The bill would prohibit a health care service plan or health insurer from taking specified actions relating to providing access to health programs and activities, including, but not limited to, denying or limiting health care services to an individual based upon the individuals sex assigned at birth, gender identity, or gender otherwise recorded. The bill would prohibit a health care service plan or health insurer, in specified circumstances, from taking various actions, including, but not limited to, denying, canceling, limiting, or refusing to issue or renew health care service plan enrollment, health insurance coverage, or other health-related coverage, or denying or limiting coverage of a claim, or imposing additional cost sharing or other limitations or restrictions on coverage, on the basis of race, color, national origin, sex, age, disability, as specified. Because a violation of the bills requirements by a health care service plan would be a crime, the bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the acts requirements a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law requires health care service plans and health insurers, as specified, within 6 months after the relevant department issues specified guidance, or no later than March 1, 2025, to require all of their staff who are in direct contact with enrollees or insureds in the delivery of care or enrollee or insured services to complete evidence-based cultural competency training for the purpose of providing trans-inclusive health care for individuals who identify as transgender, gender diverse, or intersex.

This bill would prohibit a subscriber, enrollee, policyholder, or insured from being excluded from enrollment or participation in, being denied the benefits of, or being subjected to discrimination by, any health care service plan or health insurer licensed in this state, on the basis of race, color, national origin, age, disability, or sex. The bill would define discrimination on the basis of sex for those purposes to include, among other things, sex characteristics, including intersex traits, pregnancy, and gender identity. The bill would prohibit a health care service plan or health insurer from taking specified actions relating to providing access to health programs and activities, including, but not limited to, denying or limiting health care services to an individual based upon the individuals sex assigned at birth, gender identity, or gender otherwise recorded. The bill would prohibit a health care service plan or health insurer, in specified circumstances, from taking various actions, including, but not limited to, denying, canceling, limiting, or refusing to issue or renew health care service plan enrollment, health insurance coverage, or other health-related coverage, or denying or limiting coverage of a claim, or imposing additional cost sharing or other limitations or restrictions on coverage, on the basis of race, color, national origin, sex, age, disability, as specified. Because a violation of the bills requirements by a health care service plan would be a crime, the bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

 THIRD READING  

Bill No: AB 1876

Author: Addis (D), et al.

Introduced: 2/12/26

Vote: 21

SENATE HEALTH COMMITTEE: 7-1, 6/3/26

AYES: Weber Pierson, Caballero, Durazo, Gonzalez, Menjivar, Padilla, Pérez

NOES: Grove

NO VOTE RECORDED: Valladares, Rubio, Smallwood-Cuevas

SENATE JUDICIARY COMMITTEE: 11-1, 6/23/26

AYES: Umberg, Allen, Ashby, Caballero, Durazo, Laird, Reyes, Stern, Wahab, Weber Pierson, Wiener

NOES: Niello

NO VOTE RECORDED: Valladares

SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8

ASSEMBLY FLOOR: 56-17, 5/4/26 - See last page for vote

SUBJECT: Health care coverage: nondiscrimination

SOURCE: California LGBTQ Health and Human Services Network

Equality California
Gender Justice LA
Planned Parenthood Affiliates of California
The TransLatin@ Coalition

TransFamily Support Services

DIGEST:

This bill 1) codifies a federal regulation to prevent a person from being excluded from enrollment or participation in, denied the benefits of, or subjected to discrimination by any state health plan or health insurer on the basis of race, color, national origin, age, disability, or sex; and 2) defines “discrimination on the basis of sex” to include but not be limited to discrimination on the basis of sex characteristics, including intersex traits; pregnancy or related conditions; sexual orientation; gender identity; and sex stereotypes.

ANALYSIS:

Existing federal law:

1. Establishes the federal Affordable Care Act (ACA), which, among other provisions, establishes health insurance coverage requirements for Americans and federal subsidies available through health care marketplaces (exchanges) for those Americans who qualify. (Pub. L. No. 111-148)
2. Establishes, in Section 1557 of the ACA, that an individual shall not, on the basis of race, color, national origin, sex, age, or disability, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under, any health program or activity that receives federal financial assistance or under any program or activity that is administered by a federal entity. (42 U.S.C. §18116)

Existing state law:

1. Establishes the Department of Managed Health Care (DMHC) to regulate health plans under the Knox-Keene Health Care Service Plan Act of 1975 (Knox-Keene Act) and the California Department of Insurance (CDI) to regulate health insurers under the Insurance Code. [Health and Safety Code (HSC) §1340, et seq. and Insurance Code (INS) §106, et seq.]
2. Prohibits a health plan or specialized health plan from denying a contract because of the race, color, national origin, ancestry, religion, sex, marital status, sexual orientation, or age of any contracting party, prospective contracting party, or person reasonably expected to benefit from that contract as a subscriber, enrollee, member, or otherwise. Deems it a violation for any health plan to utilize marital status, living arrangements, occupation, sex, beneficiary designation, ZIP Codes or other territorial classification, or any combination thereof for the purpose of establishing sexual orientation. “Sex” and “gender” have the same meaning. [HSC §1365.5]
3. Prohibits an admitted insurer, licensed to issue life or disability insurance, from failing or refusing to accept an application for insurance, to issue that insurance to an applicant, or issue or cancel that insurance, under conditions less favorable to the insured than in other comparable cases, except for reasons applicable alike to persons of every race, color, religion, sex, gender, gender identity, gender expression, national origin, ancestry, or sexual orientation. Prohibits race, color, religion, national origin, ancestry, or sexual orientation from constituting a condition or risk for which a higher rate, premium, or charge may be required of the insured for that insurance. [INS §10140]
4. Deems it a violation of 3) above, for any insurer to consider sexual orientation in its underwriting criteria or to utilize marital status, living arrangements, occupation, sex, beneficiary designation, ZIP Codes or other territorial classification within this state, or any combination thereof for the purpose of establishing sexual orientation or determining whether to require a test for the presence of HIV or antibodies to that virus, where that testing is otherwise permitted by law. [INS §10140]
5. Defines “sex” to have the same meaning as “gender.” “Gender” means sex and includes a person’s gender identity and gender expression. “Gender expression” means a person’s gender-related appearance and behavior whether or not stereotypically associated with the person’s assigned sex at birth. [INS §10140]

This bill:

1. Prohibits a subscriber, enrollee, policyholder, or insured from being excluded from enrollment or participation in, be denied the benefits of, or be subject to discrimination by, any health plan or health insurer licensed in California on the basis of race, color, national origin, age, disability, or sex.
2. Includes as “discrimination based on sex” discrimination based on sex characteristics, including intersex traits; pregnancy or related conditions; sexual orientation; gender identity; and sex stereotypes.
3. Prohibits a health plan or health insurer from:
   1. Denying or limiting health care services, including those typically or exclusively provided to, or associated with, individuals of one sex, to an individual based upon the individual’s sex assigned at birth, gender identity, or gender otherwise recorded;
   2. Denying or limiting, on the basis of an individual’s sex assigned at birth, gender identity, or gender otherwise recorded, a health care professional’s ability to provide health care services if the denial or limitation has the effect of excluding individuals from participation in, denying them the benefits of, or otherwise subjecting them to discrimination on the basis of sex under a covered health plan or health insurance policy;
   3. Adopting or applying any policy or practice of treating individuals differently or separating them on the basis of sex in a manner that subjects any individual to more than de minimis harm, including by adopting a policy or engaging in a practice that prevents an individual from participating in a health plan or health insurance policy consistent with the individual’s gender identity; and,
   4. Denying or limiting health care services sought for purpose of gender transition or other gender-affirming care that the health plan or health insurance policy would otherwise cover if that denial or limitation is based on an individual’s sex assigned at birth, gender identity, or gender otherwise recorded.
      
4. Prohibits a health plan or health insurer from doing any of the following:
   1. Denying, canceling, limiting, or refusing to issue or renew health plan enrollment, health insurance coverage or other health-related coverage, or denying or limiting coverage of a claim, or imposing additional cost-sharing or other limitations or restrictions on coverage, on the basis of race, color, national origin, sex, age, disability, or any combination thereof;
   2. Having or implementing marketing practices or benefit designs that discriminate on the basis of race, color, national origin, sex, age, disability, or any combination thereof, in health plan or health insurance coverage or other health-related coverage;
   3. Denying or limiting coverage, denying or limiting coverage of a claim, or imposing additional cost-sharing or other limitations or restrictions on coverage, to an individual based upon the individual’s sex assigned at birth, gender identity, or gender otherwise recorded;
   4. Having or implementing a categorical coverage exclusion or limitation for all health care services related to gender transition or other gender-affirming care;
   5. Otherwise denying or limiting coverage, denying or limiting coverage of a claim, or imposing additional cost-sharing or other limitations or restrictions on coverage, for specific health care services related to gender transition or other gender-affirming care if such denial, limitation, or restriction results in discrimination on the basis of sex; and,
   6. Having or implementing benefit designs that do not provide or administer health plan or health insurance coverage or other health-related coverage in the most integrated setting appropriate to the needs of qualified individuals with disabilities, including practices that result in the serious risk of institutionalization or segregation.
5. Does not require access to, or coverage of, a health care service for which a health plan or health insurer has a legitimate, nondiscriminatory reason for denying or limiting access to, or coverage of the health care service or determining that the health care service is not clinically appropriate for a particular individual or fails to meet applicable coverage requirements. Prohibits a health plan’s or health insurer’s determination from being based on lawful animus or bias or constitute a pretext for discrimination.
6. Requires a health plan’s or health insurer’s evidence of coverage and disclosure forms to include specified information in a notice to enrollees or insureds regarding the requirements of this bill.

Comments

According to the author:

The Trump Administration has taken steps to dismantle long-standing discrimination protections embedded in Section 1557 of the ACA. This bill takes proactive steps to codify these non-discrimination protections into California statute ensuring that all Californians maintain equitable access to healthcare.

Background

Section 1557. Title I of the ACA, “Quality, Affordable Health Care for All Americans,” establishes Section 1557 which provides that, except as otherwise provided in title I of the ACA, an individual shall not, on the grounds prohibited under title VI of the Civil Rights Act of 1964, title IX of the Education Amendments of 1972, the Age Discrimination Act of 1975, or section 504 of the Rehabilitation Act of 1973, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under, any health program or activity, any part of which is receiving federal financial assistance, including credits, subsidies, or contracts of insurance, or under any program or activity that is administered by an executive agency or any entity established under title I of the ACA. This applies to health programs or activities administered by recipients of federal financial assistance from the U.S. Department of Health and Human Services (HHS), HHS-administered health programs or activities, and title I entities that administer health programs or activities.

Section 1557 and associated rulemaking have been subject to a variety of challenges. Injunctions prohibiting enforcement of gender identity in the definition of sex discrimination are in place and will remain in place unless or until new regulations are promulgated or a federal administration takes a different action. According to the California Senate Judiciary Committee analysis of this bill, in 2020, the Supreme Court held in Bostock v. Clayton County that “discrimination on the basis of sex” under the federal Title VII, which prohibits discrimination in the workplace on the basis of race, color, religion, sex, or national origin, extends to discrimination on the basis of sexual orientation and gender identity. Additionally, the analysis indicates “Several federal district court judges issued nationwide injunctions to prevent HHS’s interpretation of Section 1557 and the final rule from taking effect. As it stands, there is no definitive federal court ruling on whether the rationale of Bostock v. Clayton County applies to Section 1557. The Ninth Circuit has, however, held that Bostock’s rationale applies in claims for discrimination on the basis of gender identity under Title IX, suggesting it would do the same in a Section 1557 challenge.”

Executive Order 14187. This executive order issued by President Trump on January 28, 2025, directed the Secretary of the federal HHS to end gender-affirming care for people 18 years and younger under Section 1557 and to withdraw Biden Administration guidance extending Section 1557 to discrimination on the basis of sexual orientation and gender identity. The California Senate Judiciary Committee analysis of this bill indicates that this executive order “facially discriminates against transgender youth and 18-year-olds, denying them treatments that are still available to cisgender individuals.” Portions of this and other actions by the Trump administration have been enjoined on a nationwide basis, including any associated funding freezes but Section 1557 is still operative because a president cannot override an act of Congress with an executive order.

Trans-Inclusive Care. According to DMHC, Trans-Inclusive Care is defined in state law as “comprehensive health care that is consistent with the standards of care for individuals who identify as transgender, gender diverse, or intersex (TGI), honors an individual’s personal bodily autonomy, does not make assumptions about an individual’s gender, accepts gender fluidity and nontraditional gender presentation, and treats everyone with compassion, understanding, and respect.” DMHC indicates that DMHC licensed health plans and CDI licensed insurers are required by California law to provide health plan enrollees and insureds who identify as TGI with medically necessary gender affirming care.

Related/Prior Legislation

SB 418 (Menjivar of 2025) in addition to the same discrimination protections as in this bill, would have permitted a person to receive coverage for a 12-month supply of federal Food and Drug Administration-approved prescription hormone therapy, and necessary supplies for self-administration, prescribed by an in-network provider and dispensed at one time, as specified, and contained an urgency clause that would have made the bill effective upon enactment. The bill was vetoed by Governor Newsom who wrote in the veto message:

This bill would require health plans and insurers to cover a 12-month supply of federal Food and Drug Administration-approved prescription hormone therapy, and necessary supplies for self-administration, prescribed by an in network provider and dispensed at one time without utilization management (UM).

I appreciate the author's intent to ensure patient access to the comprehensive care they need. While there are provisions of this bill that are worthy of support, I am concerned about the limitation on the use of UM, which is an important tool to ensure enrollees receive the right care at the right time. Prohibiting this cost containment strategy is likely to result in an increase in enrollee premiums to offset costs incurred by health plans and insurers. At a time when individuals are facing double-digit rate increases in their health care premiums across the nation, we must take great care to not enact policies that further drive up the cost of health care, no matter how well-intended.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: Yes

SUPPORT: (Verified 8/3/26)

California LGBTQ Health and Human Services Network (cosource)

Equality California (cosource)
Gender Justice LA (cosource)
Planned Parenthood Affiliates of California (cosource)
The TransLatin@ Coalition (cosource)

TransFamily Support Services (cosource)

Access Reproductive Justice
American Civil Liberties Union California Action
Advocates for Trans Equality
Alliance for TransYouth Rights
American Academy of Pediatrics, California
American Association of University Women - California
American College of Obstetricians & Gynecologists - District IX
Asian Americans Advancing Justice - Southern California
California Academy of Child and Adolescent Psychiatry

California Alliance of Child and Family Services
California Association of Marriage and Family Therapists
California Behavioral Health Association
California Chapter of the American College of Emergency Physicians

California Commission on the Status of Women and Girls

California Federation of Teachers
California Foundation for Independent Living Centers
California Legislative LGBTQ Caucus
California Pan - Ethnic Health Network
California Podiatric Medical Association

California Primary Care Association Advocates
California Psychological Association

California Service Employees International Union
City and County of San Francisco Department on the Status of Women

City of West Hollywood
County Behavioral Health Directors Association
Courage California
Disability Rights California
El/La Para Translatinas
Gender Affirming Professionals
Health Access California

Hmong Innovating Politics
Justice in Aging
LGBTQ Connection
LGBTQ+ Inclusivity, Visibility, and Empowerment
Los Angeles LGBT Center
Los Angeles LGBTQ+ Chamber of Commerce
Lyon-Martin Community Health Services
Mirror Memoirs
National Health Law Program

Oakland Privacy
ParivarBayArea
Parents, Families, and Friends of Lesbians and Gays Clayton-Concord
PFLAG Fresno
PFLAG Oakland-East Bay

PFLAG Sacramento
PFLAG San Diego County
PFLAG San Jose/Peninsula

Placer LGBTQ+ Center

Rainbow Families Action Bay Area
San Francisco AIDS Foundation
Saturn’s Wish
The Children's Partnership
The Landing Spot
The San Diego LGBT Community Center
Transgender Health and Wellness Center
Western Center on Law & Poverty, Inc.

OPPOSITION: (Verified 8/3/26)

California Family Council

Californians United for Sex-based Evidence in Policy and Law

Concerned Women for America

Democrats for an Informed Approach to Gender

International Foundation for Therapeutic and Counseling Choice

Lesbians Advocating for a Resilient Future

LGB Alliance Foundation

LGB Courage Coalition

Our Duty

Serving Family Values Alliance

Women Are Real

Women's Declaration International USA, Inc.

Women's Liberation Front

ARGUMENTS IN SUPPORT: This bill is cosponsored by the TransLatin@ Coalition to ensure that TGI, LGBTQ+, and non-English speaking people, along with pregnant people seeking abortion care services, cannot be denied or limited coverage for medically necessary health care. The TransLatin @ Coalition writes, “Given the Federal Administration’s deliberate efforts to roll back these protections, formalizing these protections on the state level is increasingly vital. In the first month of this administration, the President issued sixty-four executive orders, one of which is Executive Order 14187. This executive order functions as a denial of the existence of TGI people and consequently directs federal agencies to withhold funding from healthcare institutions and providers that offer gender-affirming care.” Planned Parenthood Affiliates of California., another cosponsor, supports public policy that fosters a social climate of acceptance, non-discrimination, destigmatization, and legal justice for all. Equality California, another cosponsor, writes that this bill strengthens and reaffirms California’s nondiscrimination protections to ensure TGI people can access medically necessary care without discrimination. Also, a cosponsor, the California LGBTQ Health and Human Services Network writes that this bill is a vital shield that guarantees the right to inclusive, respectful, and life-saving healthcare regardless of the shifting political climate in Washington D.C. Gender Justice LA, an additional cosponsor, writes with recent federal actions rolling back these protections, California has both the opportunity and responsibility to lead by ensuring that all residents can continue to rely on fair and equitable access to health care, and enshrining these provisions into state law through this bill will protect vulnerable communities from discrimination and ensure equal treatment for vulnerable communities. Disability Rights California believes that personal independence is a basic right for every person, including a person’s right to develop their personality, to express hopes and dreams, and to make choices that permit the Dignity of Risk (a concept that ensures informed decision-making by helping a client understand the risks associated with an action while not attempting to force them to choose what is viewed culturally or socially as better).

ARGUMENTS IN OPPOSITION: The California Family Council writes “by treating an insurer’s denial of coverage as unlawful discrimination, this bill removes insurers’ discretion to assess medical necessity, long-term risks, and evolving scientific evidence, particularly when the patient is a minor. These interventions carry serious lifelong consequences, including impacts on bone density, fertility, cardiovascular health, and neurological development… Additionally, this bill poses serious religious liberty concerns.” Concerned Women for America Legislative Action Committee writes “the long-term consequences of these interventions – such as hormone treatments and surgical procedures – on the natural development of the human body remain largely unknown. Moreover, these medical procedures often lead to irreversible outcomes, which can have lasting effects on an individual’s physical and psychological well-being. The side effects and complications associated with experimental drugs and treatments may increase the need for ongoing medical care and pharmaceuticals in the future, which could place a health financial burden on patients and the broader healthcare system.” The Democrats for an Informed Approach to Gender writes “this bill is a coverage mandate that requires insurers to cover a category of interventions regardless of the quality of evidence supporting them. This bill will harm Californians, mandating coverage for medical interventions that an increasing body of international and national evidence has found to be not only unsafe but actively harmful – interventions that disproportionately affect gender nonconforming minors, gays and lesbians, youth on the autism spectrum, and vulnerable adults. Section (b)(3)(D) of the proposed legislation prohibits any ‘categorical coverage exclusion’ for ‘gender transition’ or ‘gender-affirming care,’ ensuring that this cohort receives damaging medical interventions unsupported by credible evidence.” LGB Alliance USA writes “1367.0435 purports to allow for ‘legitimate, nondiscrimination reason’ for denying claims, it still allows for litigation of claim denials that are due to ‘unlawful animus or bias or constitute a pretext for discrimination.’ This could make any claim denial subject to legal scrutiny, potentially resulting in insurance providers being afraid of making medically appropriate decisions for transgender patients… This bill ignores the vulnerabilities of LGB Californians, ignores the hazards of gender medicalization in youth, and dangerously conflates gender identity with sex in medical care.”

ASSEMBLY FLOOR: 56-17, 5/4/26

AYES: Addis, Aguiar-Curry, Ahrens, Alvarez, Ávila Farías, Bains, Bauer-Kahan, Berman, Boerner, Bryan, Calderon, Connolly, Elhawary, Fong, Gabriel, Garcia, Gipson, Mark González, Haney, Harabedian, Hart, Irwin, Jackson, Kalra, Krell, Lee, Lowenthal, McKinnor, Muratsuchi, Nguyen, Ortega, Pacheco, Papan, Patel, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Ransom, Celeste Rodriguez, Michelle Rodriguez, Rogers, Blanca Rubio, Schiavo, Schultz, Sharp-Collins, Solache, Soria, Stefani, Valencia, Wallis, Ward, Wicks, Wilson, Zbur, Rivas

NOES: Castillo, Davies, DeMaio, Dixon, Ellis, Flora, Gallagher, Jeff Gonzalez, Hadwick, Hoover, Johnson, Lackey, Macedo, Patterson, Sanchez, Ta, Tangipa

NO VOTE RECORDED: Alanis, Arambula, Bennett, Bonta, Caloza, Carrillo, Chen

Prepared by: Teri Boughton / HEALTH / (916) 651-4111

8/5/26 15:04:17

**** END ****

SENATE JUDICIARY COMMITTEE

Senator Thomas Umberg, Chair

2025-2026 Regular Session

Bill No: AB 1876 (Author:Addis)

Version: February 12, 2026

Hearing Date: June 23, 2026

Fiscal: Yes

Urgency: No

Consultant: AM

SUBJECT

Health care coverage: nondiscrimination

DIGEST

This bill prohibits a health care service plan or a health insurer licensed in the state from excluding, denying benefits to, or otherwise discriminating against a subscriber, enrollee, policyholder, or insured on the basis of race, color, national origin, age, disability, or sex, as defined.

EXECUTIVE SUMMARY

Section 1557 of the Affordable Care Act (Section 1557) prohibits discrimination in the provision of health insurance or health care coverage on the basis of race, color, national origin, age, disability, or sex. (See 42 U.S.C. § 18116.) However, President Donald Trump signed Executive Order 14187, which denies the existence of transgender and nonbinary individuals, ignores the recommendations of medical experts, and attempts to prevent minors and 18-year-old adults from obtaining medically prescribed gender-affirming care. The Executive Order also instructed the Department of Health and Human Services to withdraw guidance clarifying that Section 1557’s prohibition on sex-based discrimination extends to discrimination on the basis of gender identity and gender expression.

This bill is intended codify Section 1557 in state law. Section 1557 prohibits a health care service plan or health insurer from excluding a subscriber or enrollee from, or denying them a benefit or coverage under, a health care service plan or health insurance plan, on the basis of the person’s race, color, national origin, age, disability, or sex. The bill also clarifies that “sex” includes a person’s gender identity and gender expression, and requires health care service plan providers and health insurers to provide specified disclosures to their subscribers and enrollees relating to their right to be free of discrimination. The bill’s protections would be in addition to existing antidiscrimination laws, and are intended to complement, rather than supplant, those existing laws.

This bill’s provisions are substantially similar to SB 418 (Menjivar, 2025), which was vetoed by Governor Newsom due to concerns over a provision requiring health plans and insurers to cover a 12-month supply of federal Food and Drug Administration-approved prescription hormone therapy, and the necessary supplies for self-administration, prescribed by an in-network provider and dispensed at one time without utilization management. That provision is not included in this bill. SB 418 passed this Committee on a vote of 11 to 1.

This bill is sponsored by the Alliance for TransYouth Rights, Equality California, Planned Parenthood Affiliates of California, and TransFamily Support Services. It is supported by numerous medical, nonprofit, and community organizations. This bill is opposed by the California Family Council, California Teachers Supporting Gender-Nonconforming Youth, Cause: Californians United for Sex-Based Evidence in Policy and Law, Democrats for an Informed Approach to Gender, International Foundation for Therapeutic and Counselling Choice, Lesbians Advocating for a Resilient Future, LGB (Lesbian, Gay, and Bisexual) Alliance Foundation, Our Duty, Women are Real, and the

Women's Liberation Front. The Senate Health Committee passed this bill with a vote of 7 to 1.

PROPOSED CHANGES TO THE LAW

Existing constitutional law:

1. Provides that the legislative powers of the United States are vested in the United States Congress, and that every bill that passes the House of Representatives and the Senate and is signed by the President shall become law. (U.S. Const., art. I, §§ 1, 7 cl. 2.)
2. Provides that individuals are guaranteed the right to equal protection under federal, state, and local laws. (U.S. Const., 5th & 14th amends; Adarand Constructors, Inc. v. Pena (1995) 515 U.S. 200, 216-217.)

Existing federal law:

1. Establishes the Affordable Care Act (ACA), which sets national requirements for the provision of health insurance. (Pub. L. No. 111-148 (Mar. 23, 2010).)
2. Establishes, in Section 1557 of the ACA, that an individual shall not, on the basis of race, color, national origin, sex, age, or disability, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under, any health program or activity that receives federal financial assistance or under any program or activity that is administered by a federal entity. (42 U.S.C. § 18116; see 20 U.S.C. § 1681; 29 U.S.C. § 794; 42 U.S.C §§ 2000d, 6101.)

Existing state law:

1. Defines the following relevant terms:
   1. “Enrollee” means a person who is enrolled in a health care service or specialized health care service plan and who is a recipient of services from the plan. (Health & Saf. Code § 1345(c).)
   2. “Health care service plan” or “specialized health care service plan” means either (1) any person who undertakes to arrange for the provision of health care services to subscribers or enrollees, or to pay for or to reimburse any part of the costs of those services, in return for a prepaid or periodic charge paid by or on behalf of the subscribers or enrollees, or (2) any person, whether located within or outside of this state, who solicits or contracts with a subscriber or enrollee in this state to pay for or reimburse any part of the cost of, or who takes to arrange or arranges for, the provision of health care services that are to be provided wholly or in part in a foreign country in return for a prepaid or periodic charge paid by or on behalf of the subscriber or enrollee. (Health & Saf. Code § 1345(f).)
   3. “Provider” means any professional person, organization, health facility, or other person or institution licensed by the state to deliver or furnish health care services. (Health & Saf. Code § 1345(i).)
   4. “Subscriber” means the person who is responsible for payment to a plan or whose employment or other status, except for family dependency, is the basis for eligibility for membership in the plan. (Health & Saf. Code § 1345(p).)
   5. “Health insurance” means an individual or group disability insurance policy that provides for hospital, medical, or surgical benefits, subject to specified exceptions. (Ins. Code § 106(b).)
2. Provides for regulation of health care service plans and health insurance plans as follows:
   1. The Department of Managed Health Care regulates health care service plans under the Knox-Keene Health Care Service Plan Act of 1975. (Health & Saf. Code, div. 2, ch. 2.2, §§ 1340 et seq.)
   2. The Department of Insurance regulates health insurers pursuant to the Insurance Code. (Ins. Code, div. 3, §§ 12900 et seq.)
3. Prohibits a health care service plan or specialized health care service plan from denying a contract, modifying the terms of a contract, or limiting a contract because of the race, color, national origin, ancestry, religion, sex, marital status, sexual orientation, or age of any contracting party, prospective contracting party, or person reasonably expected to benefit from that contract as a subscriber, enrollee, member, or otherwise.
   1. A health care service plan may not utilize marital status, living arrangements, occupation, sex, beneficiary designation, ZIP codes, or other territorial classification, or any combination thereof, for the purpose of establishing sexual orientation.
   2. “Sex” includes gender identity and gender expression. (Health & Saf. Code § 1365.5.)
4. Prohibits a health insurer from failing to refuse to accept an application for that insurance, issuing that insurance to an applicant thereof, or issuing or canceling that insurance under conditions less favorable to the insured than in other comparable cases, except for reasons applicable alike to persons of every race, color, religion, sex, gender, gender identity, gender expression, national origin, ancestry, or sexual orientation; and prohibits race, color, religion, national origin, ancestry, or sexual orientation from constituting a condition or risk for which a higher rate, premium, or charge may be required of the insured for that insurance. (Ins. Code § 10140(a).)
   1. A health care service plan may not utilize marital status, living arrangements, occupation, sex, beneficiary designation, ZIP codes, or other territorial classification, or any combination thereof, for the purpose of establishing sexual orientation.
   2. “Sex” includes gender identity and gender expression. (Ins. Code § 10140.)

This bill:

1. Provides that a subscriber or enrollee shall not be excluded from enrollment or participation in, be denied the benefits of, or be subjected to discrimination by, any health care service plan or health insurer licensed in this state on the basis of race, color, national origin, age, disability, or sex.
2. Provides that discrimination on the basis of sex pursuant to 1) includes, but is not limited to, discrimination on the basis of sex characteristics, including intersex traits; pregnancy or related conditions; sexual orientation; gender identity; and sex stereotypes.
3. Provides that, in providing access to health programs and activities, including arranging for the provision of health care services, a health care service plan or a health insurer shall not:
   1. Deny or limit health care services, including those that have been typically or exclusively provided to, or associated with, individuals of one sex, to an individual based upon the individual’s sex assigned at birth, gender identity, or gender otherwise recorded.
   2. Deny or limit, on the basis of an individual’s sex assigned at birth, gender identity, or gender otherwise recorded, a health care professional’s ability to provide health care services if the denial or limitation has the effect of excluding individuals from participation in, denying them the benefits of, or otherwise subjecting them to discrimination on the basis of sex under a covered health care service plan or covered health insurance policy.
   3. Adopt or apply any policy or practice of treating individuals differently or separating them on the basis of sex in a manner that subjects any individual to more than de minimis harm, including by adopting a policy of engaging in a practice that prevents an individual from participating in a health care service plan or health insurance policy consistent with the individual’s gender identity.
   4. Deny or limit health care services sought for purpose of gender transition or other gender-affirming care that the health care service plan or health insurance policy would otherwise cover if that denial or limitation is based on an individual’s sex assigned at birth, gender identity, or gender otherwise recorded.
4. Provides that a health care service plan, in providing or arranging for the provision of health care services or other health-related coverage, or a health insurer, in providing or administering health insurance coverage or other health-related coverage, shall not do any of the following:
   1. Deny, cancel, limit, or refuse to issue or renew health care plan service enrollment or other health-related coverage, or deny or limit coverage of a claim, or impose additional cost sharing or other limitations or restrictions on coverage, on the basis of race, color, national origin, sex, age, disability, or any combination thereof.
   2. Have or implement marketing practices or benefit designs that discriminate on the basis of race, color, national origin, sex, age, disability, or any combination thereof, in health care service plan coverage, insurance coverage, or other health-related coverage.
   3. Deny or limit coverage, deny or limit coverage of a claim, or impose additional cost sharing or other limitations or restrictions on coverage, to an individual based upon the individual’s sex assigned at birth, gender identity, or gender otherwise recorded.
   4. Have or implement a categorical coverage exclusion or limitation for all health care services related to gender transition or other gender-affirming care.
   5. Otherwise deny or limit coverage, deny or limit coverage of a claim, or impose additional cost sharing or other limitations or restrictions on coverage, for specific health care services related to gender transition or other gender-affirming care if such denial, limitation, or restriction results in discrimination on the basis of sex.
   6. Have or implement benefit designs that do not provide or administer health care service plan coverage, health insurance coverage, or other health-related coverage in the most integrated setting appropriate to the needs of qualified individuals with disabilities, including practices that result in the serious risk of institutionalization or segregation.
5. Provides that 1)-4) do not require access to, or coverage of, a health care service for which the health care service plan or health insurer has a legitimate, nondiscriminatory reason for denying or limiting access to, or coverage of, the health care service or determining that the health care service is not clinically appropriate for a particular individual, or fails to meet applicable coverage requirements, including reasonable medical management techniques, such as medical necessity requirements. A health care plan or health insurer’s determination under this subdivision shall not be based on unlawful animus or bias, or constitute a pretext for discrimination.
6. Requires a health care service plan or health insurer’s evidences of coverage, disclosure form, and combined evidence of coverage and disclosure form to include all of the following information in a notice to enrollees or insureds regarding the coverage requirements pursuant to 1):
   1. A statement that the health care service plan or health insurer does not discriminate on the basis of sex.
   2. How to file a grievance regarding sex-based discrimination.
   3. The health care service plan or health insurer’s website where an enrollee may file a grievance, if available.
   4. The health care service plan or health insurer’s telephone number that an enrollee may use to file a grievance regarding sex-based discrimination.
7. Provides that 1)-6) do not limit the authority of the State Director of Health Care Service or the Insurance Commissioner, a health care service plan or health insurer’s duties, or enrollees’ or insureds’ rights under specified existing law.
8. Provides that the rights, remedies, and penalties established by this section are cumulative and do not supersede the rights, remedies, or penalties established under other laws.

COMMENTS

1. Author’s comment

The author writes:

The Trump Administration has taken steps to dismantle long-standing discrimination protections embedded in Section 1557 of the Affordable Care Act. AB 1876 takes proactive steps to codify these non-discrimination protections into California statute ensuring that all Californians maintain equitable access to healthcare.

1. Federal law prohibits health insurers who receive federal funding from discriminating on the basis of race, color, national origin, sex, age, or disability

Section 1557 of the Affordable Care Act (ACA) (Section 1557) prohibits any health care provider or insurer that receives federal funding from discriminating against a patient on the basis of race, color, national origin, sex, age, or disability.^[1] This prohibition on discrimination on the basis of sex is achieved through a statutory cross-reference to the federal Title IX, which prohibits discrimination on the basis of sex in education programs that receive federal financial assistance.^[2]

In 2020, the Supreme Court held in Bostock v. Clayton County^[3] that “discrimination on the basis of sex” under the federal Title VII, which prohibits discrimination in the workplace on the basis of race, color, religion, sex, or national origin, extends to discrimination on the basis of sexual orientation and gender identity.^[4] As Justice Gorsuch explained:

[I]t is impossible to discriminate against a person for being homosexual or transgender without discriminating against that individual based on sex. Consider, for example, an employer with two employees, both of whom are attracted to men. The two individuals are, to the employer’s mind, materially identical in all respects, except that one is a man and the other a woman. If the employer fires the male employee for no other reason than the fact he is attracted to men, the employer discriminates against him for traits or actions it tolerates in his female colleague. Put differently, the employer intentionally singles out an employee to fire based in part on the employee's sex, and the affected employee’s sex is a but-for cause of the discharge. Or take an employer who fires a transgender person who was identified as a male at birth but who now identifies as a female. If the employer retains an otherwise identical employee who was identified as female at birth, the employer intentionally penalizes a person identified as male at birth for traits or actions that it tolerates in an employee identified as female at birth. Again, the individual employee’s sex plays an unmistakable and impermissible role in the [employer’s] decision.^[5]

In 2021, in light of Bostock’s interpretation of the scope of “discrimination on the basis of sex,” the Department of Health and Human Services (HHS) announced that it “would interpret Section 1557’s prohibition on sex discrimination to include (1) discrimination on the basis of sexual orientation and (2) discrimination on the basis of gender identity.”^[6] HHS subsequently issued proposed amendments to the guidance for implementing Section 1557 in 2022, and issued the final rule in 2024.^[7] Several federal district court judges issued nationwide injunctions to prevent HHS’s interpretation of Section 1557 and the final rule from taking effect.^[8]

As it stands, there is no definitive federal court ruling on whether the rationale of Bostock applies to Section 1557. The Ninth Circuit has, however, held that Bostock’s rationale applies in claims for discrimination on the basis of gender identity under Title IX, suggesting it would do the same in a Section 1557 challenge.^[9]

1. Executive Order 14187 attacks Section 1557 and transgender youth

On January 28, 2025, President Trump signed Executive Order 14187, which assailed the availability of gender-affirming care for “children.”^[10] The Executive Order defined “children” to include actual children as well as adults under the age of 19 years.^[11] Among other things, Executive Order 14187 directed the Secretary of HHS to end gender-affirming care for children and 18-year-olds under Section 1557 and to withdraw the Biden Administration’s guidance extending Section 1557 to discrimination on the basis of sexual orientation and gender identity.^[12] Executive Order 14187 followed on the heels of Executive Order 14168, signed by President Trump on the first day of his presidency, which attempts to order transgender and nonbinary persons out of existence.^[13]

Executive Order 14187 also facially discriminates against transgender youth and 18-year-olds, denying them treatments that are still available to cisgender individuals. Puberty blockers, for example, were approved by the United States Food and Drug Administration (FDA) in 1993 for treating children one year of age and older with “precocious puberty.”^[14] Puberty blockers are designed, and approved, to suppress children’s pituitary-gonadal systems, thereby preventing them from going through puberty and displaying secondary sexual characteristics.^[15] The effects are reversible, usually within six months of discontinuing puberty blockers.^[16] Under Executive Order 14187, cisgender children can continue taking puberty blockers, but transgender children cannot.

The same goes for breast reduction surgery. Although it’s rare, minors do sometimes receive breast reduction surgery.^[17] But these surgeries are overwhelmingly performed on cisgender male minors— for example, in 2019, 97 percent of breast reduction surgeries performed on minors were performed on cisgender males.^[18] Executive Order 14187 blocks the 3 percent of surgeries performed on transgender minors while leaving the 97 percent unbothered.

Portions of Executive Orders 14187 and 14168 have been enjoined on a nationwide basis.^[19] The Office of Management and Budget has also been enjoined from executing any funding freezes pursuant to those Executive Orders.^[20] In enjoining parts of Executive Order 14187 and the broader anti-trans order, Executive Order 14168, Judge Brendan A. Hurson noted that the orders do not cite any medical evidence or research indicating that gender-affirming care is harmful to minors or 18-year-olds, and that the Administration’s citation of studies in the injunction action were “merely [an] attempt to prop up the bare conclusions made by the [Executive Orders] with post hoc rationalizations and justifications that are nowhere to be found in the Orders’ text.”^[21] Judge Hurson then went on to rule that, even if the Executive Order had rested on the Administration’s cited studies, they still would be insufficient to justify “the immediate cessation of gender-affirming care for those under nineteen and the purported goal of protecting children” or to “justify the disparate treatment of transgender youth as a means of protecting them.”^[22]

Committee staff are not aware of any injunction addressing Executive Order 14187 to the extent it purports to limit Section 1557’s antidiscrimination provision. HHS rescinded the Biden Administration’s guidance on Section 1557’s prohibition of discrimination on the basis of sexual orientation and gender identity on February 20, 2025.^[23] HHS has also issued a proposed rule that would prohibit gender-affirming care from being covered as an essential health benefit by health insurers.^[24] Section 1557 is still operative because a president cannot override an act of Congress with an executive order.^[25]

1. This bill codifies in state law Section 1557’s prohibitions on discrimination by health care service plans and health insurers on the basis of race, color, national origin, age, disability, or sex

This bill codifies in state law the protections of Section 1557, consistent with the Supreme Court and Ninth Circuit Court of Appeals’ interpretation of Bostock. Specifically, this bill prevents a health care service plan or health insurer from excluding a person from enrollment or participation in, or denying them benefits under, the health care service or insurance plan, or otherwise discriminating against them, on the basis of race, color, national origin, age, disability, or sex. Consistent with Bostock, the bill defines “discrimination on the basis of sex” to include discrimination on the basis of sex characteristics, including intersex traits; pregnancy or related conditions, sexual orientation; gender identity; and sex stereotypes.

This bill’s protections are cumulative of, and consistent with, California’s existing antidiscrimination provisions, including laws preventing discrimination on the basis of the same list (or an even broader list) of characteristics in services and accommodations in business establishments,^[26] employment,^[27] housing,^[28] and education. And to be clear, this bill does more than protect transgender minors and 18-year-old adults; the bill also protects against other attacks on the availability of care that may arise if Section 1557 is repealed.

Opponents of the bill argue that it mandates coverage of gender affirming care. AB 1876 does not intrude into the relationship between a patient and their medical professional: the bill in no way affects a medical professional’s ability to recommend, or decline to recommend, any treatment or service. The bill is also clear that access or coverage is not required for a treatment or service when there is a legitimate, non-discriminatory reason to deny it, or for which is clinically inappropriate for the patient. Accordingly, this bill preserves medical professionals’ ability to prescribe treatments and services which they, in their medical judgment, deem proper, while prohibiting certain classes of people from being denied coverage for medically prescribed treatment on the basis of invidious discrimination.

1. Stakeholder statements

Equality California, a sponsor of the bill writes:

While California law requires health plans and insurers to cover medically necessary health care for TGI people, AB 1876 strengthens and reaffirms these protections by codifying the nondiscrimination standards established under Section 1557 into state law. Specifically, the bill makes clear that discrimination on the basis of sex includes discrimination based on sexual orientation, gender identity, sex stereotypes, pregnancy or related conditions, and sex characteristics, including intersex traits. By doing so, the bill helps ensure that LGBTQ+ people—and all Californians—can continue to access medically necessary health care without discrimination, regardless of shifting federal policies.

SUPPORT

Alliance for TransYouth Rights (sponsor)

Equality California (sponsor)

Planned Parenthood Affiliates of California (sponsor)

TransFamily Support Services (sponsor)

ACLU California Action

Alliance for TransYouth Liberation

American Association of University Women - California

American College of Obstetricians & Gynecologists - District IX

Asian Americans Advancing Justice-southern California

California Association of Marriage and Family Therapists

California Behavioral Health Association

California Chapter of the American College of Emergency Physicians

California Commission on the Status of Women and Girls

California Foundation for Independent Living Centers

California Legislative LGBTQ Caucus

California Pan - Ethnic Health Network

California Podiatric Medical Association

California Psychological Association

California Federation of Teachers

County Behavioral Health Directors Association, (CBHDA)

Health Access California

Hmong Innovating Politics

LGBTQ+ Inclusivity, Visibility, and Empowerment (LIVE)

Los Angeles LGBT Center

National Health Law Program

Oakland Privacy

PFLAG Clayton-Concord

PFLAG Sacramento

Placer LGBTQ+ Center

SEIU California

Western Center on Law & Poverty

OPPOSITION

California Family Council

California Teachers Supporting Gender-Nonconforming Youth

Cause: Californians United for Sex-Based Evidence in Policy and Law

Democrats for an Informed Approach to Gender

International Foundation for Therapeutic and Counselling Choice

Lesbians Advocating for a Resilient Future

LGB (lesbian, Gay, and Bisexual) Alliance Foundation

Our Duty

Women are Real

Women's Liberation Front

RELATED LEGISLATION

Pending Legislation: None known.

Prior Legislation:

SB 418 (Menjivar, 2025) see Executive Summary.

AB 1502 (Schiavo, 2023) would have prohibited a health care service plan or health insurer from discriminating on the basis of race, color, national origin, sex, age, or disability through the use of clinical algorithms in its decisionmaking. AB 1502 died in the Assembly Health Committee.

PRIOR VOTES

Senate Health Committee (Ayes 7, Noes 1)

Assembly Floor (Ayes 56, Noes 17)

Assembly Appropriations Committee (Ayes 10, Noes 4)

Assembly Judiciary Committee (Ayes 9, Noes 3)

Assembly Health Committee (Ayes 12, Noes 4)

**************

1. 42 U.S.C. § 18116. ↑

2. See ibid.; 20 U.S.C. § 1681. ↑

3. Bostock v. Clayton County (2020) 590 U.S. 644. ↑

4. Id. at pp. 659-660. ↑

5. Id. at p. 660. ↑

6. 87 Fed. Reg. 47824-01 (Aug. 4 2022) p. 47827. ↑

7. 89 Fed. Reg. 37522-01 (May 6, 2024) p. 37523. ↑

8. E.g., Texas v. Becerra (E.D. Tex., Aug. 30, 2024) Case No. 2024 WL 4490621; Texas v. EEOC (N.D. Tex. 2022) 633 F.Supp.3d 824; Tennessee v. Becerra (S.D. Miss. 2024) 739 F.Supp.3d 467. ↑

9. See Hecox v. Little (9th Cir. 2024) 104 F.4th 1061, 1079-1080. ↑

10. Exec. Order No. 14187, 90 Fed. Reg. 8771 (Jan. 28, 2025). ↑

11. Ibid. ↑

12. Ibid. ↑

13. Exec. Order No. 14168, 90 Fed. Reg. 8615 (Jan. 20, 2025). ↑

14. E.g., FDA, Lupron Depot-Ped Kit, NDA No. 020263 (Rev. Apr. 2023). ↑

15. FDA, Lupron Depot-Ped Kit, NDA No. 020263 (Rev. May 2017). ↑

16. Ibid. ↑

17. Dai, et al., Prevalence of Gender-Affirming Surgical Procedures Among Minors and Adults in the US, JAMA Open (Jun. 27, 2024), available at https://pmc.ncbi.nlm.nih.gov/articles/PMC11211955/. ↑

18. Ibid. Some researchers argue that cosmetic surgeries and procedures that are intended to align a cisgender person’s appearance with their ideal gender phenotype—breast augmentation or reduction, nose jobs, etc.---should also be referred to as gender-affirming care, to acknowledge that gender-affirming procedures are not unique to transgender and nonbinary individuals. (Ibid.) ↑

19. E.g., PFLAG v. Trump (D.Md., Mar. 4, 2025) —F.Supp.3d —, 2025 WL 685124; see also Washington v. Trump (W.D. Wash., Feb. 16, 2025) —F.Supp.3d—, 2025 WL 509617 (enjoining Executive Order 14187’s withholding of federal funds from providers unless they stop providing gender-affirming care in Washington, Oregon, and Minnesota). Funnily enough, since the beginning of 2025, Republicans in the Senate have become extremely concerned about the practice of federal district court judges issuing nationwide injunctions, to the point that Senator Chuck Grassley has introduced legislation to prohibit the practice. (See Sen. No. 1206, 119th Cong, 1st Sess. (2025).) ↑

20. New York v. Trump (D.R.I., Mar. 6, 2025) —F.Supp.3d—, 2025 WL 715621; see also Doe v. McHenry (D.D.C., Feb. 4, 2025) —F.Supp.3d—, 2025 WL 388218 (enjoining Executive Order 14168 insofar as it requires transgender federal prisoners to be relocated to penitentiaries inconsistent with their gender identities and denying them gender-affirming care). ↑

21. PFLAG, Inc., supra, at p. 26. ↑

22. Id. at p. 27 (cleaned up). ↑

23. HHS, Office of the Secretary, Letter re: Rescission of “HHS Notice and Guidance on Gender Affirming Care, Civil Rights, and Patient Privacy” (issued March 2, 2022) (Feb. 20, 2025). ↑

24. HHS, Proposed Rule, Patient Protection and Affordable Care Act; Marketplace Integrity and Affordability, 90 Fed. Reg. 12942-01 (Mar. 19, 2025). ↑

25. U.S. Const., art. I, §§ 1, 7 cl. 2; see, e.g., Youngstown Sheet & Tube Co. v. Sawyer (1952) 343 U.S. 578, 587-588; see also id. at pp. 637-638 (conc. opn. of Jackson, J.) (“When the President takes measures incompatible with the express or implied will of Congress, his power is at its lowest ebb, for then he can rely only upon his own constitutional powers minus any constitutional powers of Congress over the matter”). ↑

26. Civ. Code, § 51. ↑

27. Gov. Code, § 12940. ↑

28. Id., § 12955. ↑

SENATE COMMITTEE ON HEALTH

Senator Akilah Weber Pierson, Chair

BILL NO: AB 1876

SUBJECT: Health care coverage: nondiscrimination

SUMMARY:

Codifies a federal regulation to prevent a person from being excluded from enrollment or participation in, denied the benefits of, or subjected to discrimination by any health plan or health insurer on the basis of race, color, national origin, age, disability, or sex. Defines “discrimination on the basis of sex” to include but not be limited to discrimination on the basis of sex characteristics, including intersex traits; pregnancy or related conditions; sexual orientation; gender identity; and, sex stereotypes.

Existing federal law:

1. Establishes the federal Affordable Care Act (ACA), which, among other provisions, establishes health insurance coverage requirements for Americans and federal subsidies available through health care marketplaces (exchanges) for those Americans who qualify. (Pub. L. No. 111-148)
2. Establishes, in Section 1557 of the ACA, that an individual shall not, on the basis of race, color, national origin, sex, age, or disability, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under, any health program or activity that receives federal financial assistance or under any program or activity that is administered by a federal entity. (42 U.S.C. §18116)

Existing state law:

1. Establishes the Department of Managed Health Care (DMHC) to regulate health plans under the Knox-Keene Health Care Service Plan Act of 1975 (Knox-Keene Act) and the California Department of Insurance (CDI) to regulate health insurers under the Insurance Code.

[HSC §1340, et seq. and INS §106, et seq.]

1. Prohibits a health plan or specialized health plan from denying a contract because of the race, color, national origin, ancestry, religion, sex, marital status, sexual orientation, or age of any contracting party, prospective contracting party, or person reasonably expected to benefit from that contract as a subscriber, enrollee, member, or otherwise. Deems it a violation for any health plan to utilize marital status, living arrangements, occupation, sex, beneficiary designation, ZIP Codes or other territorial classification, or any combination thereof for the purpose of establishing sexual orientation. “Sex” and “gender” have the same meaning. [HSC §1365.5]
   
2. Prohibits an admitted insurer, licensed to issue life or disability insurance, from failing or refusing to accept an application for insurance, to issue that insurance to an applicant, or issue or cancel that insurance, under conditions less favorable to the insured than in other comparable cases, except for reasons applicable alike to persons of every race, color, religion, sex, gender, gender identity, gender expression, national origin, ancestry, or sexual orientation. Prohibits race, color, religion, national origin, ancestry, or sexual orientation from constituting a condition or risk for which a higher rate, premium, or charge may be required of the insured for that insurance. [INS §10140]
   
3. Prohibits, except as otherwise permitted by law, no admitted insurer, licensed to issue disability insurance policies for hospital, medical, and surgical expenses, from failing or refusing to accept an application for insurance, failing or refusing to issue that insurance to an applicant, canceling that insurance, refusing to renew that insurance, charging a higher rate or premium for that insurance, or offering or providing different terms, conditions, or benefits, or placing a limitation on coverage under that insurance, on the basis of a person’s genetic characteristics that may, under some circumstances, be associated with disability in that person or that person’s offspring. [INS §10140]
   
4. Prohibits an admitted insurer, licensed to issue disability insurance for hospital, medical, and surgical expenses, from seeking information about a person’s genetic characteristics for any nontherapeutic purpose. Prohibits discrimination from being made in the fees or commissions of agents or brokers for writing or renewing a policy of disability insurance, other than disability income, on the basis of a person’s genetic characteristics that may, under some circumstances, be associated with disability in that person or that person’s offspring. [INS §10140]
   
5. Deems it a violation of 3) above, for any insurer to consider sexual orientation in its underwriting criteria or to utilize marital status, living arrangements, occupation, sex, beneficiary designation, ZIP Codes or other territorial classification within this state, or any combination thereof for the purpose of establishing sexual orientation or determining whether to require a test for the presence of HIV or antibodies to that virus, where that testing is otherwise permitted by law. [INS §10140]
   
6. Defines “sex” to have the same meaning as “gender.” “Gender” means sex and includes a person’s gender identity and gender expression. “Gender expression” means a person’s gender-related appearance and behavior whether or not stereotypically associated with the person’s assigned sex at birth. [INS §10140]
   
7. Requires health plans, insurers, and Medi-Cal managed care plans to require staff who are in direct contact with enrollees or insureds in the delivery of care or services to complete evidence-based cultural competency training for the purpose of providing tans-inclusive health care for individual who identify as transgender, gender diverse, or intersex (TGI). [HSC §1367.043, INS §10133.13, and WIC §14197.09]

This bill:

1. Prohibits a subscriber, enrollee, policyholder, or insured from being excluded from enrollment or participation in, be denied the benefits of, or be subject to discrimination by, any health plan or health insurer licensed in California on the basis of race, color, national origin, age, disability, or sex.
   
2. Includes as “discrimination based on sex” discrimination based on sex characteristics, including intersex traits; pregnancy or related conditions; sexual orientation; gender identity; and sex stereotypes.
   
3. Prohibits a health plan or health insurer from:
   1. Denying or limiting health care services, including those typically or exclusively provided to, or associated with, individuals of one sex, to an individual based upon the individual’s sex assigned at birth, gender identity, or gender otherwise recorded;
   2. Denying or limiting, on the basis of an individual’s sex assigned at birth, gender identity, or gender otherwise recorded, a health care professional’s ability to provide health care services if the denial or limitation has the effect of excluding individuals from participation in, denying them the benefits of, or otherwise subjecting them to discrimination on the basis of sex under a covered health plan or health insurance policy;
   3. Adopting or applying any policy or practice of treating individuals differently or separating them on the basis of sex in a manner that subjects any individual to more than de minimis harm, including by adopting a policy or engaging in a practice that prevents an individual from participating in a health plan or health insurance policy consistent with the individual’s gender identity; and,
   4. Denying or limiting health care services sought for purpose of gender transition or other gender-affirming care that the health plan or health insurance policy would otherwise cover if that denial or limitation is based on an individual’s sex assigned at birth, gender identity, or gender otherwise recorded.
      
4. Prohibits a health plan or health insurer from doing any of the following:
   1. Denying, canceling, limiting, or refusing to issue or renew health plan enrollment, health insurance coverage or other health-related coverage, or denying or limiting coverage of a claim, or imposing additional cost-sharing or other limitations or restrictions on coverage, on the basis of race, color, national origin, sex, age, disability, or any combination thereof;
   2. Having or implementing marketing practices or benefit designs that discriminate on the basis of race, color, national origin, sex, age, disability, or any combination thereof, in health plan or health insurance coverage or other health-related coverage;
   3. Denying or limiting coverage, denying or limiting coverage of a claim, or imposing additional cost-sharing or other limitations or restrictions on coverage, to an individual based upon the individual’s sex assigned at birth, gender identity, or gender otherwise recorded;
   4. Having or implementing a categorical coverage exclusion or limitation for all health care services related to gender transition or other gender-affirming care;
   5. Otherwise denying or limiting coverage, denying or limiting coverage of a claim, or imposing additional cost-sharing or other limitations or restrictions on coverage, for specific health care services related to gender transition or other gender-affirming care if such denial, limitation, or restriction results in discrimination on the basis of sex; and,
   6. Having or implementing benefit designs that do not provide or administer health plan or health insurance coverage or other health-related coverage in the most integrated setting appropriate to the needs of qualified individuals with disabilities, including practices that result in the serious risk of institutionalization or segregation.
      
5. Does not require access to, or coverage of, a health care service for which a health plan or health insurer has a legitimate, nondiscriminatory reason for denying or limiting access to, or coverage of the health care service or determining that the health care service is not clinically appropriate for a particular individual or fails to meet applicable coverage requirements. Prohibits a health plan’s or health insurer’s determination from being based on lawful animus or bias or constitute a pretext for discrimination.
   
6. Requires a health plan’s or health insurer’s evidence of coverage and disclosure forms to include specified information in a notice to enrollees or insureds regarding the requirements of this bill.

FISCAL EFFECT:

According to the Assembly Appropriations Committee, CDI estimates costs of $6,000 in fiscal year (FY) 2026-27 and $18,000 in FY 2027-28 to review insurers’ evidence of coverage and disclosure forms (Insurance Fund). DMHC anticipates minor and absorbable costs.

PRIOR VOTES:

COMMENTS:

1. Author’s statement. According to the author, the Trump Administration has taken steps to dismantle long-standing discrimination protections embedded in Section 1557 of the ACA. This bill takes proactive steps to codify these non-discrimination protections into California statute ensuring that all Californians maintain equitable access to healthcare.
   
2. Section 1557. Title I of the ACA, “Quality, Affordable Health Care for All Americans,” establishes individual and group health insurance market reforms, health benefit exchanges and qualified health plans, premium tax credits and cost-sharing reductions, individual and employer health coverage mandates, and Section 1557 with respect to nondiscrimination (among many other provisions). Section 1557 provides that, except as otherwise provided in title I of the ACA, an individual shall not, on the grounds prohibited under title VI of the Civil Rights Act of 1964, title IX of the Education Amendments of 1972, the Age Discrimination Act of 1975, or section 504 of the Rehabilitation Act of 1973, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under, any health program or activity, any part of which is receiving federal financial assistance, including credits, subsidies, or contracts of insurance, or under any program or activity that is administered by an executive agency or any entity established under title I of the ACA. This applies to health programs or activities administered by recipients of federal financial assistance from the U.S. Department of Health and Human Services (HHS), HHS-administered health programs or activities, and title I entities that administer health programs or activities.
   
3. Effective dates. Final regulations for Section 1557 were effective beginning July 5, 2024, or within a specified time frame after that date, depending upon the specific provision. For health insurance coverage or other health-related coverage that was not subject to the July 5, 2024, requirement, the provisions are effective by the first day of the first plan year (in the individual market, policy year) beginning on or after January 1, 2025. The final regulation has disclosures, training and other requirements.
   
4. Health insurance provisions in Section 1557 regulations. Section 92.207 covers nondiscrimination in health insurance coverage and other health-related coverage. A covered entity must not, in providing or administering health insurance coverage or other health-related coverage, discriminate on the basis of race, color, national origin, sex, age, disability, or any combination thereof. A covered entity must not provide or administer health insurance coverage or other health-related coverage that would:
   • 1. Deny, cancel, limit, or refuse to issue or renew health insurance coverage or other health-related coverage, or deny or limit coverage of a claim, or impose additional cost sharing or other limitations or restrictions on coverage, on the basis of race, color, national origin, sex, age, disability, or any combination thereof;
     2. Have or implement marketing practices or benefit designs that discriminate on the basis of race, color, national origin, sex, age, disability, or any combination thereof, in health insurance coverage or other health-related coverage;
     3. Deny or limit coverage, deny or limit coverage of a claim, or impose additional cost sharing or other limitations or restrictions on coverage, to an individual based upon the individual's sex assigned at birth, gender identity, or gender otherwise recorded;
     4. Have or implement a categorical coverage exclusion or limitation for all health services related to gender transition or other gender-affirming care;
     5. Otherwise deny or limit coverage, deny or limit coverage of a claim, or impose additional cost sharing or other limitations or restrictions on coverage, for specific health services related to gender transition or other gender-affirming care if such denial, limitation, or restriction results in discrimination on the basis of sex; or
     6. Have or implement benefit designs that do not provide or administer health insurance coverage or other health-related coverage in the most integrated setting appropriate to the needs of qualified individuals with disabilities, including practices that result in the serious risk of institutionalization or segregation.

The final rule does not require coverage of any health service where the covered entity has a legitimate, nondiscriminatory reason for denying or limiting coverage of the health service or determining that such health service fails to meet applicable coverage requirements, including reasonable medical management techniques such as medical necessity requirements. Such coverage denial or limitation must not be based on unlawful animus or bias or constitute a pretext for discrimination. Nothing in the rule is intended to preclude a covered entity from availing itself of protections described in federal laws on civil rights, education, rehabilitation, or age discrimination.

1. Litigation. Section 1557 and associated rulemaking have been subject to a variety of litigation. Injunctions prohibiting enforcement of gender identity in the definition of sex discrimination are in place and will remain in place unless or until new regulations are promulgated or a federal administration takes a different action. The California Senate Judiciary Committee analysis of SB 418 (Menjivar of 2025), which contained the same discrimination protections as this bill, indicates “Several federal district court judges issued nationwide injunctions to prevent HHS’s interpretation of Section 1557 and the final rule from taking effect. As it stands, there is no definitive federal court ruling on whether the rationale of Bostock applies to Section 1557. The Ninth Circuit has, however, held that Bostock’s rationale applies in claims for discrimination on the basis of gender identity under Title IX, suggesting it would do the same in a Section 1557 challenge.”
   
2. Executive Order 14187. This executive order issued by President Trump on January 28, 2025, directed the Secretary of the federal HHS to end gender-affirming care for people 18 years and younger under Section 1557 and to withdraw Biden Administration guidance extending Section 1557 to discrimination on the basis of sexual orientation and gender identity. The California Senate Judiciary Committee analysis of SB 418 indicates that this executive order “facially discriminates against transgender youth and 18-year-olds, denying them treatments that are still available to cisgender individuals.” Portions of this and other actions by the Trump administration have been enjoined on a nationwide basis, including any associated funding freezes.
3. Trans-Inclusive Care. According to DMHC, Trans-Inclusive Care is defined in state law as “comprehensive health care that is consistent with the standards of care for individuals who identify as TGI, honors an individual’s personal bodily autonomy, does not make assumptions about an individual’s gender, accepts gender fluidity and nontraditional gender presentation, and treats everyone with compassion, understanding, and respect.” DMHC indicates that DMHC licensed health plans and CDI licensed insurers are required by California law to provide health plan enrollees and insureds who identify as TGI with medically necessary gender affirming care.
   
4. Double referral. This bill has been double referred. Should this bill pass out of this Committee, it will be referred to the Senate Judiciary Committee.
   
5. Prior legislation. SB 418 (Menjivar of 2025) in addition to the same discrimination protections as in this bill, would have permitted a person to receive coverage for a 12-month supply of federal Food and Drug Administration-approved prescription hormone therapy, and necessary supplies for self-administration, prescribed by an in-network provider and dispensed at one time, as specified, and contained an urgency clause that would have made the bill effective upon enactment. SB 418 was vetoed by the Governor Newsom who wrote in the veto message:

This bill would require health plans and insurers to cover a 12-month supply of federal Food and Drug Administration-approved prescription hormone therapy, and necessary supplies for self-administration, prescribed by an in network provider and dispensed at one time without utilization management (UM).

I appreciate the author's intent to ensure patient access to the comprehensive care they need. While there are provisions of this bill that are worthy of support, I am concerned about the limitation on the use of UM, which is an important tool to ensure enrollees receive the right care at the right time. Prohibiting this cost containment strategy is likely to result in an increase in enrollee premiums to offset costs incurred by health plans and insurers. At a time when individuals are facing double-digit rate increases in their health care premiums across the nation, we must take great care to not enact policies that further drive up the cost of health care, no matter how well-intended.

SB 923 (Wiener, Chapter 822, Statutes of 2022) requires health plans and insurers to require all of its support staff who are in direct contact with enrollees or insureds to complete evidence-based cultural competency training for the purpose of providing trans-inclusive health care for individuals who identify as TGI. SB 923 adds processes to continuing medical education requirements related to cultural and linguistic competency for physicians and surgeons specific to gender-affirming care services, as specified.

1. Support. This bill is cosponsored by the TransLatin@ Coalition to ensure that TGI, LGBTQ+, and non-English speaking people, along with pregnant people seeking abortion care services, cannot be denied or limited coverage for medically necessary health care. The TransLatin @ Coalition writes, “Given the Federal Administration’s deliberate efforts to roll back these protections, formalizing these protections on the state level is increasingly vital. In the first month of this administration, the President issued sixty-four executive orders, one of which is Executive Order 14187. This executive order functions as a denial of the existence of TGI people and consequently directs federal agencies to withhold funding from healthcare institutions and providers that offer gender-affirming care.” Planned Parenthood Affiliates of California., another cosponsor, supports public policy that fosters a social climate of acceptance, non-discrimination, destigmatization, and legal justice for all. Equality California, another cosponsor, writes that this bill strengthens and reaffirms California’s nondiscrimination protections to ensure TGI people can access medically necessary care without discrimination. Also, a cosponsor, the California LGBTQ Health and Human Services Network writes that this bill is a vital shield that guarantees the right to inclusive, respectful, and life-saving healthcare regardless of the shifting political climate in Washington D.C. Gender Justice LA, an additional cosponsor, writes with recent federal actions rolling back these protections, California has both the opportunity and responsibility to lead by ensuring that all residents can continue to rely on fair and equitable access to health care, and enshrining these provisions into state law through this bill will protect vulnerable communities from discrimination and ensure equal treatment for vulnerable communities. Disability Rights California believes that personal independence is a basic right for every person, including a person’s right to develop their personality, to express hopes and dreams, and to make choices that permit the Dignity of Risk (a concept that ensures informed decision-making by helping a client understand the risks associated with an action while not attempting to force them to choose what is viewed culturally or socially as better).
2. Opposition. The California Family Council writes “by treating an insurer’s denial of coverage as unlawful discrimination, this bill removes insurers’ discretion to assess medical necessity, long-term risks, and evolving scientific evidence, particularly when the patient is a minor. These interventions carry serious lifelong consequences, including impacts on bone density, fertility, cardiovascular health, and neurological development… Additionally, this bill poses serious religious liberty concerns.” Concerned Women for America Legislative Action Committee writes “the long-term consequences of these interventions – such as hormone treatments and surgical procedures – on the natural development of the human body remain largely unknown. Moreover, these medical procedures often lead to irreversible outcomes, which can have lasting effects on an individual’s physical and psychological well-being. The side effects and complications associated with experimental drugs and treatments may increase the need for ongoing medical care and pharmaceuticals in the future, which could place a health financial burden on patients and the broader healthcare system.” The Democrats for an Informed Approach to Gender writes “this bill is a coverage mandate that requires insurers to cover a category of interventions regardless of the quality of evidence supporting them. This bill will harm Californians, mandating coverage for medical interventions that an increasing body of international and national evidence has found to be not only unsafe but actively harmful – interventions that disproportionately affect gender nonconforming minors, gays and lesbians, youth on the autism spectrum, and vulnerable adults. Section (b)(3)(D) of the proposed legislation prohibits any ‘categorical coverage exclusion’ for ‘gender transition’ or ‘gender-affirming care,’ ensuring that this cohort receives damaging medical interventions unsupported by credible evidence.” LGB Alliance USA writes “1367.0435 purports to allow for ‘legitimate, nondiscrimination reason’ for denying claims, it still allows for litigation of claim denials that are due to ‘unlawful animus or bias or constitute a pretext for discrimination.’ This could make any claim denial subject to legal scrutiny, potentially resulting in insurance providers being afraid of making medically appropriate decisions for transgender patients… This bill ignores the vulnerabilities of LGB Californians, ignores the hazards of gender medicalization in youth, and dangerously conflates gender identity with sex in medical care.”
   

SUPPORT AND OPPOSITION:

Support: California LGBTQ Health and Human Services Network (cosponsor)

Equality California (cosponsor)
Gender Justice LA (cosponsor)
Planned Parenthood Affiliates of California (cosponsor)
The TransLatin@ Coalition (cosponsor)

TransFamily Support Services (cosponsor)

Access Reproductive Justice
American Civil Liberties Union California Action
Advocates for Trans Equality
Alliance for TransYouth Rights
American Academy of Pediatrics, California
American Association of University Women - California
American College of Obstetricians & Gynecologists - District Ix
Asian Americans Advancing Justice - Southern California
California Academy of Child and Adolescent Psychiatry

California Alliance of Child and Family Services
California Association of Marriage and Family Therapists
California Behavioral Health Association
California Chapter of the American College of Emergency Physicians

California Commission on the Status of Women and Girls

California Federation of Teachers
California Foundation for Independent Living Centers
California Legislative LGBTQ Caucus
California Pan - Ethnic Health Network
California Podiatric Medical Association

California Primary Care Association Advocates
California Psychological Association

California Service Employees International Union
City and County of San Francisco Department on the Status of Women

City of West Hollywood
County Behavioral Health Directors Association
Courage California
Disability Rights California
El/La Para Translatinas
Gender Affirming Professionals
Health Access California

Hmong Innovating Politics
Justice in Aging
LGBTQ Connection
LGBTQ+ Inclusivity, Visibility, and Empowerment
Los Angeles LGBT Center
Los Angeles LGBTQ+ Chamber of Commerce
Lyon-Martin Community Health Services
Mirror Memoirs
National Health Law Program

Oakland Privacy
ParivarBayArea
Parents, Families, and Friends of Lesbians and Gays (PFLAG) Clayton-Concord
PFLAG Fresno
PFLAG Oakland-East Bay

PFLAG Sacramento
PFLAG San Diego County
PFLAG San Jose/Peninsula

Placer LGBTQ+ Center
Rainbow Families Action Bay Area
San Francisco AIDS Foundation
Saturn’s Wish
The Children's Partnership
The Landing Spot
The San Diego LGBT Community Center
Transgender Health and Wellness Center
Western Center on Law & Poverty, Inc.

Oppose: California Family Council
Californians United for Sex-based Evidence in Policy and Law
Concerned Women for America
Democrats for an Informed Approach to Gender

International Foundation for Therapeutic and Counseling Choice
Lesbians Advocating for a Resilient Future
LGB Alliance Foundation
LGB Courage Coalition
Our Duty
SFV Alliance
Women Are Real
Women's Declaration International USA, Inc.
Women's Liberation Front

-- END --

ASSEMBLY THIRD READING

ATR Bill Id:AB 1876

Author:(Addis)

As Introduced Ver:February 12, 2026

Majority vote

SUMMARY

Prohibits a health plan or health insurance subscriber, enrollee or policyholder from being excluded from enrollment or participation in, being denied the benefits of, or being subjected to discrimination by, any health plan or health insurer on the basis of race, color, national origin, age, disability, or sex.

Major Provisions

COMMENTS

Affordable Care Act (ACA). The ACA was signed into law on March 23, 2010, and is the most significant legislative reform of the U.S. health care system since the establishment of Medicare and Medicaid in 1965. The passage of the ACA brought sweeping changes to health care coverage in California, including establishing more generous eligibility rules and federal funding for Medi-Cal (California′s Medicaid program), providing federally funded premium and cost-sharing subsidies offered through Covered California (the state′s health benefit exchange), and imposing new requirements on health insurance that make it easier for individuals with pre-existing conditions to obtain coverage.

Section 1557 of the ACA provides that, except as otherwise provided in Title I of the ACA, an individual is prohibited from being excluded from participation in, be denied the benefits of, or be subjected to discrimination under, any health program or activity, any part of which is receiving federal financial assistance. This includes credits, subsidies, or contracts of insurance, or under any program or activity that is administered by an executive agency or any entity established under Title I of the ACA. This anti-discrimination provision applies to health programs or activities administered by recipients of federal financial assistance from the federal Department of Health and Human Services (DHHS), DHHS-administered health programs or activities, and Title I entities that administer health programs or activities.

In 2020, the Supreme Court held in the decision in Bostock v. Clayton County that ″discrimination on the basis of sex″ under the federal Title VII, which prohibits discrimination in the workplace on the basis of race, color, religion, sex, or national origin, extends to discrimination on the basis of sexual orientation and gender identity. In 2021, in light of the Supreme Court′s interpretation of the scope of ″discrimination on the basis of sex,″ DHHS announced that it ″would interpret Section 1557′s prohibition on sex discrimination to include (i) discrimination on the basis of sexual orientation and (ii) discrimination on the basis of gender identity.″ DHHS subsequently issued proposed amendments to the guidance for implementing Section 1557 in 2022, and issued a final rule in 2024. Several federal district court judges issued nationwide injunctions to prevent DHHS′s interpretation of Section 1557 and its proposed rules from taking effect.

Executive Order (EO) 14187. On January 28, 2025, President Trump issued EO 14187, which states ″it is the policy of the United States that it will not fund, sponsor, promote, assist, or support the so-called ′transition′ of a child from one sex to another, and it will rigorously enforce all laws that prohibit or limit these destructive and life-altering procedures.″ EO 14187 directed the Secretary of DHHS, consistent with applicable law, to take all appropriate actions to end the ″chemical and surgical mutilation of children,″ including regulatory and sub-regulatory actions, which may involve laws, programs, issues, or documents, including Medicare or Medicaid conditions of participation or conditions for coverage, clinical-abuse or inappropriate-use assessments relevant to State Medicaid programs, and Section 1557 of the ACA. EO 14187 also directed the Secretary of DHHS to promptly withdraw DHHS′s Biden-era guidance from 2022, and directed the Secretary, in consultation with the Attorney General, to issue new guidance protecting whistleblowers who take action related to ensuring compliance with this order.

According to the Author

"While the federal government works to weaken nondiscrimination protections, California is standing firm in our values. The author argues that this bill ensures all Californian can access health care without fear of discrimination."

Arguments in Support

The TransLatin@ Coalition is a co-sponsor of this bill, stating that it would ensure that Transgender, Gender-Expansive, and Intersex (TGI), LGBTQ+, and non-English speaking people, along with pregnant people seeking abortion care services, cannot be denied or limited coverage for medically necessary health care. The TransLatin@ Coalition continues that in the first month of this administration, the current President issued sixty-four executive orders, one of which functions as a denial of the existence of TGI people and consequently directs federal agencies to withhold funding from healthcare institutions and providers that offer gender-affirming care. The TransLatin@ Coalition argues that this bill would make clear that health plans and insurers are prohibited from discriminating against individuals on the basis of race, color, national origin, age, disability, or sex. The TransLatin@ Coalition concludes that this bill would protect the rights of our TGI and immigrant community members who have seen longer life spans and greater quality of life when able to access these critical services.

Equality California (EQCA) is a cosponsor of this bill, stating that California law requires health plans and insurers to cover medically necessary health care for TGI people, and this bill strengthens and reaffirms these protections by codifying the nondiscrimination standards established under Section 1557 of the ACA into state law. By doing so, EQCA argues that this bill helps ensure that LGBTQ+ people—and all Californians—can continue to access medically necessary health care without discrimination, regardless of shifting federal policies.

Arguments in Opposition

The SFV Alliance opposes this bill, stating that its major goal is to mandate health provider insurance to pay for so called gender affirming care. The SFV Alliance continues that gender affirming care is, in their analysis, harmful to a person. The SFV Alliance argues that gender affirming care takes the body for a state of homeostasis to unpredictable, an unstable body state that will have to rely on medication to survive, with possible unknown side effects and complications that our modern medical technology will have no answer or treatment for. The SFV Alliance continues that this bill will create a newly increased cost to health care providers which would have to be absorbed by all of those with medical insurance in California. The SFV Alliance concludes that these procedures are not only going to be a financial burden on the overall base of the insured, they will cause the patient unnecessary harm.

The California Family Council (CFC) is also opposed to this bill, arguing that by treating an insurer′s denial of coverage as unlawful discrimination this bill removes insurers′ discretion to assess medical necessity, long-term risks, and evolving scientific evidence, particularly when the patient is a minor. CFC argues that interventions carry serious lifelong consequences, including impacts on bone density, fertility, cardiovascular health, and neurological development. CFC continues that surgical procedures performed on minors are permanent and irreversible, and insurers should retain the ability to exercise careful medical and actuarial judgment without facing sweeping penalties. CFC concludes that compelling employers or individuals through insurance mandates to subsidize gender-transition procedures would violate deeply held religious beliefs and conscience protections.

FISCAL COMMENTS

According to the Assembly Committee on Appropriations, the Department of Insurance estimates costs of $6,000 in fiscal year (FY) 2026-27 and $18,000 in FY 2027-28 to review insurers′ evidence of coverage and disclosure forms (Insurance Fund). The Department of Managed Health Care anticipates minor and absorbable costs.

VOTES

ASM HEALTH: 12-4-0

YES: Bonta, Addis, Aguiar-Curry, Ahrens, Caloza, Carrillo, Mark González, Patel, Rogers, Schiavo, Sharp-Collins, Stefani

NO: Chen, Johnson, Patterson, Sanchez

ASM JUDICIARY: 9-3-0

YES: Kalra, Bauer-Kahan, Bryan, Connolly, Harabedian, Pacheco, Papan, Stefani, Zbur

NO: Macedo, Dixon, Sanchez

ASM APPROPRIATIONS: 10-4-1

YES: Wicks, Arambula, Calderon, Caloza, Fong, Mark González, Krell, Pacheco, Pellerin, Solache

NO: Hoover, Dixon, Ta, Tangipa

ABS, ABST OR NV: Muratsuchi

UPDATED

VERSION: February 12, 2026

CONSULTANT: Riana King / HEALTH / (916) 319-2097 FN: 0002441

Date of Hearing: April 29, 2026

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Buffy Wicks, Chair

ABPCA Bill Id:AB 1876

Author:(Addis) – As Introduced Ver:February 12, 2026

Urgency: No State Mandated Local Program: Yes Reimbursable: No

SUMMARY:

This bill prohibits a health plan or health insurer (collectively, health insurer) from denying coverage or benefits, or otherwise discriminating against, a subscriber, enrollee, or policyholder on the basis of race, color, national origin, age, disability, or sex.

Specifically, this bill:

1. Defines “discrimination on the basis of sex” for purposes of this bill to include, but not be limited to, discrimination on the basis of sex characteristics, including intersex traits, pregnancy or related conditions, sexual orientation, gender identity, or sex stereotypes.
2. Prohibits a health insurer from engaging in various specified activities based on an individual’s sex assigned at birth, gender identity, or gender otherwise recorded, race, color, national origin, sex, age, disability, or any combination thereof.
   
3. Requires a health insurer’s evidences of coverage, disclosure form, and combined evidence of coverage and disclosure form to include in a notice to enrollees:
   
   1. A statement that the health plan or health insurer does not discriminate on the basis of a characteristic protected under applicable state law.
      
   2. How to file a grievance regarding discrimination, including the health insurer’s website where an enrollee may file a grievance, if available, and the telephone number an enrollee may use to file a grievance regarding discrimination.
      

FISCAL EFFECT:

The Department of Insurance estimates costs of $6,000 in fiscal year (FY) 2026-27 and $18,000 in FY 2027-28 to review insurers’ evidence of coverage and disclosure forms (Insurance Fund).

The Department of Managed Care anticipates minor and absorbable costs.

COMMENTS:

1. Purpose. This bill is co-sponsored TransLatin@ Coalition, Equality California, Planned Parenthood Affiliates of California, Trans Family Support Services, and Gender Justice LA. According to the author:

While the federal government works to weaken nondiscrimination protections, California is standing firm in our values. [This bill] ensures all Californians can access health care without fear of discrimination.

1. Background. On January 28, 2025, President Donald Trump issued Executive Order (EO) 14187, titled "Protecting Children from Chemical and Surgical Mutilation.” EO 14187 prohibits the use of federal funds to perform surgeries, provide hormone therapy, subscribe puberty blockers, or perform any other gender-affirming treatments on a person 19 years of age or younger. Although some hospitals (including one in Los Angeles) stopped providing gender affirming care, within a month several lawsuits had been filed challenging the EO on multiple grounds, including that the EO exceeded the President’s authority to override anti-discrimination provisions of Section 1557 of the Affordable Care Act (ACA). Although litigation is still pending, most federal district courts hearing the issue have sided with plaintiffs and enjoined the federal government from withholding federal funds. In addition, a coalition of Attorneys General of several states filed a suit challenging EO 14187.

The author and supporters present this bill as a response to the efforts of the Trump Administration to use the power of the federal purse to deny access to certain kinds of health care that the administration disfavors, including some reproductive care for women, and especially, gender-affirming care for minors by codifying in state law federal anti-discrimination provisions in the ACA.

1. Opposition. The California Family Council writes in opposition:

By treating an insurer’s denial of coverage as unlawful discrimination, AB 1876 removes insurers’ discretion to assess medical necessity, long-term risks, and evolving scientific evidence, particularly when the patient is a minor. These interventions carry serious lifelong consequences, including impacts on bone density, fertility, cardiovascular health, and neurological development. Surgical procedures performed on minors are permanent and irreversible. Insurers should retain the ability to exercise careful medical and actuarial judgment without facing sweeping penalties.

Additionally, AB 1876 poses serious religious liberty concerns. Many faith-based employers and individuals hold sincere religious convictions that sex is immutable. Compelling employers or individuals through insurance mandates to subsidize gender-transition procedures would violate deeply held religious beliefs and conscience protections.

Analysis Prepared by: Allegra Kim / APPR. / (916) 319-2081

Date of Hearing: April 14, 2026

ASSEMBLY COMMITTEE ON JUDICIARY

Ash Kalra, Chair

ABPCA Bill Id:AB 1876

Author:(Addis) – As Introduced Ver:February 12, 2026

SUBJECT: Health care coverage: nondiscrimination

KEY ISSUE: should california reiterate that health care service plans and health insurers are prohibited from discriminating against subscribers, enrollees, or policy holders on the basis of race, color, national origin, age, disability, or sex?

SYNOPSIS

This bill prohibits a health care service plan or health insurer from denying coverage to a subscriber, enrollee, or policy holder on the basis of race, color, national origin, age, disability, or sex. The bill defines discrimination on the basis of sex for these purposes to include, among other things, discrimination on the basis of intersex traits, pregnancy, and gender identity. Specifically, the bill takes federal anti-discrimination provisions in the Affordable Care Act (ACA) and codifies those protections into state law. According to the author, the bill is necessary to preserve these protections in light of the efforts of the Trump administration to limit the scope of sex discrimination, especially in the area of health care.

Because existing law generally prohibits health plans and health insurers from engaging in this kind of discrimination, the bill appears intended to reiterate California’s commitment to protecting these rights rather than substantively changing existing law. In the face of continued aggression towards the LGBTQ+ by the federal administration this bill is laudable. However, if forthcoming federal policies are deemed to preempt state law, then the provisions of this bill will still be forced to give way to the federal edict. If the federal policies are not deemed to preempt California’s more protective state laws, then existing California law may already be sufficient. The bill, in short, is more of a statement against the direction of federal law than a change in state law.

This bill is co-sponsored The TransLatin@ Coalition, Equality California, Planned Parenthood Affiliates of California, Trans Family Support Services, California LGBTQ Health and Human Services Network, and Gender Justice LA. It is supported by several other groups. The bill is opposed by an otherwise diverse group united in common opposition to expanding the definition of “sex” beyond a biological male-female binary. The bill recently passed out of the Assembly Health Committee on a 12-4 vote.

SUMMARY: Prohibits a health care service plan or health insurer from denying coverage or benefits, or otherwise discriminating against, a subscriber, enrollee, or policyholder on the basis of race, color, national origin, age, disability, or sex. Specifically, this bill:

1. Defines discrimination on the basis of sex for purposes of this bill to include, but not be limited to, discrimination on the basis of any of the following:
   1. Sex characteristics, including intersex traits.
   2. Pregnancy or related conditions.
   3. Sexual orientation.
   4. Gender identity.
   5. Sex stereotypes.
2. Prohibits a health plan or health insurer from doing any of the following:
   1. Denying or limiting health care services, including those that have been typically or exclusively provided to, or associated with, individuals of one sex, to an individual based upon the individual’s sex assigned at birth, gender identity, or gender otherwise recorded.
   2. Denying or limiting, on the basis of an individual’s sex assigned at birth, gender identity, or gender otherwise recorded, a health care professional’s ability to provide health care services if the denial or limitation has the effect of excluding individuals from participation in, denying them the benefits of, or otherwise subjecting them to discrimination on the basis of sex under a covered health plan or health insurer.
   3. Adopting or applying any policy or practice of treating individuals differently or separating them on the basis of sex in a manner that subjects any individual to more than de minimis harm, including by adopting a policy or engaging in a practice that prevents an individual from participating in a health care service plan consistent with the individual’s gender identity.
   4. Denying, cancelling, or limiting health care services sought for purpose of gender transition or other gender-affirming care that the health plan or health insurer would otherwise cover if that denial or limitation is based on an individual’s sex assigned at birth, gender identity, or gender otherwise recorded.
3. Prohibits a health plan or health insurer, in providing or arranging for the provision of health care services or other health-related coverage, from doing any of the following:
   1. Denying, canceling, limiting, or refusing to issue or renew health care service plan enrollment or other health-related coverage, or denying or limiting coverage of a claim, or imposing additional cost-sharing or other limitations or restrictions on coverage, on the basis of race, color, national origin, sex, age, disability, or any combination thereof.
   2. Having or implementing marketing practices or benefit designs that discriminate on the basis of race, color, national origin, sex, age, disability, or any combination thereof, in health plan or health insurance coverage or other health-related coverage.
   3. Denying or limiting coverage, denying or limiting coverage of a claim, or imposing additional cost sharing or other limitations or restrictions on coverage, to an individual based upon the individual’s sex assigned at birth, gender identity, or gender otherwise recorded.
   4. Having or implementing a categorical coverage exclusion or limitation for all health care services related to gender transition or other gender-affirming care.
   5. Denying or limiting coverage, denying or limiting coverage of a claim, or imposing additional cost-sharing or other limitations or restrictions on coverage, for specific health care services related to gender transition or other gender-affirming care if such denial, limitation, or restriction results in discrimination on the basis of sex.
   6. Having or implementing benefit designs that do not provide or administer health plan or health insurance coverage or other health-related coverage in the most integrated setting appropriate to the needs of qualified individuals with disabilities, including practices that result in the serious risk of institutionalization or segregation.
4. Prohibits the above-described provisions from requiring access to, or coverage of, a health care service for which the health plan or health insurer has a legitimate, nondiscriminatory reason for denying or limiting access to, or coverage of, the health care service or determining that the health care service is not clinically appropriate for a particular individual, or fails to meet applicable coverage requirements, including reasonable medical management techniques, such as medical necessity requirements.
5. Requires a health plan or health insurer’s evidences of coverage, disclosure form, and combined evidence of coverage and disclosure form, to include all of the following information in a notice to enrollees regarding the coverage requirements imposed above:
   1. A statement that the health plan or health insurer does not discriminate on the basis of a characteristic protected under applicable state law, including this bill.
   2. How to file a grievance regarding discrimination.
   3. The health plan or health insurer’s internet website where an enrollee may file a grievance, if available.
   4. The health plan’s or health insurer’s telephone number that an enrollee may use to file a grievance regarding discrimination.
6. Prohibits the above-described provisions from limiting the Department of Managed Care (DMHC) director’s or the California Department of Insurance (CDI) commissioner’s authority, a health plan or health insurer’s duties, or enrollees’ rights.
7. Requires the rights, remedies, and penalties established by the above-described provisions to be cumulative and not supersede the rights, remedies, or penalties established under other laws, including existing anti-discrimination provisions, or the Unruh Civil Rights Act.

EXISTING LAW:

1. Prohibits, under the Patient Protection and Affordable Care of Act of 2010 (ACA), discrimination on the grounds of race, color, national origin, sex, age, and disability in certain health programs and activities. (42 U.S.C. Section 18116.)
2. Establishes the Department of Managed Health Care to regulate health care service plans under the Knox-Keene Health Care Service Plan Act of 1975 and the California Department of Insurance to regulate health insurers under the Insurance Code. (Health and Safety Code Section 1340 et seq. and Insurance Section 106 et seq.)
3. Prohibits a health plan or specialized health plan, from refusing to enter into any contract or from canceling or declining to renew or reinstate any contract because of the race, color, national origin, ancestry, religion, sex, marital status, sexual orientation, or age of any contracting party, prospective contracting party, or person reasonably expected to benefit from that contract as a subscriber, enrollee, member, or otherwise. Deems it a violation for any health plan to utilize marital status, living arrangements, occupation, sex, beneficiary designation, ZIP Codes or other territorial classification, or any combination thereof for the purpose of establishing sexual orientation. Defines “sex” to mean “gender,” and defines “gender” to include gender identity and gender expression (defined as a person’s gender-related appearance and behavior regardless of whether it is stereotypically associated with the person’s assigned sex at birth). (Health & Safety Code Section 365.5.)
4. Prohibits an admitted insurer, licensed to issue life or disability insurance, from failing or refusing to accept an application for that insurance, to issue that insurance to an applicant therefor, or issue or cancel that insurance, under conditions less favorable to the insured than in other comparable cases, except for reasons applicable alike to persons of every race, color, religion, sex, gender, gender identity, gender expression, national origin, ancestry, or sexual orientation. Prohibits race, color, religion, national origin, ancestry, or sexual orientation from, of itself, constituting a condition or risk for which a higher rate, premium, or charge may be required of the insured for that insurance. Allows, unless otherwise prohibited by law, premium, price, or charge differentials because of the sex of any individual when based on objective, valid, and up-to-date statistical and actuarial data or sound underwriting practices. (Insurance Code Section 10140.)
5. Deems it be a violation of 4) above for any insurer to consider sexual orientation in its underwriting criteria or to utilize marital status, living arrangements, occupation, sex, beneficiary designation, ZIP Codes or other territorial classification within this state, or any combination thereof for the purpose of establishing sexual orientation or determining whether to require a test for the presence of the human immunodeficiency virus or antibodies to that virus, where that testing is otherwise permitted by law. (Insurance Code Section 10140.)
6. Defines for purposes of 4) and 5) above, “sex” to have the same meaning as gender and defines gender to include a person’s gender identity and gender expression, and it defines “gender expression” to mean a person’s gender-related appearance and behavior whether or not stereotypically associated with the person’s assigned sex at birth. (Insurance Code Section 10140.)
7. Provides that a parent or guardian must consent to medical treatment for a minor, subject to certain exceptions for emancipated minors, for emergency care, and for certain treatments related to pregnancy or mental health, as specified. However, even where providers treat a minor without parental or guardian consent under one of the statutory exceptions, they are required to involve parents or guardians, unless they believe it is inappropriate to involve them. (Family Code Sections 6926-6929, Business & Professions Code Section 2397, and Health & Safety Code Section 124260.)

FISCAL EFFECT: As currently in print this bill is keyed fiscal.

COMMENTS: This bill is a response to the Trump Administration’s efforts to scale back long-standing non-discrimination protections for Medicaid recipients and, more ambitiously, to impose a binary, biological definition of “sex” into all anti-discrimination law. According to the author, “AB 1876 takes proactive steps to codify provisions of Section 1557 of the [federal Affordability Care Act] into state law to ensure healthcare access for all in California.” By defining “sex” to include such characteristics as pregnancy, sexual orientation, and gender identity, the author believes the bill will “preserve and enforce non-discrimination protections and prevent an individual from being excluded from enrollment or participation in any health plan or health insurer licensed in California. . . While the federal government works to weaken nondiscrimination protections, California is standing firm in our values. AB 1876 ensures all Californian can access health care without fear of discrimination.”

Executive Order 14187 in the courts. On January 28, 2025, President Donald Trump issued Executive Order (EO) 14187, one of a flurry of orders issued to launch his second term. Titled "Protecting Children from Chemical and Surgical Mutilation,” EO 14187 prohibits the use of federal funds to perform surgeries, provide hormone therapy, subscribe puberty blockers, or perform any other gender-affirming treatments on a person 19 years of age or younger. Although some hospitals (including one in Los Angeles) stopped providing gender affirming care in the immediate aftermath of the executive order, within a month several lawsuits had been filed challenging the EO on multiple grounds, including that the EO exceeded the President’s authority to override anti-discrimination provisions of Section 1557 of the Affordable Care Act (ACA). Although litigation is still pending, most federal district courts hearing the issue have sided with plaintiffs and enjoined the federal government from withholding federal funds. (For useful tracking on the fate of these orders see, “Trump Anti-LGBTQ+ Litigation Tracker,” available at www.lgbtqbar.org.) In addition, a coalition of Attorneys General of several states filed a suit challenging the EO 14187 order. More generally, they have expressed their commitment to protect their residents from discrimination and have informed health care providers, health plans, and health insurers to comply with state anti-discrimination law. (New York Times August 1, 2025.)

This bill is presented by the author and several supporters as a response to the efforts of the Trump Administration to use the power of the federal purse to deny persons access to certain kinds of health care that the administration disfavors, including some reproductive care for women and, especially, gender-affirming care for minors. In an effort to confront the trend in federal policy, this bill prohibits a health care service plan or health insurer from denying coverage to any subscriber, enrollee, or policy holder on the basis of race, color, national origin, age, disability, or sex. Specifically, the bill takes federal anti-discrimination provisions in Section 1557 of the ACA and codifies those protections into state law. Accordingly, the bill defines discrimination on the basis of sex to include, among other things, discrimination on the basis of intersex traits, pregnancy, and gender identity.

According to the author, the bill is necessary to protect the rights of Californians should the Trump administration eventually prevail in the challenges to EO 14187, or should he concoct new orders that are equally if not more harmful. Because existing law already prohibits health plans and health insurers from engaging in this kind of discrimination, the bill is apparently intended to reiterate California’s commitment to protecting these rights rather than to change existing law. If the purpose of this bill is to protect Californians from acts the current administration might take in the future, then its impact may be more muted. If forthcoming federal policies are deemed to preempt state law, then the provisions in California law will not matter.

This bill may inadvertently further provoke the federal administration. Just as the President has issued executive orders purporting to limit access to any form of health care that does not accept a binary definition of “sex,” he has also threatened to cut federal aid to states that do not comply with federal policies, whether that pertains to providing gender-affirming care, implementing DEI programs, or teaching a view of American history that is not sufficiently patriotic. This behavior is in keeping with the President’s ongoing efforts to punish those who displease him. As with the legal uncertainty around the fate of executive orders, there is also legal uncertainty about the President’s ability to cut federal funds because of political or policy differences. Still, the author and Committee may wish to consider whether making a statement against the President’s Executive Orders is worth providing the administration with a pretext for withholding federal funds from California. In addition, the bill could face legal challenges that produce judicial opinions that weaken rather than strengthen anti-discrimination law. To be clear, this is not to suggest that the President will necessarily prevail in any effort to retaliate against state law that directly challenges the President’s authority; nor is it to deny the vital importance of calling out the current administration’s unprecedented assault on legal norms. However, the potential adverse and unintended consequences are at least worth considering, especially given that the bill does not dramatically change existing law or protect the state from federal preemption, if indeed federal policies are deemed to preempt state law.

The opponents’ grievances are mostly with existing law. In reading the letters of opposition one would never guess that the bill represents a modest change to existing law. The opponents maintain that this bill poses serious dangers by making it easier for individuals, especially young people, to obtain reproductive or gender affirming care. However, the opponents’ concerns are rooted in existing law, which already prohibits health plans and health insurers from discriminating against subscribers and enrollees on the basis of “sex.” Existing law already defines “sex” to include “gender identity” and “gender expression,” with the latter term defined to include a person’s gender-related appearance and behavior regardless of whether it is stereotypically associated with the person’s assigned sex at birth. Moreover, neither existing law nor this bill gives minors unlimited access to gender-affirming care. Minors cannot obtain medical care, including gender-affirming care, without the consent of a parent or guardian. Although there are exceptions to this rule, including treatment for pregnancy and mental health, gender-confirming care is not one of the exceptions. Nothing in this bill would change that. (See Family Code Sections 6926-6929, Business & Professions Code Section 2397, and Health & Safety Code Section 124260.)

Similarly, the opposition’s claim that it is unconstitutional to compel religious employers to indirectly fund something they find morally objectionable may or may not be persuasive as a matter of constitutional law, but this claim has more to do with existing law than with this bill.

ARGUMENTS IN SUPPORT: Courage California writes in support:

This critical bill would codify federal nondiscrimination protections issued under

Section 1557 of the Affordable Care Act (ACA) into state law. This would explicitly prohibit health plans and insurers from discriminating against individuals on the basis of race, color, national origin, age, disability, or sex. This bill defines discrimination on the basis of sex to include, but not be limited to, discrimination on the basis of gender identity, sexual orientation, sex characteristics, sex stereotypes, or conditions of pregnancy.

This bill would ensure that Transgender, Gender-Expansive, and Intersex (TGI), LGBTQ+, and non-English speaking people, along with pregnant people seeking abortion care services, cannot be denied or limited coverage for medically necessary health care.

ARGUMENTS IN OPPOSITION: The California Family Council writes in opposition:

This bill would prohibit insurance companies from denying coverage for sex rejecting medical procedures and drugs, like puberty blockers, cross-sex hormones, or double mastectomies for minors, described in the text as "gender-affirming care."

By treating an insurer’s denial of coverage as unlawful discrimination, AB 1876 removes insurers’ discretion to assess medical necessity, long-term risks, and evolving scientific evidence, particularly when the patient is a minor. These interventions carry serious lifelong consequences, including impacts on bone density, fertility, cardiovascular health, and neurological development. Surgical procedures performed on minors are permanent and irreversible. Insurers should retain the ability to exercise careful medical and actuarial judgment without facing sweeping penalties.

Additionally, AB 1876 poses serious religious liberty concerns. Many faith-based employers and individuals hold sincere religious convictions that sex is immutable. Compelling employers or individuals through insurance mandates to subsidize gender-transition procedures would violate deeply held religious beliefs and conscience protections.

REGISTERED SUPPORT / OPPOSITION:

Support

California LGBTQ Health and Human Services Network (co-sponsor)

Equality California (co-sponsor)

Gender Justice LA (co-sponsor)

Trans Family Support Services (co-sponsor)

TransLatin@ Coalition (co-sponsor)

Access Reproductive Justice
ACLU California Action
Advocates for Trans Equality
Alliance for Trans Youth Liberation
American Academy of Pediatrics, California
American Association of University Women - California
American College of Obstetricians & Gynecologists - District IX
Asian Americans Advancing Justice-Southern California
California Association of Marriage and Family Therapists
California Behavioral Health Association
California Chapter of the American College of Emergency Physicians
California Legislative LGBTQ Caucus
California Pan - Ethnic Health Network
California Podiatric Medical Association
California Psychological Association
California Teachers Association Member
CFT – a Union of Educators & Classified Professionals
County Behavioral Health Directors Association
Courage California
CPCA Advocates, Subsidiary of the California Primary Care Association
Disability Rights California
El/La Para TransLatinas
Families United for Trans Rights, Eastbay Chapter
Gender Affirming Professionals
Gender Health Center
Health Access California
Invisible T Men
Justice in Aging
LGBTQ Connection
LGBTQ+ Inclusivity, Visibility, and Empowerment (LIVE)
Los Angeles LGBT Center
Lyon-Martin Community Health Services
Mirror Memoirs, a Project of Community Partners
National Health Law Program
Parivar Bay Area
PFLAG Clayton-Concord
PFLAG Fresno
PFLAG Oakland-east Bay
PFLAG Sacramento
PFLAG San Diego County
PGLAG San Jose/Peninsula
Placer LGBTQ Center
Planned Parenthood Affiliates of California
Rainbow Families Action Bay Area
San Francisco Aids Foundation
Saturn’s Wish
The Children's Partnership
The Landing Spot
The San Diego LGBT Community Center
Training in Early Abortion for Comprehensive Health Care
Transgender Health and Wellness Center
West Hollywood/Hernan Molina, Governmental Affairs Liaison
Western Center on Law & Poverty

Opposition

California Catholic Conference

California Family Council
Cause: Californians United for Sex-based Evidence in Policy and Law
Concerned Women for America
Democrats for an Informed Approach to Gender
International Foundation for Therapeutic and Counselling Choice
Lesbians Advocating for a Resilient Future
LGB Alliance Foundation
LGB Courage Coalition
Our Duty
SFV Alliance
Women are Real
Women's Declaration International USA
Women's Liberation Front

Analysis Prepared by: Tom Clark / JUD. / (916) 319-2334

Date of Hearing: March 17, 2026

ASSEMBLY COMMITTEE ON HEALTH

Mia Bonta, Chair

ABPCA Bill Id:AB 1876

Author:(Addis) – As Introduced Ver:February 12, 2026

SUBJECT: Health care coverage: nondiscrimination.

SUMMARY: Prohibits a health plan or health insurance subscriber, enrollee or policyholder from being excluded from enrollment or participation in, being denied the benefits of, or being subjected to discrimination by, any health plan or health insurer on the basis of race, color, national origin, age, disability, or sex. Specifically, this bill:

1. Defines discrimination on the basis of sex for purposes of this bill to include, but not be limited to, discrimination on the basis of any of the following:
   1. Sex characteristics, including intersex traits;
   2. Pregnancy or related conditions;
   3. Sexual orientation;
   4. Gender identity; or,
   5. Sex stereotypes.
2. Prohibits a health plan or health insurer, in providing access to health programs and activities, including arranging for the provision of health care services, from doing any of the following:
   1. Denying or limiting health care services, including those that have been typically or exclusively provided to, or associated with, individuals of one sex, to an individual based upon the individual’s sex assigned at birth, gender identity, or gender otherwise recorded;
   2. Denying or limiting, on the basis of an individual’s sex assigned at birth, gender identity, or gender otherwise recorded, a health care professional’s ability to provide health care services if the denial or limitation has the effect of excluding individuals from participation in, denying them the benefits of, or otherwise subjecting them to discrimination on the basis of sex under a covered health plan or health insurer;
   3. Adopting or applying any policy or practice of treating individuals differently or separating them on the basis of sex in a manner that subjects any individual to more than de minimis harm, including by adopting a policy or engaging in a practice that prevents an individual from participating in a health care service plan consistent with the individual’s gender identity; and,
   4. Denying, cancelling, or limiting health care services sought for purpose of gender transition or other gender-affirming care that the health plan or health insurer would otherwise cover if that denial or limitation is based on an individual’s sex assigned at birth, gender identity, or gender otherwise recorded.
3. Prohibits a health plan or health insurer, in providing or arranging for the provision of health care services or other health-related coverage, from doing any of the following:
   1. Denying, canceling, limiting, or refusing to issue or renew health care service plan enrollment or other health-related coverage, or denying or limiting coverage of a claim, or imposing additional cost-sharing or other limitations or restrictions on coverage, on the basis of race, color, national origin, sex, age, disability, or any combination thereof;
   2. Having or implementing marketing practices or benefit designs that discriminate on the basis of race, color, national origin, sex, age, disability, or any combination thereof, in health plan or health insurance coverage or other health-related coverage;
   3. Denying or limiting coverage, denying or limiting coverage of a claim, or imposing additional cost sharing or other limitations or restrictions on coverage, to an individual based upon the individual’s sex assigned at birth, gender identity, or gender otherwise recorded;
   4. Having or implementing a categorical coverage exclusion or limitation for all health care services related to gender transition or other gender-affirming care.
   5. Otherwise denying or limiting coverage, denying or limiting coverage of a claim, or imposing additional cost-sharing or other limitations or restrictions on coverage, for specific health care services related to gender transition or other gender-affirming care if such denial, limitation, or restriction results in discrimination on the basis of sex; or,
   6. Having or implementing benefit designs that do not provide or administer health plan or health insurance coverage or other health-related coverage in the most integrated setting appropriate to the needs of qualified individuals with disabilities, including practices that result in the serious risk of institutionalization or segregation.
4. Prohibits the above-described provisions from requiring access to, or coverage of, a health care service for which the health plan or health insurer has a legitimate, nondiscriminatory reason for denying or limiting access to, or coverage of, the health care service or determining that the health care service is not clinically appropriate for a particular individual, or fails to meet applicable coverage requirements, including reasonable medical management techniques, such as medical necessity requirements. Prohibits a health plan or health insurer’s determination from being based on unlawful animus or bias, or constituting a pretext for discrimination.
5. Requires a health plan or health insurer’s evidences of coverage, disclosure form, and combined evidence of coverage and disclosure form, to include all of the following information in a notice to enrollees regarding the coverage requirements imposed above:
   1. A statement that the health plan or health insurer does not discriminate on the basis of a characteristic protected under applicable state law, including this bill;
   2. How to file a grievance regarding discrimination;
   3. The health plan or health insurer’s internet website where an enrollee may file a grievance, if available; and,
   4. The health plan’s or health insurer’s telephone number that an enrollee may use to file a grievance regarding discrimination.
6. Prohibits the above-described provisions from limiting the Department of Managed Care (DMHC) director’s or the California Department of Insurance (CDI) commissioner’s authority, a health plan or health insurer’s duties, or enrollees’ rights.
7. Requires the rights, remedies, and penalties established by the above-described provisions to be cumulative and not supersede the rights, remedies, or penalties established under other laws, including existing anti-discrimination provisions, or the Unruh Civil Rights Act.

EXISTING LAW:

1. Prohibits, under the Patient Protection and Affordable Care of Act of 2010 (ACA), discrimination on the grounds of race, color, national origin, sex, age, and disability in certain health programs and activities. [Title 42, United States Code (USC) § 18116]
2. Establishes the DMHC to regulate health plans under the Knox-Keene Health Care Service Plan Act of 1975 and the CDI to regulate health insurers under the Insurance Code. [Health and Safety Code (HSC) § 1340, et seq. and Insurance Code (INS) §106, et seq.]
3. Prohibits a health plan or specialized health plan, from refusing to enter into any contract or from canceling or declining to renew or reinstate any contract because of the race, color, national origin, ancestry, religion, sex, marital status, sexual orientation, or age of any contracting party, prospective contracting party, or person reasonably expected to benefit from that contract as a subscriber, enrollee, member, or otherwise. Deems it a violation for any health plan to utilize marital status, living arrangements, occupation, sex, beneficiary designation, ZIP Codes or other territorial classification, or any combination thereof for the purpose of establishing sexual orientation. Requires sex to have the same meaning as gender, and defines sex by cross reference to mean “gender” and to include a person’s gender identity and gender expression (defined as a person’s gender-related appearance and behavior regardless of whether it is stereotypically associated with the person’s assigned sex at birth). [HSC § 1365.5]
4. Prohibits an admitted insurer, licensed to issue life or disability insurance, from failing or refusing to accept an application for that insurance, to issue that insurance to an applicant therefor, or issue or cancel that insurance, under conditions less favorable to the insured than in other comparable cases, except for reasons applicable alike to persons of every race, color, religion, sex, gender, gender identity, gender expression, national origin, ancestry, or sexual orientation. Prohibits race, color, religion, national origin, ancestry, or sexual orientation from, of itself, constituting a condition or risk for which a higher rate, premium, or charge may be required of the insured for that insurance. Allows, unless otherwise prohibited by law, premium, price, or charge differentials because of the sex of any individual when based on objective, valid, and up-to-date statistical and actuarial data or sound underwriting practices. [INS § 10140]
5. Deems it be a violation of 4) above for any insurer to consider sexual orientation in its underwriting criteria or to utilize marital status, living arrangements, occupation, sex, beneficiary designation, ZIP Codes or other territorial classification within this state, or any combination thereof for the purpose of establishing sexual orientation or determining whether to require a test for the presence of the human immunodeficiency virus or antibodies to that virus, where that testing is otherwise permitted by law. [INS § 10140]
6. Defines for purposes of 4) and 5) above, “sex” to have the same meaning as gender and defines gender to mean sex, and to include a person’s gender identity and gender expression, and defines gender expression to mean a person’s gender-related appearance and behavior whether or not stereotypically associated with the person’s assigned sex at birth. [INS § 10140]

FISCAL EFFECT: Unknown. This bill has not been analyzed by a fiscal committee.

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, while the federal government works to weaken nondiscrimination protections, California is standing firm in our values. The author argues that this bill ensures all Californian can access health care without fear of discrimination.
2. BACKGROUND.
   1. ACA. The ACA was signed into law on March 23, 2010, and is the most significant legislative reform of the U.S. health care system since the establishment of Medicare and Medicaid in 1965. The passage of the ACA brought sweeping changes to health care coverage in California, including establishing more generous eligibility rules and federal funding for Medi-Cal (California’s Medicaid program), providing federally funded premium and cost-sharing subsidies offered through Covered California (the state’s health benefit exchange), and imposing new requirements on health insurance that make it easier for individuals with pre-existing conditions to obtain coverage.

Section 1557 of the ACA provides that, except as otherwise provided in Title I of the ACA, an individual is prohibited from being excluded from participation in, be denied the benefits of, or be subjected to discrimination under, any health program or activity, any part of which is receiving federal financial assistance. This includes credits, subsidies, or contracts of insurance, or under any program or activity that is administered by an executive agency or any entity established under Title I of the ACA. This anti-discrimination provision applies to health programs or activities administered by recipients of federal financial assistance from the federal Department of Health and Human Services (DHHS), DHHS-administered health programs or activities, and Title I entities that administer health programs or activities.

In 2020, the Supreme Court held in the decision in Bostock v. Clayton County that “discrimination on the basis of sex” under the federal Title VII, which prohibits discrimination in the workplace on the basis of race, color, religion, sex, or national origin, extends to discrimination on the basis of sexual orientation and gender identity. In 2021, in light of the Supreme Court’s interpretation of the scope of “discrimination on the basis of sex,” DHHS announced that it “would interpret Section 1557’s prohibition on sex discrimination to include (i) discrimination on the basis of sexual orientation and (ii) discrimination on the basis of gender identity.” DHHS subsequently issued proposed amendments to the guidance for implementing Section 1557 in 2022, and issued a final rule in 2024. Several federal district court judges issued nationwide injunctions to prevent DHHS’s interpretation of Section 1557 and its proposed rules from taking effect.

• 1. Executive Order (EO) 14187. On January 28, 2025, President Trump issued EO 14187, which states “it is the policy of the United States that it will not fund, sponsor, promote, assist, or support the so-called ‘transition’ of a child from one sex to another, and it will rigorously enforce all laws that prohibit or limit these destructive and life-altering procedures.” EO 14187 directed the Secretary of DHHS, consistent with applicable law, to take all appropriate actions to end the “chemical and surgical mutilation of children,” including regulatory and sub-regulatory actions, which may involve laws, programs, issues, or documents, including Medicare or Medicaid conditions of participation or conditions for coverage, clinical-abuse or inappropriate-use assessments relevant to State Medicaid programs, and Section 1557 of the ACA. EO 14187 also directed the Secretary of DHHS to promptly withdraw DHHS’s Biden-era guidance from 2022, and directed the Secretary, in consultation with the Attorney General, to issue new guidance protecting whistleblowers who take action related to ensuring compliance with this order.

1. SUPPORT. The TransLatin@ Coalition is a co-sponsor of this bill, stating that it would ensure that Transgender, Gender-Expansive, and Intersex (TGI), LGBTQ+, and non-English speaking people, along with pregnant people seeking abortion care services, cannot be denied or limited coverage for medically necessary health care. The TransLatin@ Coalition continues that in the first month of this administration, the current President issued sixty-four executive orders, one of which functions as a denial of the existence of TGI people and consequently directs federal agencies to withhold funding from healthcare institutions and providers that offer gender-affirming care. The TransLatin@ Coalition argues that this bill would make clear that health plans and insurers are prohibited from discriminating against individuals on the basis of race, color, national origin, age, disability, or sex. The TransLatin@ Coalition concludes that this bill would protect the rights of our TGI and immigrant community members who have seen longer life spans and greater quality of life when able to access these critical services.

Equality California (EQCA) is a cosponsor of this bill, stating that California law requires health plans and insurers to cover medically necessary health care for TGI people, and this bill strengthens and reaffirms these protections by codifying the nondiscrimination standards established under Section 1557 of the ACA into state law. By doing so, EQCA argues that this bill helps ensure that LGBTQ+ people—and all Californians—can continue to access medically necessary health care without discrimination, regardless of shifting federal policies.

1. OPPOSITION. The SFV Alliance opposes this bill, stating that its major goal is to mandate health provider insurance to pay for so called gender affirming care. The SFV Alliance continues that gender affirming care is, in their analysis, harmful to a person. The SFV Alliance argues that gender affirming care takes the body for a state of homeostasis to unpredictable, an unstable body state that will have to rely on medication to survive, with possible unknown side effects and complications that our modern medical technology will have no answer or treatment for. The SFV Alliance continues that this bill will create a newly increased cost to health care providers which would have to be absorbed by all of those with medical insurance in California. The SFV Alliance concludes that these procedures are not only going to be a financial burden on the overall base of the insured, they will cause the patient unnecessary harm.

The California Family Council (CFC) is also opposed to this bill, arguing that by treating an insurer’s denial of coverage as unlawful discrimination this bill removes insurers’ discretion to assess medical necessity, long-term risks, and evolving scientific evidence, particularly when the patient is a minor. CFC argues that interventions carry serious lifelong consequences, including impacts on bone density, fertility, cardiovascular health, and neurological development. CFC continues that surgical procedures performed on minors are permanent and irreversible, and insurers should retain the ability to exercise careful medical and actuarial judgment without facing sweeping penalties. CFC concludes that compelling employers or individuals through insurance mandates to subsidize gender-transition procedures would violate deeply held religious beliefs and conscience protections.

1. PREVIOUS LEGISLATION.
   1. SB 418 (Menjivar) of 2025, contained provisions that were substantially similar to this bill. SB 418 would have additionally required a health plan contract or a health insurance policy to cover up to a 12-month supply of a Food and Drug Administration (FDA)-approved prescription hormone therapy, and the necessary supplies for self-administration, that is prescribed by a network provider within their scope of practice and dispensed at one time at a location licensed or otherwise authorized to dispense drugs or supplies. Would have also required a pharmacist to dispense, at a patient’s request, up to a 12-month supply of an FDA-approved prescription hormone therapy pursuant to a valid prescription that specifies an initial quantity followed by periodic refills. SB 418 was vetoed by Governor Newsom, who stated:

“This bill would require health plans and insurers to cover a 12-month supply of federal Food and Drug Administration-approved prescription hormone therapy, and necessary supplies for self-administration, prescribed by an in-network provider and dispensed at one time without utilization management (UM).

I appreciate the author's intent to ensure patient access to the comprehensive care they need. While there are provisions of this bill that are worthy of support, I am concerned about the limitation on the use of UM, which is an important tool to ensure enrollees receive the right care at the right time. Prohibiting this cost containment strategy is likely to result in an increase in enrollee premiums to offset costs incurred by health plans and insurers. At a time when individuals are facing double-digit rate increases in their health care premiums across the nation, we must take great care to not enact policies that further drive up the cost of health care, no matter how well-intended.”

• 1. SB 923 (Wiener), Chapter 822, Statutes of 2022, requires health plans and insurers to require all of its support staff who are in direct contact with enrollees or insureds to complete evidence-based cultural competency training for the purpose of providing trans-inclusive health care for individuals who identify as TGI. SB 923 adds processes to continuing medical education requirements related to cultural and linguistic competency for physician and surgeons specific to gender-affirming care services, as specified.

REGISTERED SUPPORT / OPPOSITION:

Support

California LGBTQ Health and Human Services Network (sponsor)

Equality California (sponsor)

Gender Justice LA (sponsor)

Planned Parenthood Affiliates of California (sponsor)

The TransLatin@ Coalition (sponsor)

Transfamily Support Services (sponsor)

ACLU California Action
Advocates for Trans Equality
Alliance for Transyouth Liberation
American Academy of Pediatrics, California
Asian Americans Advancing Justice-Southern California
California Pan - Ethnic Health Network
California Psychological Association
California Teachers Association Member

City of West Hollywood
California Federation of Teachers
Courage California
El/la Para Translatinas
Families United for Trans Rights, Eastbay Chapter
Gender Affirming Professionals
Gender Health Center
Health Access California
Invisible T Men
Justice in Aging
LGBTQ Connection
LGBTQ+ Inclusivity, Visibility, and Empowerment (LIVE)
Los Angeles LGBT Center
Lyon-martin Community Health Services
Mirror Memoirs, a Project of Community Partners
National Health Law Program
Parivarbayarea
PFLAG Fresno
PFLAG Oakland-east Bay
PFLAG San Diego County
PFLAG San Jose/peninsula
Placer LGBTQ+ Center
San Francisco Aids Foundation
Saturns Wish
The Children's Partnership
The Landing Spot
The San Diego LGBT Community Center
Training in Early Abortion for Comprehensive Health Care

Numerous individuals

Opposition

California Family Council
Cause: Californians United for Sex-based Evidence in Policy and Law
Lesbians Advocating for a Resilient Future
LGB Alliance Foundation
LGB Courage Coalition

Our Duty
SFV Alliance
Women are Real
Women's Declaration International USA, Inc.

Analysis Prepared by: Riana King / HEALTH / (916) 319-2097