Senate Standing Committee on Health

The Senate Committee on Health will begin in ten seconds in in Room 2100. The Senate Committee on Health will come to order. We are in Room 2100 today. So if you are on the committee, please come and join us. Good afternoon.

File item five, AB 2194 by Assembly Member Valencia and file item 9, AB 2706 by Assembly Member Soria have been pulled from today's agenda. That leaves nine bills on the agenda with six of them on our proposed consent calendar. That's file item two, AB 1126 by Patterson. File item three, AB 1672 by Solache . File item seven, AB 2565 by Wallis.

File item eight, AB 272571 by Flora with amends. File item 10, ACR 1 by Quirk-Silva and Mark Gonzalez. And file item 11, ACR 94 by Assembly Member Patel. We need one more Member to establish a quorum, and we also need any of the authors of the three bills that we are scheduled to hear today to come to Room 2100. We now have six Members, so let's establish a quorum.

Assistant, please call the roll.

[Roll Call]

A quorum has been established. We will now consider the consent calendar. Once again, these are files 2, 3, 7, 8, 10, and 11. ABs, 1126, 1672, 2565, 2571 with amends ACR 1 and ACR 94. Do I have a motion on the consent calendar?

Motions made by Vice Chair Valladares. Assistant, please call the roll.

Senators Weber Pearson. Aye. Weber Pearson, aye. Valadares. Aye.

[Roll Call] It is six zero on call.

The consent calendar is 60. We will place that on call. I do see that we have an author for file item number six. File item number six, AB2233. Assembly member, Ta, you may begin when you are ready.

That's fast. Thank you. We appreciate that. Good afternoon, Chair and Members. Good afternoon, Chair and Members.

AB 2233 ensure that autistic patient can actually access the care and has been prescribed and approved for them. First, I would like to thank the chair and committee staff for their collaboration on the bill, and we'll be happy to accept the committee amendments to ensure that this bill will protect the health care plan ability to exercise disabled utilization management as a safeguard against fraud.

And children with autism across California are facing real challenge accessing applied behavior analysis therapy even after care is prescribed and health and health plan authorize it. Family often cannot fully use those hour. This result in a significant gap between approval and actual access.

Families are not declining care. They are unable to find a valuable provider or are navigating cancellation and scheduling barriers when children miss treatment section due to illness, travel, or provide availability, those unused hour will be count against them, causing these people to lose access to really go rigorous care. When I recognize that health plan play a really, really good role in managing care and responsibility and safeguarding against inappropriate use through utilization review and medical determination. AB 2233 does not interfere with the process.

Health plan will continue to have full authority to review care, ensure the process and address any concerns as any any fraud.

And this bill does is clarify that One Care is authorized. It should not be effectively reduced to administrative constraint that are unrelated to medical need. AB 2233 does not expand benefit or mandate new services. It simply ensure that assisting approved care is accessible throughout the authorization period. Families should not lose an access to care due to circumstance outside their control.

And I have my I have my witnesses, to explain. Thank you. All the detail, please.

Thank you. You will have a combined of five minutes for your presentations. You may begin.

Thank you. Good afternoon, committee Members. My name is Jessica Rountree, and I'm a board certified behavior analyst serving children with autism and their families throughout the greater Sacramento region. I'm here today in support of this bill because it addresses a problem I encounter regularly in my clinical practice, the inability to provide already authorized care when a child needs it most. I would like to share two examples from my practice.

The first involves a child currently experiencing a significant behavioral health crisis. He engages in severe self injurious behavior, including scratching, hitting himself, and bending his fingers back hard enough to cause sprains. He also engages in aggression that can be severe enough to require medical care for himself or others. During this period, the clinical need is clear. The child needs more support and his caregivers need more support in order to keep him safe.

The authorized hours already existed, but I could not use those hours when they were needed because doing so would have exceeded a utilization cap. Any good clinician is going to make the same choice. We're going to help the child, but that's not a choice Clinicians should have to make. My second example involves a child whose funding source imposes weekly limits on both direct treatment and supervisory services.

He's currently out of school and has increased availability for treatment, but his primary clinician has a scheduled vacation approaching and he lives in a rural area where staffing shortages make coverage particularly difficult.

As a clinician, I know exactly what would best support this child. We should be able to increase services before the clinician's absence and take advantage of his availability. However, despite having authorized hours available, weekly utilization limits prevent us from doing so. As a result, he will likely go without services during that week, not because funding is unavailable and not because treatment is unnecessary, but because the timing of those services cannot be adjusted. This bill does not increase the amount of treatment a child receives.

Insurers still determine what is authorized and what is medically necessary. What it does is provide the flexibility to use already authorized services when they will have the greatest clinical impact for our clients. I respectfully ask for your support. Thank you.

Good afternoon, Members of the committee. My name is Brianna Jimenez, and I'm a board certified behavior analyst with autism behavior services, and I also teach behavior technician program in the workforce development department at Santiago Community College. I appear today in strong support of Assembly Bill 2233. I want to share a story that shows exactly why this bill matters. I work with a single mother raising two children, both authorized to receive ABA services.

She works multiple jobs and to support her household. There are times when work obligation requires her to cancel a session. She contacts us, asks to reschedule, and remains committed to her children's care, care that is already deemed medically necessary. Under a weekly authorization model, those missed hours would not roll forward. They would be forfeited.

Her children would lose approved treatment through no fault of their own and no change in the clinical need. This is not uncommon. Industry data indicates that practices utilizing only 42.6% of authorized hours on average. For example, a child authorized for forty hours a week may only receive about seventeen, not because the need has decreased, but because of workforce shortages, provided illness, staff turnover, scheduling barriers, and unavoidable family disruptions. AB 2,233 is a preventative measure.

Health plans have not yet imposed these weekly caps, and this bill ensures they cannot do so. It preserves flexibility across the full six month authorization period, protecting a patient's right to receive care already prescribed. At this time, we must address the workforce issue directly. Local community colleges and behavior technician programs are part of the solution. These programs train professionals to work directly with the client and help build the staffing capacity needed to improve access to care.

The answer is not to restrict families. The answer is to preserve flexibility while strengthening workforce. I respectfully urge you to this committee to vote yes to AB 2233. Thank you for your time and your services to the people of the state.

Thank you. If there's anyone else in the audience that would like to speak in support of this bill, please come to the microphone. State your name, your organization, and your position only.

Come on. Come on. Come on. Tell him your name.

My name is Alex. I got it. It's Alex. Alright. Hey.

Say, hey. I need your vote.

Hey. I need your vote. Hey. I need a vote.

Yeah. I

need the first, Waba.

Say I don't know what we're gonna say. I I believe

And the dream that we have gotten more than a little turkey.

Yeah. Alright. My name is Akbar. I'm Alex's dad. Alex is we're from analogs.

Where's that? And I want Alec alright. Alright. Hold on. I want to watch his show.

Alright. Wait. Let's Sit down. Sit down. And My brother.

The boxer's brother, Jack. And Alex I know you ain't gonna believe this, but Alex only weighed a pound at birth. And, you know, I can't express how much, the services and everything that we've received have saved him and made everything you're seeing just a possibility. I mean, he's speaking even with the different behaviors. We now have just an amazing opportunity, for him and the challenges.

So we really need your support and your vote, and and I'm begging to that from you. And thank you for your time today. Alright. Say bye, Alex. Bye. Alright. Come on.

Thank you, Alex. For others, please state your name, your position, and your organization only.

Sure, George Cruz on behalf of the California Behavioral Health Association in support.

Thank you.

Good afternoon. Tyler Rinde, California Psychological Association in support. Thank you.

Thank you. Hello. Jennifer Oren. I'm the BCBA Northern California Regional Director at ButterflyFX, and I'm in support. Thank you.

Hello. Kelly McMillan on behalf of the American Academy of Pediatrics, California in support.

Thank you.

Hi. Rachel Blucher on behalf of the California Association for Behavioral Analysis in support. Thank you.

Thank you.

Hi. Odessa MacLean, a BCBA for Applied Behavior Consultants Incorporated in support. Thank you.

Rick Rollins, legislative advocate for the Autism Business Association, the sponsor of this bill. Appreciate your

Thank you. Seeing no one else that wants to come and speak in support, do we have any lead witnesses in opposition? If so, this is your time to come to the table. Seeing none, are there any people who would like to speak or register their opposition? Please state your name, your organization, and your position only.

Thank you, Chair and Members. Cassidy Heckman on behalf of the California Association of Health Plans. I wanna thank the author, his staff, and the committee staff for working with us on this bill. We had significant concerns with the bill in print due to, fraud, waste, and abuse in this area, which if you've been tracking the news and, investigations by the feds and the state, it it's been pretty prevalent. That said, we appreciate the amendments that preserve utilization management.

And after reviewing them in print, we're looking forward to removing our opposition. Thank you.

Thank you.

Good afternoon, Chair and Members. Matt Akin with the Association of California Life and Health Insurance Companies. We'd just like to align my comments with my colleague, Git Cap. We will also be removing opposition and wanna sincerely thank the chair, the committee, and the author for the work on this bill. Thank you.

Thank you. Seeing no one else who would like to register support or opposition, we'll bring it back to the committee. Senator Viadares.

Well, first of all, I wanna thank the author for bringing this bill forward. I wanna thank Alex. I know he stepped outside of the room, but Alex and Alex's dad for sharing their story. Many of you know I'm a long time autism advocate and voice for the autism community. I remember the time when we were fighting so that ABA services and therapies and treatments could be covered under insurance.

So it is kind of awesome to see ten years. That was about a decade when when, ABA, became, available to so many families. It's been about a decade. It's great to see that we're here and we're having continued conversations. In the autism community, they say if you've met one person with autism, you've went you've met one person with autism because it is so different for so many individuals and families on the spectrum.

And whether it is needing ABA therapy, whether it's, the diagnosis and treatment of other comorbidities, every individual is different. Every need, every therapeutic is different. And it's so vitally important that and sometimes that changes too. And it's so vitally important that the services are being provided when they're needed most, which is why I would love to be a co author on this bill. It's vitally important.

We need more resources for this community, and this is another starting point. I wanna thank you for bringing it forward.

We really appreciate that, Senator. Thank you so

much. Thank you. Seeing no further comments, Assemblymember Ta, would you like to close?

I want to thank you the Chair for your support. I really, really appreciate that. I wanna thanks all the committee staff. They're amazing. And I want to thank all the members from the autism committee for being here and show your support.

That really mean a lot to my bill and to the autism committee. Really appreciate that, and I respectfully ask for your vote.

Thank you. Assembly Member, I am move by Senator Caballero. Assistant, please call the roll. The motion is do passed as amended and re refer to the committee on appropriations.

[Roll Call]

7, 0. That bill has enough to get out of this committee, but we'll place it on call. Thank you.

Thank you. Thank you.

We will now move back and file to file item number one, AB 96 by Assembly Member Jackson. You may begin when you are ready.

Thank you very much, Madam Chair and committee Members. I'm here to present AB 96, which would remove the high school diploma or equivalent requirement to become a certified Medi Cal peer support specialist. With me today is Don Morrison with Youth for Change and Amir Rashid with County with County Behavioral Health Directors Association.

Thank you. You each have a combined five minutes for your presentations.

Good afternoon, Chair Weber Pierson and members of the Senate Health Committee. First, I'd like to express my gratitude to Assemblymember Jackson for authoring AB 96. My name is Don Morrison, and I serve as the Peer Services Program Manager for Youth Change, a non profit behavioral health organization based in Chico. My program is contracted with Sutter Yuba Behavioral Health, where our team of certified peer support specialists supports three programs within the county's behavioral health system.

I am also a certified peer support specialist bringing my lived experience with serious mental health and substance use challenges to this vital work.

Peer support is recognized by SAMHSA and other credible entities as an evidence based practice that yields positive, significant positive outcomes for those we serve. Unlike traditional doctor patient or therapist client relationships, peer support is rooted in mutuality. This approach allows us to meet individuals where they are, sharing our lived experiences to model recovery and provide effective support. Our program operates the Sutter Yuba Wellness and Recovery Center, a daytime educational and wellness based initiative for adult outpatients receiving services for serious mental illness and substance use disorders.

Given our commitment to serving individuals where they are, I believe a high school diploma or equivalency should not be a prerequisite for certification as a peer support worker.

In fact, I have identified several participants at our wellness and recovery center who would excel in peer support roles, but are unable to obtain state certification due to this requirement. This limitation directly impacts our ability to hire qualified individuals as we are mandated to bill Medi Cal for services and staff must be certified to do so. Peer support is an invaluable resource that can help address the service gaps created by the current shortage of licensed therapists and counselors.

The existing requirement for a high school diploma or equivalency acts as a barrier, preventing a significant pool of promising candidates from entering the peer support workforce. I strongly urge this committee to vote yes on AB 96.

Thank you for your time and consideration.

Thank you, Chair and Members for the opportunity to speak to you today. My name is Amar Ashied here on behalf of the County Behavioral Health Directors Association of California, the leaders of the public behavioral health agencies that serve the mental health and substance use disorder needs of California's Medi Cal uninsured, and underinsured populations. And we're a proud cosponsor of AB 96, which proposes to update current law regarding criteria necessary to be certified as a peer by removing that high school graduation requirement.

As noted, peers bring vital and irreplaceable expertise in providing outreach and developing profound trust with clients in need of mental health and substance use disorder services. And the skills necessary for effective peer support such as communication, empathy, self awareness, and cultural competency, all while being grounded in lived experience are critical in helping connect with clients who we aim to provide these life saving mental health and substance use disorder treatments to.

These current requirements for a high school degree may inadvertently or have inadvertently created barriers for which exclude individuals with that important lived experience from being able to participate and excel in these important roles, in the peers workforce. AB 96 embraces those with that important lived experience that are moving that graduation requirement and making it easier for individuals with that critical lived experience to get the training they need to become certified peers.

And this is a central step in addressing some of the growing behavioral health needs we're seeing across our communities. The peers workforce is critical in assisting outreach individuals for those who are unhoused, youth experiencing crisis, and a number of other high priority populations and receive significant amount of training as part of their certification to ensure that they can take advantage of those lived experiences and illustrate the necessary core competencies to help these individuals.

So removing this graduation requirement again will dramatically help the peers workforce, which is why we're proud cosponsors of this bill, have and hopefully or excuse me, and ask and request your aye vote and happy to answer any questions.

Thank you. If there's anyone else in the audience that would like to speak in support of this bill, please come to the microphone, state your name, your organization, and your position. Thank you.

Clifton Wilson on behalf of the Tulare County Board of Supervisors in support. Thank you for the measure.

Maron Naganefer with Cal Voices cosponsor also in support, Mental Health America of California, DRC, COMPRO, Western Center on Law and Poverty. Thank you.

Thank you.

George Cruz on behalf of the California Behavioral Health Association in support.

Thank you.

Josh Gauger on behalf of the Santa Clara County Board of Supervisors in support.

Thank you.

Nicole Wordelman on behalf of the Children's Partnership in support.

Vanessa Flores on behalf of Alameda County in support. Thank you.

Thank you.

Thank you.

Sarah Weber on behalf of the Drug Policy Alliance in support. Thank you.

Omar Altemini with CPAN, the California Pan Ethnic Health Network in support. Thank you.

Thank you.

Rachel Blucher on behalf of the County Of San Diego in support. Thank you.

Thank you. Seeing no further individuals that would like to register their support, if there's anyone in the audience that would like to speak as in lead opposition, this is your time to come to the table. Seeing no one, if there's any anyone in the audience that would like to register their opposition, please come to the microphone. State your name, your organization, and your position.

Good afternoon, Madam Chair and Members. Carlos Gutierrez here on behalf of the California Consortium of Addiction Programs and Professionals, CCAP in opposition.

Thank you. Seeing no further member of the audience that would like to speak, we'll turn it back over to anyone. If anyone has any questions, Senator Durazo.

Thank you. And thank you to the author and and all of you. I just I definitely don't think that a high school diploma should be a barrier, especially because these are not just jobs, but potential careers. You mentioned cultural competency and the need for more for more people to to enter into these occupations and careers.

Could you explain a little bit further the standards issue that has has been raised about the standards that California has in place or that you believe fulfill the responsibility to have standards.

Right? So if you could get into that a little bit more, maybe in in real practice what's Sure. Sure.

Yeah. I'm happy to do that. So in existing law, currently, the standards are with SAMHSA at the state level, which allow us to be able to certify, decide what those core competencies will be, and and be billable. And we have an entity, Cal Mesa, which then takes those standards and ensures that any training organizations are meeting them.

And if you want to be certified as a peer, you would go through 80 of training under those core competencies, which list things like documentation, digital literacy, the core competencies I mentioned earlier such as, cultural cultural expertise, empathy, etcetera, and going through those different core competencies in that eighty hour training period, then taking a test for certification, illustrating that you have grasped and mastered those concepts and can illustrate, you know, a mastery of them.

And then every two years, there's an additional recertification process, which requires an additional twenty hours of continuing education to continue to hone in on those different skills that we've indicated. And and I really wanna underscore, I know that there's been some discussion around, that that reading and writing piece, and it is explicitly spelled out in our existing standards, in existing law that this bill does not touch whatsoever. That digital literacy and documentation are part of those core competencies that are trained, in that certification process.

Seeing, no further, questions, I wanna thank the author for, bringing this book forward and the sponsors. You know, I too agree that having a high school diploma should not a requirement to have one should not prevent you from, using your lived experiences to assist someone else, who is going through something that you have previously gone through before. And, thank you so much for bringing up, you know, some of the things that they do have to be trained on in order to get this certification.

It's not like just anybody can do it, as you stated, eighty hours. The curriculum must include things like the concepts of hope, recovery, wellness, the role of advocacy, the role of consumers and family members, psychiatric rehabilitation skills and serve redelivery, addition recovery, cultural competence training, trauma informed care, group facilitation skills, self awareness and self care, conflict resolution, professional boundaries and ethics, safety and crisis planning, navigation of and referring to other services, understanding how to prepare for employment opportunities, documentation skills and standards and confidentiality.

So these are all things that someone must be trained in for eighty hours prior to receiving certification. So, you know, I think that most people who just have a high school diploma don't have these things. And, the fact that this is a requirement that you must have in order to become certified, I think, is is, is definitely reasonable, and we should remove this barrier. So with that, I wanna thank you for bringing this bill forward, and you may close.

Respectfully ask for an Aye vote.

Thank you. The looking for a motion. Moved by our, Vice Chair, Valladares. The motion is due passed and we refer to the committee on appropriation. Secretary, please call the roll.

[Roll Call]

7, 0.

7, 0. 7, 0. We replaced that bill on call. Thank you.

Thank you.

We will now move to our final bill that we will be hearing today, file item four, AB 1876. I recommend that if there are any Members of this committee that have not come down, this is your time to come down so that you may vote. And Assemblymember Addis, you may begin when you are ready.

It's on. Okay. Thank you, Madam Chair and Members. We're here to present AB 1876, the Fair Care for All Act that would codify federal nondiscrimination protections into state law to ensure that no individual is excluded from health care coverage or services based on a protected class. And with that, I have two witnesses here.

Malakai Kote, director of gender of the Gender Health Center, and Alex Bass, policy associate associate with the Trans Latine Coalition. And I might add that, this committee heard this bill last year carried by Senator Menjivar and the Senate fully supported it as did the assembly. So I'll turn it over to my witnesses and hear for any questions.

Thank you. You have a combined of five minutes for your presentation.

Thank you. Good afternoon, Chair Weber, Pearson, and Senators. My name is Alex Bass. I'm a Los Angeles resident. I identify as transgender and non binary.

And I am the policy associate at the Trans Latina Coalition. The Trans Latina Coalition is the largest transgender led organization in the nation, serving transgender, gender expansive, and intersex Latina immigrants. We are a proud cosponsor of AB 1876, and we identified this bill to be a crucial piece in protecting access to health care for TGI people. AB 1876 provides a definition of sex based discrimination that would account for the various factors that make TGI people vulnerable when navigating health care systems.

This is particularly important for TGI people who may face discrimination based on compounding factors, such as perceived gender identity, sex stereotypes, and institutional racism.

I know firsthand the positive impact of accessible affirming care. I accessed gender affirming care under Medi Cal, and it completely improved my overall well-being. Before receiving care, gender dysphoria was a severe barrier. Getting access to medical gender affirming care not only alleviated the weighted dysphoria but vastly improved my mental health and self esteem. These benefits extended to improve stability and motivation.

Access to this medically necessary care saved my life. It allowed me to pursue my professional and personal goals and become a more productive member of my community. However, this has not been the case for all people and right now, many TGI people struggle to secure continuity of care amidst federal developments. At the Trans Latina Coalition, we have witnessed members of our community losing access to gender affirming care and have faced significant personal distress and institutional barriers, particularly in rural areas.

As such, it is imperative that California is clear in its legislation that comprehensive health programs continue to be protected and accessible to all patient populations.

Thank you and we respectfully request your aye vote.

Greetings, state Senators. My name is Doctor Malachi Cote. I use he, they, and fam pronouns. And I'm the executive director of the Gender Health Center.

And I'm a licensed psychologist here in Sacramento, and and I'm here in strong support of AB 1876. At the Gender Health Center, we provide low barrier services to all community. This includes a free hosted gender affirming hormone prescription clinic and a hosted electrolysis services, HIV, STI testing and linkage to care, mental health counseling, support groups and cultural programs, harm reduction services, legal assistance, health care navigation, case management, resource referrals, and education and training.

Our services are open to everyone and we center on serving BIPOC, two spirit, transgender, gender diverse, and intersex communities. At the GHC, we have witnessed people coming into their own lives, becoming fully who they are and experiencing what some call gender euphoria.

We have seen the profound impact of gender congruence and joy associated with access to gender affirming care and health more generally as an entryway to fully living. But I'll tell you what, in the past year and a half, many families have come to the GHC experiencing fear of the potential loss of medically necessary care for their youth or teen, or they have lost access and are looking to find care elsewhere.

And it's been an extremely stressful time for families as parents and caregivers are typically only looking to support the growth development and thriving of their child. So it is for these reasons that we support AB 1876, which would strengthen protections against discriminatory health care, coverage plans.

It would ensure service coverage for all patient populations and as such would also preserve the autonomy of a person and their support systems to make medical decisions and collaboration with their medical provider and be self determined when it comes to their own health care.

So it is for these reasons we respectfully ask for your Aye vote. Thank you.

Thank you. If there's anyone else in the audience that would like to register their support, please come to the microphone, state your name, your organization, and your position.

Katherine Squire on behalf of the California Commission on the Status of Women and Girls in support.

Good afternoon. Tyler Rinde, California Psychological Association in support. Thank you.

Clifton Wilson on behalf of the California State Association of Psychiatrists as well as the City and County Of San Francisco both in support. Thank you.

George Cruz on behalf of the California Behavioral Health Association in support.

Katie Van Deynes with Health Access California in support. Thank you.

Omar Altenimi here with the California Pan Ethnic Health Network, Disability Rights California, and Western Center on Law and Poverty, all in support.

Emily Patterson, on behalf of Planned Parenthood Affiliates in California as a proud cosponsor, in support, and on behalf of the ACLU, in support.

Cesar Gonzalez Garcia with the California Rural Indian Health Board, in support.

Hello. Kelly McMillan on behalf of the California Associations of Marriage and Family Therapists and the American Academy of Pediatrics, California. Thank you.

Tim Madden, representing the California Chapter for the American College of Emergency Physicians in support.

Hi. Kathy Van Osten on behalf of the American Association of University Women of California in support.

Thank you. Seeing no further individuals wishing to speak in support, if there are anyone in the audience that would like to speak and lead opposition to this bill, this is your time to come forward to the table. Thank you. You will both have a total of five minutes for your presentation. Thank you.

My name is Luke Healy. I'm a California detransitioner. I identified as a transgender woman from the ages of 11 to 22, and I took estrogen for much of that time. I'm here because this bill would have helped further guarantee my destruction and deterioration. I was groomed online into this starting at age 10.

Older men and women online as both as activists told me that I was really a girl. They sent me pornographic images, videos, coached me to dress as a girl because they said I was really a girl, and what followed was years of depression, self harm, drugs, and alcohol abuse. No mental health provider tried to unravel why I believed I was a woman. I said that I was trans, and that was all it took.

The medical providers even counseled me to tell my parents that I would kill myself to coerce them to consent to hormones.

I left home at age 18 and at one point lived on what I can only describe as a transgender commune where insurance covered my hormones. I got them through Planned Parenthood and Kaiser Permanente. Kaiser doctors pressured me to get sex rejecting surgeries, and other doctors coached me how to get the state of California to pay for facial feminization surgery through the University of California system. I could get breasts and damage my reproduction or get my reproductive organs destroyed at little to no cost.

The medical complex and insurance were set up to destroy my body, steal my fertility, and my manhood.

AB 1876 will enshrine the system of perversion into law. Insurers will be prohibited from maintaining any categorical exclusion for sex rejecting interventions. It does not matter if the patient is actively addicted to substances, had unresolved sexual trauma, or other mental health issues under this bill, denying body destroying interventions to anyone, even someone in my condition, will be no will be illegal discrimination. Please vote no. Thank you.

Erin Friday, attorney, president of Our Duty, a national organization of parents whose children have been harmed by the gender industry. We oppose. California law already requires that insurers cover medically necessary sex rejecting treatments. Setting aside the false premise that sterilization or the use of hormones is medically necessary to affirm a fictitious internal sense of self. This law removes the clinical safety valves.

Prior authorization, medically necessary reviews, evidence based clinical criteria from insurers. It mandates coverage by anyone who requests requests it, anyone, irrespective of age or mental capacity for all types of requested sex rejecting interventions. The governor vetoed SB 418 last year that tried the same mandating sex rejecting interventions because it would suppress utilization management by insurers.

This bill prevents an insurer from maintaining a categorical exclusion for the removal of a 12 year old girl's ovaries in the if she's if she's seeking to affirm her gender identity. An insurer cannot exclude from coverage the removal of 11 year old's testicles because at that moment in time, he thinks he is a girl.

Insurance carriers who wanna follow the AMA or the Society of Plastic Surgeons positions withdrawing support for sex rejecting surgeries on minors because, I quote, there is insufficient evidence demonstrating a favorable risk benefit ratio for the pathway of gender related endocrine and surgical interventions in children and adolescents cannot because this law will make it criminal. A carrier that recognizes the impending tsunami of detransitioner lawsuits and the harms of sex rejecting interventions, can only approve approve these devastating interventions.

You ignore detransitioners, parents, the systematic reviews, the studies, what other countries are doing. What will it take you to stop hurting kids, autistic people, and mentally unwell people, and Lesbian and gays. Trans is repackaged eugenics.

Vote no.

Thank you. Is there anyone else in the audience that would like to register their opposition? Please come to the microphone, state your name, your organization, and your position.

Nicole Young, parent, and a member of the SFV Alliance in strong opposition.

Meg Madden on behalf of CAUSE, Californians United for Sex Based Evidence in Policy and Law, on behalf of Democrats for an Informed Approach to Gender, and on behalf of Women Are Real, in strong opposition to AB 1876.

Leandra Wells with the California Family Council. We're in opposition. Thank you.

Thank you. I will now, seeing no further comments from the audience, I will now bring it back to my colleagues to see if anyone has any questions or comments. The bill has been moved by Senator Menjivar. I do have a question for opposition. You've made some pretty strong statements today.

How exactly does this bill change the requirement for coverage in California since there's already a law in place that requires medically necessary gender affirming care?

Because this law is is actually mandating it, and so an insurance carrier yeah. And you can you can look at the, the analysis that is online. What it is doing, it is forcing insurance carriers to cover all gender interventions irrespective of age because of the fear of being criminally liable. This bill can assert a 10,000 per incident incident against an insurance carrier. Per.

It also has a felony component to it. It has a year jail time. If an insurance carrier discriminates against someone who says that they are transgender. So a an 11 year old who comes in and says, I want my penis removed, and the insurance carrier says no, they can be taken up criminally under this bill, be fined $10,000, and face a felony if it's looked at as they are being discriminatory against this patient.

Thank you. I will let the author respond to that.

Oh, well, thank you, Madam Chair. Really, this is a very, very simple bill that codifies, discrimination projections that are already in federal law in Section 57 of the Affordable Care Act. So it just takes those anti discrimination provisions and puts those into state law. Very simple bill.

Okay. So it wouldn't require something that's not already required?

The bill does not expand coverage at all. It simply takes the existing nondiscrimination provisions from federal law and puts them into state law. But there's no, requirement of expansion of coverage.

Okay. Thank you. And with that, would you like to close?

Well, I just wanna say thank you so much, to our witnesses and the sponsors and the supporters who came out. I know that every time we do these bills, you have to sit and listen to a lot of hate. And I think it's a prime example of why we do need this bill is, what our witnesses experience every single time we do a bill in this space. So thank you to you for your decorum and your bravery and thank you to the committee.

I trust the committee knows facts from fiction. So I respectfully ask for your Aye vote.

Thank you. The, bill has been moved by Senator Menjivar. The motion is due passed and we refer to the committee on judiciary. Assistant, please call the roll.

[Roll Call] 6, 0.

6, 0. Will place that bill on call. Thank you. We will go back to open the role starting with the consent calendar. Assistant, please call the absent Members.

[Roll Call] 7, 0.

7, 0. We're on call. File item one. Assistant, please call the absent Members.

[Roll Call] 7, 0. 7, 0.

Alright. With that, we will hold the roll open for another ten minutes. If you would like to vote in Senate Health today and you have not, please come to Room 2100. Okay. We're gonna open up the role starting with the consent calendar.

Assistant, please call the absent Members.

[Roll Call]

9, 0. 9, 0. That bill is out. We will now go to file item one AB 96. Assistant, please call the absent Members.

[Roll Call]

9, 0. That bill is out. We will go to the final bill, bill six AB 2233.

We will do file item four AB 1876. Assistant, please call the roll.

[Roll Call]

Ayes 7, Noes 0, that bill is out. We will go to the final bill. File item six AB 2233. Assistant, please call the absent Member.

[Roll Call] 9, 0.

9, 0. That bill is out as well. We will now we have now concluded Senate health.