Health care coverage: prescription hormone therapy and nondiscrimination.

Senator Menjivar's prescription hormone therapy legislation requires California health plans, insurers and Medi-Cal to cover up to 12 months of FDA-approved hormone treatments when prescribed by network providers, while establishing broad protections against discrimination in healthcare coverage and services.

The bill mandates that health plans cannot impose utilization controls or other restrictions limiting hormone therapy supplies to less than 12 months when safely stored at room temperature. Pharmacists must dispense up to a year's supply upon patient request with a valid prescription, unless the prescriber specifies otherwise or the medication is a controlled substance. The coverage requirements expire January 1, 2035.

The legislation also prohibits healthcare discrimination based on race, color, national origin, age, disability, or sex - including sex characteristics, pregnancy, sexual orientation, gender identity and sex stereotypes. Health plans and insurers cannot deny or limit services based on sex assigned at birth or gender identity, implement categorical exclusions for gender-affirming care, or adopt policies that prevent individuals from accessing care aligned with their gender identity. Plans must provide clear information about these protections and establish grievance procedures for discrimination complaints.

For Medi-Cal beneficiaries, the bill ensures coverage of 12-month hormone therapy supplies under the same parameters as private insurance, while maintaining existing utilization controls. The legislation includes an urgency clause making it effective immediately upon enactment, citing ongoing challenges to gender-affirming care access.