Gender‑affirming care

This announcement serves as official notice of our expectations of subcontracted delegates who care for our members regarding access to gender‑affirming care services. We monitor grievance data to ensure delegates are properly handling requests for access to gender‑affirming care services for our members. If necessary, we will escalate and enforce proper handling standards. If a grievance is filed relating to a care provider’s or staff’s failure to provide trans‑inclusive care, and a decision is made in favor of the complainant, the applicable individual must complete a refresher course by retaking the Medicaid Essential Practices for Inclusive Care at Medallia before serving the next Anthem member.

Proper handling of gender‑affirming care is a compliance requirement of CA DMHC APL 24‑018, CA DHCS APL 24‑017, and CA Senate Bill 923. Failure to follow the guidelines above could lead to additional escalation and enforcement by Anthem, Department of Health Care Services (DHCS), and L.A. Care (if applicable).

Definitions

Subcontracted delegates: vendors, PMGs/IPAs/MSOs, their providers, and staff who serve our health plan members

Gender‑affirming care: comprehensive healthcare that respects a member's bodily autonomy, avoids gender assumptions, accepts gender fluidity, and treats members with compassion and respect

Staff: employees who have face‑to‑face, written, or spoken contact with members

Subcontracted delegates must adhere to the following guidelines:

1. Delegates must ensure their staff and care providers complete our Medicaid Essential Practices for Inclusive Care at Medallia by August 8, 2025.
2. Delegates must ensure their staff and care providers complete the Medicaid Essential Practices for Inclusive Care at Medallia annually thereafter as a part of their annual diversity, equity, and inclusion training.
3. If care provider data given on the delegate’s roster submission indicates, for directory display, that they offer gender‑affirming care services to our members, the care provider must render those services.
4. If care provider data given on the delegate’s roster submission indicates, for directory display, that they do not offer gender‑affirming care services, the delegate is required to refer the member to an in‑network provider who does render gender‑affirming care services when requested by the member or member’s advocate, if available.
5. If no in‑network care provider is available, the delegate must refer the member to an out‑of‑network care provider who does render gender‑affirming care services.
6. Any out‑of‑network referrals must be reported to us as part of the monthly Managed Care Program Data (MCPD) data exchange submissions, and cases should be submitted as out‑of‑network (OON) referrals.

Through our efforts, we strive to help our care provider partners deliver high‑quality, equitable healthcare.