Illegal immigrants living in San Francisco homeless shelters have undergone sex-change procedures and received cross-sex hormone therapy on the California taxpayer's dime, and Governor Gavin Newsom's own office confirmed it.
Manhattan Institute fellow Chris Rufo brought the issue to national attention through a video documenting encounters with transgender illegal immigrants outside taxpayer-funded shelters in San Francisco. The footage showed individuals who accessed gender-related medical services through Medi-Cal, California's Medicaid program, which Newsom expanded in January 2024 to cover all immigrants regardless of legal status.
The governor's office did not deny it. A Newsom spokesperson told Fox News Digital:
"Undocumented Californians don't get special treatment. Everyone on Medi-Cal gets the same access to care."
That statement is meant to sound reasonable. Read it again. It means illegal immigrants receive the same taxpayer-funded coverage as low-income American citizens, including access to sex reassignment hormone therapy and surgical procedures. Newsom's office confirmed exactly that to Fox News Digital.
The numbers behind this policy are staggering. California spends roughly $9 billion in taxpayer dollars providing healthcare to illegal immigrants through Medi-Cal, which in some cases includes what the state calls "gender-affirming care." Approximately 1.7 million illegal immigrants received full-scope coverage under the program.
Meanwhile, California faces a $21 billion budget deficit for fiscal year 2027. The state already paused new Medi-Cal enrollment in January for adults over age 19 who lack legal immigration status. The fiscal strain is real, and growing.
A Fox News video segment described Newsom as facing scrutiny for a $12 billion Medi-Cal expansion. That is money drawn from the pockets of Californians who play by the rules, pay their taxes, and increasingly cannot afford to live in the state they subsidize.
The California Department of Health Care Services pushed back on Rufo's reporting, telling Fox News Digital that his video and article contained "significant factual errors" and "mischaracterizes both Medi-Cal eligibility and covered benefits." But DHCS did not specify which facts were wrong.
The agency offered this clarification:
"It suggests that the State broadly provides gender-affirming surgeries to specific populations without limitation, which is completely false. Medi-Cal is a needs-based program with strict eligibility requirements."
DHCS further stated that Medi-Cal covers gender-related care "for members with full-scope Medi-Cal only when it is medically necessary, based on established clinical standards and consistent with nationally recognized clinical practice guidelines."
Note what that defense concedes. The state does not deny that illegal immigrants receive these procedures. It argues only that the procedures must be deemed "medically necessary." A Medi-Cal manual obtained by Rufo outlined that medical intervention qualifies for coverage when treatment "will alleviate symptoms of gender dysphoria." Reconstructive surgery, the manual states, is approved for coverage if it is "determined to be medically necessary for the treatment of gender dysphoria."
So the guardrail is a clinical judgment call, not a prohibition. And the patients include people who entered the country illegally and reside in taxpayer-funded shelters.
When pressed, Newsom's spokesperson offered a line that tells you everything about the governor's posture. The spokesperson told Fox News Digital:
"If you want to call California woke for not letting politicians interfere with doctors, or not wanting people to die in the streets, then go ahead."
That framing conflates two very different questions. No one is arguing that people should die in the streets. The question is whether American taxpayers should fund elective surgical procedures, breast implants, hormone regimens, sex reassignment operations, for people who are in the country unlawfully and living in government shelters. Newsom's office treats that question as settled. Most voters would disagree.
White House Communications Director Steven Cheung weighed in on the social media platform X, writing:
"This is like the holy trinity of woke, liberal, out-of-touch, perverse ideology from Scumbag Gavin Newsom."
The language was blunt. But the underlying policy critique resonated beyond the White House. A state running a $21 billion deficit chose to extend full medical coverage, including gender-related surgeries, to 1.7 million people who are not legally present in the United States. That is not a marginal budget line. It is a statement of priorities.
Even as the state paused new enrollment to manage costs, Democratic lawmakers in Sacramento moved in the opposite direction. State legislators introduced Senate Bill 1422, which would ensure all illegal immigrants in California receive coverage under Medi-Cal. The legislation signals that for California's ruling party, the enrollment pause is a temporary inconvenience, not a course correction.
The bill's introduction came against the backdrop of a budget crisis that shows no signs of easing. California's deficit projections are not speculative. They reflect the compounding cost of policies that extend full public benefits to populations that grow faster than the revenue base can support.
Several basic questions remain unresolved. How many illegal immigrants have received transgender-related procedures or hormone therapy through Medi-Cal? What specific surgeries were performed beyond what Rufo documented? What exactly are the "significant factual errors" that DHCS claims exist in Rufo's reporting, and why hasn't the agency identified them publicly? And what is the current legislative status of Senate Bill 1422?
The state's unwillingness to provide those details is itself revealing. DHCS called Rufo's work riddled with errors but declined to name them. That is not a rebuttal. It is a press release.
Gavin Newsom expanded Medi-Cal to every immigrant in California regardless of legal status in January 2024. His own office confirmed that the coverage includes sex reassignment procedures and hormone therapy. The state spends $9 billion a year on healthcare for illegal immigrants while staring down a $21 billion deficit. And Democratic lawmakers want to make the expansion permanent.
Newsom's spokesperson dared critics to call California "woke." The governor may find that voters are happy to oblige, and to draw their own conclusions about a state that funds breast implants for illegal immigrants in homeless shelters while telling its own citizens the budget is broken.
When a government treats every demand as a right and every taxpayer as an ATM, the deficit is not the disease. It is the symptom.