Does California provide 'sex-change procedures' to immigrants without legal status? Claim omits key context

On April 15, 2026, the conservative activist Christopher Rufo and journalist Jonathan Choe published an article in City Journal claiming the state of California was providing "sex-change procedures to homeless illegal aliens."

The claim quickly spread in conservative circles. The New York Post ran a version of Rufo and Choe's article, while Fox News published a story about their work. Posts conveying the same message made the rounds on social media sites such as X and Facebook in the following days. Snopes readers searched the site looking for more information.

(U.S. Representative Young Kim/Facebook)

Because we were unable to solidly confirm or disprove the allegations independently, Snopes cannot apply a truth rating to the overall claim. We contacted California Gov. Gavin Newsom's office and the state's Department of Health Care Services for a response to the claim, and received multiple responses, which are included below. We also reached out to Rufo and will update this report if we hear back.

Overall, we found that the allegations were generally true but excluded context. 

That is, California's policies between 2024 and 2025 allowed all immigrants, regardless of legal status or housing, to apply for Medi-Cal, the state's Medicaid program, and Medi-Cal does cover gender-affirming care, according to Snopes' review of the plan. As such, it's plausible that an immigrant who entered the country without legal authorization could apply for Medi-Cal and later receive gender-affirming care, including surgeries.

Anthony Cava, a spokesperson for the state health department, provided the following statement in response to the allegations:

City Journal's story includes significant factual errors and mischaracterizes both Medi-Cal eligibility and covered benefits. It suggests that the State broadly provides gender-affirming surgeries to specific populations without limitation. That's completely false.

Cava said Rufo and Choe's reporting neglected to mention California's recent announcement of restrictions on Medi-Cal eligibility. (A freeze on new enrollments is already in place as of this writing, while further restrictions go into effect on July 1, 2026). Those restrictions target many classes of immigrants who entered the country without authorization, or, using the state's wording, have an "unsatisfactory immigration status."

Affected people will still be allowed to renew their coverage regardless of their immigration status if they have Medi-Cal before July 1, 2026, according to the state's website. However, they will no longer be eligible for full Medi-Cal, which would be required to cover gender-affirming care. 

Furthermore, according to Cava, Rufo and Choe's phrasing of the claim incorrectly implied that the state was simply giving this money out freely and automatically. To the contrary, gender-affirming care is covered by Medi-Cal only when it has been deemed medically necessary, which is described as treatments "reasonable and necessary to protect life, to prevent significant illness or significant disability, or to alleviate severe pain through the diagnosis and treatment of disease, illness or injury, and are evaluated on an individual, case-by-case basis." 

As with any other medical procedure, Medi-Cal requires prior authorization for the procedures. 

The City Journal article based its claims on the testimony of three transgender immigrants living at homeless shelters in San Francisco (the story describes them as "men who identified as transgender women"). 

One, identified as Lyca, said she entered the country without documentation. A second, Jaqueline, said she was a lawful U.S. resident. The story did not specify the immigration status of the third, named Alondra. 

Alondra and Lyca said they both received food and shelter from the state. Lyca and Jaqueline both said they were on Medi-Cal and had received gender affirming hormone therapy. Jaqueline, the lawful resident, said she also had received top surgery. 

That was about the extent of the evidence. 

In a video Rufo posted to X, a journalist (likely Choe) can be seen talking to Lyca and Alondra through a translator. After asking questions about immigration status and what assistance they receive through the state, the interviewer asks whether they're "concerned about taking resources from Americans." 

"No," the translator says, "Because they have seen [the Americans] receive more help."

Diana Crofts-Pelayo, a spokesperson for Newsom's office, provided the following statement in response to the allegations:

Undocumented Californians with Medi-Cal coverage don't get special treatment. Everyone on Medi-Cal gets the same access to care. 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.