California is dealing with a long-term structural budget deficit, yet the state is still spending taxpayer funds on transgender medical procedures for illegal immigrants, according to a report that recently drew attention as Americans mark tax day.
An investigation by the team at City Journal, led by Chris Ruffo, began after a whistleblower alleged that illegal immigrants in California were receiving taxpayer-funded transgender treatments. Reporters visited several publicly funded shelters in San Francisco to speak with staff members and residents about shelter policies and medical services.
During their visits, the journalists said they found that some shelters housed illegal immigrants who identified as transgender women and were seeking or receiving gender-related medical treatments funded through state programs. According to the report, state and local resources were being used to provide these services.
One facility cited in the investigation was St. Vincent De Paul’s MSC-South shelter in San Francisco. Staff at the location reportedly acknowledged that residents included migrants from countries such as El Salvador and Venezuela. The reporters said they interviewed two Honduran men, identified as “Lyca” and “Alondra,” who said they were staying at the shelter and identified as transgender women.
One of the residents said he had access to Medi-Cal, California’s state healthcare program. Under policies expanded by Governor Gavin Newsom, Medi-Cal provides full coverage to illegal immigrants and includes services described as “gender-affirming care.” The individual reportedly said he was receiving hormone therapy through the program.
The City Journal team also visited another government-funded location, the Embarcadero SAFE Navigation Center. There they spoke with a resident identified as “Jacqueline,” a Mexican national who described himself as a transgender woman. While he reportedly said he was a lawful U.S. resident, he told reporters that undocumented migrants were also living in the shelter.
According to the report, Jacqueline said Medi-Cal paid for breast implants as well as hormone treatments. He also claimed that undocumented immigrants could receive similar procedures through the same healthcare program.
He explained that individuals seeking such surgeries typically undergo counseling and hormone therapy beforehand and described the process as gradual. He also indicated he was waiting for additional surgery in the future. The report noted that multiple clinics in San Francisco offer these procedures and that Medi-Cal covers them.
A third location mentioned in the investigation was the Taimon Booton Navigation Center, a government-funded shelter specifically designated for transgender, gender-nonconforming, and intersex residents. Outside the building, reporters said they encountered several migrants from Mexico, Honduras, and other countries who identified as transgender women and said they had come to California seeking medical treatment.
SCOOP: California is giving free sex-change procedures to homeless illegal aliens. Our team went into the shelters and discovered that trans migrants are coming into the state for hormones, breast implants, and “bottom surgeries”—all on the taxpayer dime. https://t.co/mDs7ivwjG5
— Christopher F. Rufo ⚔️ (@christopherrufo) April 15, 2026
According to the report, some migrants suggested that information about available services had spread through transgender communities in parts of Latin America. The authors argued that California’s policies may encourage migrants to travel to the state in hopes of receiving housing, healthcare, and medical procedures.
The report linked these developments to California’s broader sanctuary policies and healthcare regulations. State law requires Medi-Cal to provide coverage for gender-related medical care without discrimination. At the same time, many shelters operating within the sanctuary framework do not ask residents about immigration status or cooperate with federal immigration enforcement.
Critics say the combination of these policies allows undocumented migrants to enter shelters, enroll in Medi-Cal, and access medical treatments funded by taxpayers. Supporters argue that the policies are intended to ensure healthcare access and safety for vulnerable populations regardless of immigration status.
EXCLUSIVE: Homeless transgender illegals in California are crossing the border to receive taxpayer-funded sex changes. It’s one of the worst kept secrets on the streets.
Meanwhile, the state is facing a multibillion dollar budget shortfall. I wonder why? https://t.co/J29AIPyHW2 pic.twitter.com/AZiOcsphsS— Jonathan Choe (@choeshow) April 15, 2026
The issue is drawing attention because California continues to face significant projected budget deficits. Critics argue that funding expensive medical treatments for non-citizens places additional strain on limited public resources that also support infrastructure, education, and emergency services.
The debate also extends to the medical field itself. Some studies and reviews have questioned the long-term evidence supporting certain transgender medical treatments. The United Kingdom’s Cass Review and a 2025 report from the U.S. Department of Health and Human Services examining pediatric gender dysphoria concluded that evidence showing lasting mental-health benefits from such procedures remains limited.
EXCLUSIVE: “Jacqueline” is a transgender migrant who lives in a California homeless shelter and told us the state gave him free breast implants.
Now he’s waiting for “bottom surgery,” in which doctor will castrate him and create an artificial vagina—all funded by Gavin Newsom. pic.twitter.com/ADeJbMqLZn
— Christopher F. Rufo ⚔️ (@christopherrufo) April 15, 2026
The federal report also noted potential medical risks associated with treatments, including infertility, bone density loss, sexual dysfunction, cardiovascular complications, and psychiatric concerns. It suggested that some claimed benefits of the treatments may be overstated in existing research.
Guidelines from the World Professional Association for Transgender Health, which California references when determining medical necessity for these procedures, were also criticized in the Cass Review for not fully meeting traditional standards of evidence-based medicine.
The controversy highlights broader disagreements about immigration policy, healthcare funding, and the role of state governments in providing medical services to undocumented residents. As California grapples with ongoing financial challenges, critics and supporters alike continue to debate how taxpayer funds should be allocated and what responsibilities the state has toward people living within its borders.