The Trump administration is attacking LGBTQ+ rights nationwide, and San Francisco has declared itself sanctuary city for transgender people. But even as the city anticipates an influx of newcomers fleeing persecution elsewhere, older trans adults already living here face discrimination and threats to their health as the federal government cuts funding for crucial programs and erases data about their demographic groups.
“It’s important to acknowledge that the trans community is facing a different degree of discrimination with the anti-LGBT laws that we are witnessing across the country,” said Jupiter Peraza, manager of statewide coalition at Open House, a San Francisco nonprofit focusing on older LGBTQ+ adults.
Advocates expect LGBTQ+ seniors in particular to be negatively affected by the gutting of Medicaid, funding cuts at every level, and the erasure of key data about these groups. San Francisco’s population of older adults has been growing rapidly, which strains limited resources. Many trans advocacy organizations in San Francisco are also reporting increased requests for help moving to San Francisco from across the country — more than double and sometimes triple the number they were used to, Peraza said.
Medicaid cuts
On July 4, President Trump signed a Republican spending and tax bill that over the next decade cuts nearly $1 trillion from Medicaid, the public health insurance program for low-income Americans. The bill also imposes work requirements on those enrolled in the program. The cuts will cause nearly 12 million people to lose health care coverage by 2034, the Congressional Budget Office estimates. Nearly 256,000 San Franciscans are enrolled in Medi-Cal, the state’s version of Medicaid.
Older LGBTQ adults are especially vulnerable to the effects of Medicaid cuts because they are disproportionately affected by poverty and might not have a traditional family structure to turn to for care, said Denny Chan, managing director for equity advocacy at Justice in Aging, a national organization fighting poverty among seniors.
For instance, discrimination against these groups can make it harder for them to secure employment, creating barriers to health insurance, according to a report by SAGE, a national advocacy organization for LGBTQ+ older adults. It also found that older LGBT people are also less likely than cisgender and heterosexual elders to have children and are more likely to be single, meaning they might not be able to turn to family for in-home health support. Medicaid can help by subsidizing personal care aide service.
A recent statewide study of older LGBTQ+ adults in California found that trans people experienced higher rates of discrimination socially and medically than their cisgender peers, including by clinicians. These problems are exacerbated by the ongoing cuts, Peraza said.
Restrictions on gender-affirming care
Legislators across the country are proposing laws targeting gender-affirming care and its coverage by state health insurance programs.
Gender-affirming care, which can include mental and behavioral health care, hormone therapy and surgical procedures, is covered by Medi-Cal. A prohibition on federal funding for gender-affirming care was removed from Trump’s bill before it passed the Senate.
But an increasing number of bans and restrictions on providing this care for youths could create a chilling effect for other populations, advocates said. Though there are no such bans in California, Stanford Medicine halted gender-affirming surgeries for youth in early June.
Chan said limiting youth access to care raises questions about “whether providers who are providing gender-affirming care to other populations might be chilled from doing so.”
Peraza also highlighted why prioritizing care for trans people is important for the entire LGBTQ+ community: “When a trans person of color can access the programs and services they desire with peace, comfort and safety, I can guarantee you that other community members of the LGBTQIA+ community can access those same services with as much ease, comfort and care, if not more.”
Local groups must tighten belts
San Francisco LGBTQ+ organizations are also contending with local funding cuts, as are city agencies and departments that provide crucial support to vulnerable communities.
“Much of those cuts impact LGBT communities,” Peraza said, noting that San Francisco is a hub for those communities, especially those who are immigrants or have HIV.
Anya Worley-Ziegmann listed several initiatives facing deep cuts whose clients include LGBTQ+ older adults. Worley-Ziegmann works with the People’s Budget Coalition, a collective of more than 150 community organizations including unions and other nonprofits.
For example, El/La Para TransLatinas, which focuses on transgender Latina rights, this year stands to lose $350,000 in city funding that it would use for violence prevention and advocacy. Community Forward, a service provider for people experiencing homelessness is losing $200,000 in funding for gender-inclusive reentry services at a Woman’s Place, a drop-in center and shelter for anyone who identifies as a woman trying to secure housing.
San Francisco’s population is aging rapidly. To read more coverage about issues affecting older adults, sign up for our email newsletter.
The Queer Women of Color Media Arts Project in March saw $500,000 in city contracts canceled — representing 50% of the organization’s budget. Those funds were previously awarded as part of the Dream Keeper Initiative, a program designed to support the city’s Black communities that has become mired in a corruption scandal. Most of that money was slated for workforce development programs for queer and trans filmmakers of color, including people in their 60s and 70s, said Madeleine Lim, executive director of the organization.
“The only way that our doors are still open is because I had been shoring up our reserves, but we have none left,” she said.
Additionally, the city’s latest budget reduces “cost of doing business” adjustments in its contracts with nonprofit service providers by $16.8 million. Worley-Ziegmann said that reduction will contribute to a reduction in services.
Peraza said cuts to departments like Homelessness and Supportive Housing could mean the city won’t have enough social workers, and that might mean less support for LGBTQ+ people.
During conversations with city officials regarding the budget in April, advocates stressed that more trans people are “going to come to the city as the destination hub that it is, seeking refuge and seeking sanctuary,” Peraza said. “And if the city is not prepared to meet those new residents,” it will face “a crisis.”
Looming federal cuts challenged
LGBTQ+ communities are using courts to fight federal funding cuts.
In June, the San Francisco AIDS Foundation and other local organizations won a reprieve when a federal judge in Oakland temporarily blocked efforts to defund social services and medical organizations that support LGBTQ+ people. The cuts were tied to Trump’s executive orders on gender ideology and diversity, equity and inclusion.
“The current administration’s policy goal is to not observe the existence of transgender people as valid or true,” said Kell Olson, the F. Curt Kirschner Jr. strategist for LGBTQ+ Seniors at Lambda Legal, a legal aid nonprofit. “Grants that might conflict with that could be under attack.”
He also pointed to the elimination of hundreds of thousands of dollars in National Institutes of Health grants for research aimed at improving the health of LGBT people, including some studies on aging, a cut that Lambda Legal is fighting.
Statewide study amid erasure of data
Advocates also expressed concerns about the loss of data focused on LGBTQ+ people, typically called SOGI data, an acronym for sexual orientation and gender identity. The Trump administration recently stopped collecting this data across Medicare and Medicaid. NPR reported in February that the Census Bureau also stopped collecting data that could protect trans rights.
“Not being able to track SOGI data makes it really hard to prove that services are being accountably provided to LGBTQ communities when those communities can’t even be identified,” Chan said. “And that really is the strategy here, is to render a lot of these groups invisible from a public policy standpoint.”
California researchers recently completed a first-of-its-kind study of the health, wellbeing and service needs of older LGBTQ+ adults, with Peraza leading the coalition of organizations that helped survey participants. Its creators hope to use this knowledge tobetter inform policy-making and programs affecting older LGBTQ+ adults.
“We are witnessing databases and knowledge disappear,” under the Trump administration, she said. “Knowing your community and what your community is up against and what they need is absolutely crucial.”