• What Happened: A Christopher Rufo and Jonathan Choe City Journal investigation found California is providing free sex change procedures including hormone therapy, breast implants, and "bottom surgeries" to homeless illegal immigrants through Medi-Cal at San Francisco shelters. Newsom's office confirmed it is happening and doubled down, suggesting that without state-funded procedures migrants will "die in the streets."
  • Why It Matters: The same state that faces a massive budget deficit after Newsom's Medi-Cal expansion to illegal immigrants cost billions more than projected is now confirming it covers full surgical gender transitions for undocumented homeless migrants. The largest homeless shelter where Rufo found this happening signed a $66 million city contract in 2024 and instructs employees to refuse ICE cooperation.
  • Bottom Line: Newsom cut back on free health care for illegal immigrants because it was bleeding the state dry. Then confirmed he is paying for their sex changes. Welcome to California.

Christopher Rufo got a tip. He went to San Francisco's homeless shelters and found something the state of California was apparently happy to confirm when asked about it.

California is providing free sex change procedures to homeless illegal immigrants. Hormones. Breast implants. Bottom surgeries. All funded by California taxpayers through the state's Medi-Cal program. And when Rufo's City Journal investigation exposed it Wednesday, Newsom's office did not deny it. They doubled down, suggesting that without state-funded breast implants and genital reconstruction surgeries, migrants would "die in the streets."

Rufo and co-author Jonathan Choe, a senior fellow at the Discovery Institute, visited multiple publicly funded shelters in San Francisco after receiving a whistleblower tip. Their first stop was St. Vincent De Paul's MSC-South facility, the largest homeless shelter in San Francisco, which signed a $66 million service contract with the city in 2024. A shelter employee confirmed that illegal immigrants are housed there and that the shelter does not check immigration status. The employee also confirmed that when ICE came calling, management called a meeting and told staff: "We ain't letting them in."

Among the residents Rufo and Choe encountered were several Honduran men who identified as transgender women. One, identified only as "Lyca," confirmed to them directly that he was an illegal immigrant and that he has Medi-Cal, the California state health care program that, under Governor Gavin Newsom, was expanded to provide "full scope" coverage to illegal immigrants. That full scope coverage explicitly includes transgender procedures.

A second resident, "Jacqueline," was more expansive. Wearing rouge and a low-cut red shirt, Jacqueline told the investigators that the state had already provided him with free breast implants through Medi-Cal and that he is currently waiting for bottom surgery. When asked whether undocumented immigrants can access the same procedures, Jacqueline was direct. "Even though you're undocumented," he said, "you can get them." He described the process as requiring therapy and hormones first. "Es un proceso," he said.

At a second city-funded shelter, Rufo and Choe found additional transgender illegal immigrants who said they were also waiting on state-funded procedures.

The mechanics that make this possible are straightforward. California law requires Medi-Cal to cover gender-affirming care without discrimination. California's sanctuary framework prevents shelters from asking about immigration status or cooperating with federal enforcement. The result is that any illegal immigrant who reaches California, enters a shelter, and enrolls in Medi-Cal is eligible for a full suite of surgical gender transition procedures funded by California taxpayers.

Newsom had previously pulled back on his offer of universal free health care for illegal immigrants after the cost came in billions higher than projected, contributing significantly to the state's current budget crisis. His office's response to this story was not to announce a similar correction. It was to suggest that cutting the benefit would cause migrants to "die in the streets."

California cannot maintain its roads. It cannot fix its homeless crisis. It faces a massive budget deficit. But it has confirmed, on the record, that it is paying for breast implants and genital surgeries for homeless illegal immigrants and that anyone who objects is apparently fine with people dying in the streets.

The state's largest homeless shelter is under a $66 million city contract, refuses to cooperate with federal immigration authorities, and is currently housing illegal immigrants waiting on taxpayer-funded sex change procedures.

Only in California.