As the Trump administration threatens to revoke federal funding for programs that support trans people and the larger LGBTQ+ community, Santa Clara County is shifting local dollars to cover some of those initiatives before they are defunded.

The recommendation from County Executive James Williams, which will be finalized with the rest of the 2025-26 fiscal year budget on June 12, is part of the county’s broader strategy to get ahead of anticipated cuts coming from the federal government. In Williams’ proposed budget, which was released on May 1, the county’s top official advised pulling $70 million in federal funds they would typically anticipate out of the upcoming budget to avoid what he called a “drip, drip, drip of cuts.”

But since then, President Donald Trump’s “Big, Beautiful Bill” passed through the House of Representatives with a provision that Medicaid — publicly-funded health insurance for low-income individuals — would no longer cover gender-affirming care. The county, which operates four hospitals and more than a dozen clinics, is heavily reliant on federal health revenues from Medicaid and Medicare.

Williams’ recommendation comes as a federal judge in California on Monday blocked an executive order that tried to require recipients of grant funds to end programs that promoted diversity, equity and inclusion or acknowledged the existence of transgender people.

In an effort to protect the tranche of money for gender-affirming care, Santa Clara County plans to fiscally separate the Gender Health Center and the Gender Clinic, which is an arm of the Valley Homeless Healthcare Program, from other federally funded health care programs. Instead, the county will fund those programs using $1.27 million in local dollars that is being drawn from a $2.86 million reserve set aside earlier this year to offset the financial impacts of federal actions.

In an interview, Williams said that it’s the county’s job to act “as the safety net for those families who have nowhere else to turn and nowhere else to go.”

“That absolutely includes our LGBTQ community that has been so targeted for so long and has significant health care and behavioral health care needs,” he said. “(We need to) make sure there is welcoming access to those services by providers, by the community and by the county government so that they can continue to have the health care and behavioral health care that they need and deserve just like everyone else in our community.”

Located in downtown San Jose, the Gender Health Center opened in late 2018 and was the first all-ages clinic in the South Bay offering health care for transgender and non-binary individuals. The county’s Gender Clinic in East San Jose also offers care for transgender and non-binary people who are homeless.

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Dr. Manisha Yadav, a physician at the Gender Health Center, said that aside from offering hormone replacement therapy, connecting patients with surgeons to help with their transition and other gender-affirming care, the center also provides primary care services.

“They’re getting comprehensive care under one roof,” Yadav said, adding that studies often show that transgender and non-binary individuals struggle with finding good medical care.

The 2022 U.S. Trans Survey — the largest community survey of its kind that canvassed more than 92,000 people — found that of those who saw a health care provider within the last 12 months, 48% reported having at least one negative experience.

Yadav said that the next closest clinic that offers a similar level of gender-affirming care is more than 50 miles north at UCSF Medical Center.

“Where else would they go? There is no other place for them to go here,” she said about the need for the county to continue funding the Gender Health Center. “This is home for them, this is where they feel safe, this is where they can get care — the initial support, the psychiatric assistance, the emotional support, medications and referrals for surgery.”