The rise of health cost-sharing ministries in the United States reflects a growing dissatisfaction with conventional healthcare systems. Initially, these programs catered to religious groups seeking alternatives to traditional insurance. However, over the past decade, they have evolved into more secular options, attracting millions of Americans looking for cheaper and less bureaucratic ways to manage medical expenses. Despite their appeal, these ministries come with significant risks and limitations, leaving many participants vulnerable to high medical bills and insufficient coverage.

The Evolution of Health Cost-Sharing Programs

Health cost-sharing ministries began as faith-based initiatives, primarily serving religious communities who objected to traditional insurance. Members pooled their resources to cover each other's medical expenses, adhering to ethical principles defined by their beliefs. Over time, these programs have become more inclusive, broadening their appeal beyond religious groups. The Affordable Care Act (ACA) further fueled this expansion by exempting ministry members from the individual mandate, leading to a surge in enrollment.

By 2023, an estimated 1.7 million Americans had joined health cost-sharing ministries. Companies like Sedera have played a pivotal role in this transformation. Founded by Tony Dale, a British-born doctor, Sedera has positioned itself as a comprehensive healthcare solution, partnering with direct primary care clinics. These collaborations offer members access to a range of services, including wellness programs and specialist referrals, while bypassing traditional insurance networks. Despite their growth, these ministries remain largely unregulated, raising concerns about consumer protection.

The Risks and Limitations of Health Cost-Sharing Ministries

While health cost-sharing ministries promise affordability and simplicity, they lack the robust protections offered by conventional insurance. Unlike regulated plans, these ministries do not guarantee compensation for medical claims and can exclude coverage for preexisting conditions or specific services. This has led to numerous cases where members faced astronomical bills after being denied coverage for critical treatments.

For instance, Rachel Kaplan and Andrew Sheffield encountered significant financial hardship when their Sedera plan refused to cover childbirth expenses during their first year of membership. Similarly, a Christian pastor was left with nearly $38,000 in unpaid bills after his heart surgery was deemed ineligible under his plan's terms. These incidents highlight the inherent risks of relying on cost-sharing ministries for essential healthcare needs.

State regulators are increasingly concerned about the potential consequences for consumers. Many states have enacted laws protecting these ministries from oversight, despite their expanding market share and resemblance to traditional insurance products. As media reports shed light on these shortcomings, the future of health cost-sharing ministries remains uncertain. While they may offer temporary relief from rising healthcare costs, they cannot provide the comprehensive protection needed in a truly effective healthcare system.

New legislation in California mandates comprehensive cultural competency training for healthcare providers, insurers, and Medi-Cal managed care entities. This initiative aims to foster a more inclusive environment for transgender, gender-diverse, and intersex (TGI) patients. The law emphasizes the importance of respectful communication, addressing health disparities, and ensuring that all staff who interact with patients are adequately trained.

The training requirements extend to frontline personnel such as call center representatives, nurses, and other patient-facing staff. Specialized plans offering only dental or vision services and Medicare Advantage plans are exempt from this mandate. Training must be completed by February 14, 2025, for full-service healthcare service plans, while other regulated entities have until March 1, 2025. Additionally, ongoing refresher courses will be required every two years to maintain competency. Newly hired staff must complete the training within 45 days of starting their roles. Regulators may impose sanctions or penalties for noncompliance, underscoring the importance of adherence.

By March 1, 2025, health plans, insurers, and Medi-Cal managed care plans must update their provider directories to identify in-network providers who offer gender-affirming services. These services can include hormone therapy, gender-confirming surgeries, gynecological care, and voice therapy. Since 2006, continuing medical education (CME) courses in California have included cultural and linguistic competency. SB 923 further amends CME curricula to incorporate TGI health needs, including the use of correct names, pronouns, and gender-neutral language, avoiding assumptions about gender or sexual orientation, and understanding implicit bias.

SB 923 marks a significant step toward ensuring that TGI patients receive respectful and informed healthcare. As healthcare organizations implement these new mandates, they contribute to a more inclusive and equitable healthcare system. The law reflects a commitment to improving health outcomes for marginalized communities and fostering an environment where all patients feel respected and valued. By adhering to these requirements, healthcare providers can enhance patient trust and provide better, more compassionate care, ultimately leading to improved health outcomes for everyone.