Budget (finally) delivers on menopause care and education

Not long ago, menopause was hardly part of the conversation in the California Capitol. Now it’s in the state budget.

After several years of legislative attempts to expand menopause care – including a bill Gov. Gavin Newsom vetoed last year – California has enacted new requirements to expand treatment, educate patients and providers and change how health plans decide on menopause care. The provisions are the latest step in a shift that has turned a once rarely discussed stage of women’s lives into a growing area of state health policy.

Much of that shift has played out through legislation championed by Assemblymember Rebecca Bauer-Kahan (D-Orinda), who has spent the past several years pushing menopause further into the state’s health policy conversation.

Her latest attempt was AB 432 in 2025, which would have encouraged greater provider education and improved insurance access to treatment. It passed through the Legislature before Newsom ultimately vetoed it, saying its broad insurance coverage and its restriction on utilization management by health insurance plans raised cost and implementation concerns.

But Newsom’s veto didn’t end the effort. Behind the scenes, conversations continued.

Bauer-Kahan told Capitol Weekly in February that her team had been in discussions with the governor’s office for “quite a bit of time” before his menopause budget proposal was released, and that they had been able to provide input.

For Bauer-Kahan, the governor’s embrace of the issue reflected a broader shift already underway.

“Menopause is having its moment,” she said.

Women, she said, are increasingly recognizing how menopause can affect them not only during the transition itself but throughout their lives, and are demanding better care. Bauer-Kahan said that momentum helped drive the broad bipartisan support her legislation received and, ultimately, the governor’s decision to act.

That action took shape in Newsom’s 2026-27 budget proposal, which brought many of the ideas lawmakers had been debating into the state’s spending plan, including new requirements around insurance coverage, provider education and patient information.

The proposal evolved as it moved through the budget process. According to the Department of Finance (DOF), the final health budget trailer bill retained the administration’s original coverage, treatment and provider-education provisions. It also added standards governing how health plans and insurers determine whether menopause care is medically necessary, and menopause-related continuing education provisions for registered nurses, nurse practitioners and physician assistants.

In practice, the first change means insurers can still review whether a menopause treatment is medically necessary, but they will have new guardrails around the clinical standards used to make that determination.

The new standards are just one piece of a package that reaches across private insurance, Medi-Cal and the healthcare workforce.

Under the new law, health plans and insurers that provide prescription drug benefits will be required to cover medically necessary, FDA-approved treatments for symptoms of perimenopause, menopause and postmenopause. That includes hormone therapy, but also nonhormonal treatments such as certain low-dose antidepressants, anticonvulsants, osteoporosis medications and drugs used to treat hot flashes.

The package also addresses provider education, which has repeatedly surfaced in the Capitol’s menopause debate.

Beginning in July 2027, California will offer enhanced continuing-education credit to qualifying physicians, nurse practitioners and physician assistants who complete menopause coursework. The law also directs the Board of Registered Nursing to consider menopause-related coursework as part of continuing-education standards.

The changes come with a direct state investment. The 2026 Budget Act provides $3.4 million in one-time General Fund money for perimenopause and menopause care coverage and statewide public awareness, with University of California, Los Angeles’ Comprehensive Menopause Program leading the UC system’s coordination, provider training and outreach.

The Department of Managed Health Care will also receive two positions and $407,000 from the Managed Care Fund in 2026-27, dropping to $391,000 annually thereafter, to implement the new requirements.

The growing attention to menopause isn’t confined to the Capitol.

Among the experts lawmakers heard from while considering menopause legislation was someone who might, at first, seem like an unusual witness: an Alzheimer’s researcher.

Suzanne Baker is a senior scientist at Lawrence Berkeley National Laboratory, where she heads the Cellular and Tissue Imaging Department and studies aging and dementia using neuroimaging. Baker testified before the Assembly Health Committee in April 2025 in support of AB 432, offering lawmakers a window into the emerging research on menopause and women’s brain health. Her research has focused in part on amyloid plaques and tau tangles, proteins associated with Alzheimer’s disease.

Baker told Capitol Weekly that she spent part of her own career studying the brain without appreciating how important hormones might be to brain health.

“If this is my specialty, how can I expect people who are non-scientists to make that link?” Baker said.

Estrogen and progesterone are commonly associated with reproduction, she said, but researchers are increasingly examining how the hormonal changes that occur during menopause may affect systems throughout the body, including the brain, heart, bones and muscles.

“The science is just snowballing,” Baker said.

That growing scientific interest is being matched by women eager for answers. Baker said women in their 40s and 50s regularly approach her wanting to know more once they find out her area of study – and asking how they can participate in the research.

“I’ve never come across people wanting this information so much,” Baker said. “They are not kidding around. They want to talk about it. They want to engage in the research. They want to know what’s going on.”