(

a) An application for a grant under this

chapter shall be made on a form to be developed by the department. (

b) An application shall include both of the following:

(1) A justification of the amount of grant funds requested, including both of the following: (

A) The cost of uncompensated abortion, contraception, and gender-affirming care services the applicant provided to patients with household incomes at or below percent of the federal poverty level in the previous months. (

B) The anticipated cost of uncompensated abortion, contraception, and gender-affirming care services to be provided to patients with household incomes at or below percent of the federal poverty level in the upcoming months.

(2) Other pertinent information that the department requires. (

c) The department shall develop an application form and shall begin accepting applications for grants pursuant to this

chapter on or before January 1, 2027. (

d) For purposes of subdivision (b), the cost of uncompensated abortion, contraception, and gender-affirming care services shall:

(1) Be calculated based on the amount the provider would expect to receive for providing these services to a patient enrolled in the Medi-Cal program.

(2) Include those services provided through prescription, including laboratory and pharmaceutical, as well as services that are the result of complications related to services provided pursuant to this chapter, to the extent they would be covered pursuant to

Section of the Welfare and Institutions Code. (

e) For purposes of this section, the department shall not require the submission of personal information about individuals receiving uncompensated abortion, contraception, and gender-affirming care services as part of an application. Information required by the department shall only include information in

summary, statistical, or other forms that do not identify particular individuals. (

f) Contracts, grants, and related information created pursuant to this

chapter shall not be made public and are exempt from disclosure under the California Public Records Act (Division 10 (commencing with

Section 7920.000) of Title of the Government Code).