H.R. 498

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 498 Engrossed in House (EH)]

<DOC>

119th CONGRESS
1st Session
H. R. 498

_______________________________________________________________________

AN ACT

To amend title XIX of the Social Security Act to prohibit Federal 
Medicaid funding for gender transition procedures for minors.

Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the ``Do No Harm in Medicaid Act''.

SEC. 2. PROHIBITING FEDERAL MEDICAID FUNDING FOR GENDER TRANSITION FOR 
MINORS.

(a) In General.--Section 1903(i) of the Social Security Act (42 
U.S.C. 1396b(i)) is amended--
(1) in paragraph (26), by striking ``; or'' and inserting a 
semicolon;
(2) in paragraph (27), by striking the period at the end 
and inserting ``; or''; and
(3) by inserting after paragraph (27) the following new 
paragraph: ``(28) with respect to any amount expended for 
specified gender procedures under section 1905(kk) to an 
individual under 18 years of age enrolled in a State plan (or 
waiver of such plan), including any amounts expended for the 
administration of a State program that furnishes specified 
procedures and drugs to individuals under 18 years of age.''.
(4) in the flush left matter at the end, by striking ``and 
(18),'' and inserting ``(18), and (28)''.
(b) Prohibiting Federal Medicaid Funding for Gender Transitions for 
Minors.--Section 1905 of the Social Security Act (42 U.S.C. 1396d) is 
amended by adding at the end the following new subsection:
``(KK) Prohibiting federal medicaid funding for 
gender transitions for minors.--
``(A) For purposes of section 1903(i)(28), except 
as provided in subparagraph (B), the term `specified 
gender transition procedures' means, with respect to an 
individual, any of the following when performed for the 
purpose of intentionally changing the body of such 
individual (including by disrupting the body's 
development, inhibiting its natural functions, or 
modifying its appearance) to no longer correspond to 
the individual's sex:
``(i) Performing any surgery, including--
``(I) castration;
``(II) sterilization;
``(III) orchiectomy;
``(IV) scrotoplasty;
``(V) vasectomy;
``(VI) tubal ligation;
``(VII) hysterectomy;
``(VIII) oophorectomy;
``(IX) ovariectomy;
``(X) metoidioplasty;
``(XI) clitoroplasty;
``(XII) reconstruction of the fixed 
part of the urethra with or without a 
metoidioplasty or a phalloplasty;
``(XIII) penectomy;
``(XIV) phalloplasty;
``(XV) vaginoplasty;
``(XVI) vaginectomy;
``(XVII) vulvoplasty;
``(XVIII) reduction 
thyrochondroplasty;
``(XIX) chondrolaryngoplasty;
``(XX) mastectomy; and
``(XXI) any plastic, cosmetic, or 
aesthetic surgery that feminizes or 
masculinizes the facial or other 
physiological features of an 
individual.
``(ii) Any placement of chest implants to 
create feminine breasts or any placement of 
erection or testicular prosetheses.
``(iii) Any placement of fat or artificial 
implants in the gluteal region.
``(iv) Administering, supplying, 
prescribing, dispensing, distributing, or 
otherwise conveying to an individual 
medications, including--
``(I) gonadotropin-releasing 
hormone (GnRH) analogues or other 
puberty-blocking drugs to stop or delay 
normal puberty; and
``(II) testosterone, estrogen, 
progesterone or other androgens to an 
individual at doses that are 
supraphysiologic, greater or more 
potent than would normally be produced 
endogenously in a healthy individual of 
the same age and sex.
``(B) Exception.--Subparagraph (A) shall not apply 
to the following when furnished to an individual by a 
health care provider with the consent of such 
individual's parent or legal guardian:
``(i) Puberty suppression or blocking 
prescription drugs for the purpose of 
normalizing puberty for an individual 
experiencing precocious puberty.
``(ii) Appropriate and medically necessary 
procedures or treatments to correct for--
``(I) a medically verifiable 
genetic disorder of sex development, 
including--
``(aa) 46,XX chromosomes 
with virilization;
``(bb) 46,XY chromosome 
with undervirilization; and
``(cc) both ovarian and 
testicular tissue;
``(II) sex chromosome structure, 
sexsteroid hormone production, or sex 
hormone action, if determined to be 
abnormal for a healthy individual of 
the same sex and age by a physician 
through genetic or biochemical testing;
``(III) infection, disease, injury, 
or disorder caused or exacerbated by a 
previous procedure described in 
subparagraph (A), or a physical 
disorder, physical injury, or physical 
illness that would, as certified by a 
physician, place the individual in 
imminent danger of death or impairment 
of a major bodily function unless the 
procedure is performed, not including 
procedures performed for the 
alleviation of mental distress; or
``(IV) procedures to restore or 
reconstruct the body of the individual 
in order to correspond to the 
individual's sex after one or more 
previous procedures described in 
subparagraph (A), which may include the 
removal of a pseudo phallus or breast 
augmentation.
``(C) Sex.--For purposes of subparagraph(A), the 
term `sex' means either male or female, as biologically 
determined and defined by clause (i) and clause (ii).
``(i) Female.--The term `female' means an 
individual who naturally has, had, will have, 
or would have, but for a developmental or 
genetic anomaly or historical accident, the 
reproductive system that at some point 
produces, transports, and utilizes eggs for 
fertilization.
``(ii) Male.--The term `male' means an 
individual who naturally has, had, will have, 
or would have, but for a developmental or 
genetic anomaly or historical accident, the 
reproductive system that at some point 
produces, transports, and utilizes sperm for 
fertilization.''.

Passed the House of Representatives December 18, 2025.

Attest:

Clerk.
119th CONGRESS

1st Session

H. R. 498

_______________________________________________________________________

AN ACT

To amend title XIX of the Social Security Act to prohibit Federal 
Medicaid funding for gender transition procedures for minors.