S. 3386

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 3386 Placed on Calendar Senate (PCS)]

<DOC>

Calendar No. 285
119th CONGRESS
1st Session
S. 3386

To provide a health savings account contribution to certain enrollees, 
to reduce health care costs, and for other purposes.

_______________________________________________________________________

IN THE SENATE OF THE UNITED STATES

December 8 (legislative day, December 4), 2025

Mr. Crapo (for himself and Mr. Cassidy) introduced the following bill; 
which was read the first time

December 8, 2025

Read the second time and placed on the calendar

_______________________________________________________________________

A BILL

To provide a health savings account contribution to certain enrollees, 
to reduce health care costs, and for other purposes.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

(a) Short Title.--This Act may be cited as the ``Health Care 
Freedom for Patients Act of 2025''.
(b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
TITLE I--INCREASING CHOICE AND REDUCING PREMIUMS

Sec. 101. Exchange plan HSAs.
Sec. 102. Exchange plan HSA contribution program.
Sec. 103. Funding cost-sharing reduction payments.
Sec. 104. Allowing all individuals purchasing health insurance in the 
individual market the option to purchase a 
lower premium plan.
TITLE II--PUTTING AMERICAN PATIENTS FIRST

Sec. 201. Expansion FMAP for certain States providing payments for 
health care furnished to certain 
individuals.
Sec. 202. Prohibiting Federal financial participation under Medicaid 
and CHIP for individuals without verified 
citizenship, nationality, or satisfactory 
immigration status.
TITLE III--PREVENTING WASTEFUL SPENDING

Sec. 301. Prohibiting coverage of gender transition procedures as an 
essential health benefit under plans 
offered by Exchanges.
Sec. 302. Prohibiting Federal Medicaid and CHIP funding for certain 
items and services.

TITLE I--INCREASING CHOICE AND REDUCING PREMIUMS

SEC. 101. EXCHANGE PLAN HSAS.

(a) In General.--Section 223 of the Internal Revenue Code of 1986 
is amended by adding at the end the following new subsection:
``(i) Exchange Plan HSAs.--For purposes of this section--
``(1) In general.--In the case of an Exchange plan HSA, 
this section shall be applied as provided in paragraphs (3) 
through (4).
``(2) Exchange plan hsa.--The term `Exchange plan HSA' 
means a health savings account which is designated as an 
Exchange plan HSA upon the establishment of such account.
``(3) No rollovers permitted.--Except in the case of a 
contribution from one Exchange plan HSA to another Exchange 
plan HSA, subsection (f)(5) shall not apply.
``(4) Restriction on use of amounts.--For purposes of 
subsection (d)(2)(A), amounts paid for--
``(A) abortion, other than--
``(i) if the pregnancy is the result of an 
act of rape or incest, or
``(ii) in the case where a woman suffers 
from a physical disorder, physical injury, or 
physical illness, including a life-endangering 
physical condition caused by or arising from 
the pregnancy itself, that would, as certified 
by a physician, place the woman in danger of 
death unless an abortion is performed, or
``(B) any sex trait modification procedure or 
service (as defined in section 156.400 of title 45, 
Code of Federal Regulations, as in effect on the date 
of the enactment of this subsection),
shall not be treated as paid for medical care.''.
(b) Treatment of Governmental Contributions.--Paragraph (4) of 
section 223(b) of the Internal Revenue Code of 1986 is amended by 
striking ``and'' at the end of subparagraph (B), by striking the period 
at the end of subparagraph (C) and inserting ``, and'', and by 
inserting after subparagraph (C) the following new subparagraph:
``(D) the aggregate amount contributed to an 
Exchange plan HSA pursuant to section 102(a) of the 
Health Care Freedom for Patients Act of 2025 which is 
excludable from the taxpayer's gross income for the 
taxable year under section 102(f) of such Act (and such 
amount shall not be allowed as a deduction under 
subsection (a)).''.
(c) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 2025.

SEC. 102. EXCHANGE PLAN HSA CONTRIBUTION PROGRAM.

(a) In General.--As soon as administratively feasible, the 
Secretary of Health and Human Services shall make payments to the 
Exchange plan HSA of each individual who is an eligible enrollee, for 
each month which is an eligible month with respect to such individual, 
in the amount described in subsection (c).
(b) Eligible Month.--For purposes of this section, the term 
``eligible month'' with respect to an individual means a calendar 
month--
(1) occurring in calendar year 2026 or 2027, and
(2) for which the individual is enrolled in a bronze level 
qualified health plan or a catastrophic plan through an 
Exchange established under subtitle D of title I of the Patient 
Protection and Affordable Care Act (42 U.S.C. 18021 et seq.).
(c) Payment Amount.--The amount of each payment under subsection 
(a) for any individual for an eligible month is \1/12\ of--
(1) $1,000, in the case of an eligible enrollee who has 
attained age 18, and has not attained age 50, as of the first 
day of the calendar year which includes such month, and
(2) $1,500, in the case of an eligible enrollee who has 
attained age 50, and has not attained age 65, as of the first 
day of such calendar year.
(d) Eligible Enrollee.--For purposes of this section, with respect 
to months occurring during a calendar year, the term ``eligible 
enrollee'' means an eligible individual (as defined in section 
223(c)(1) of the Internal Revenue Code of 1986)--
(1) who has attained age 18, and has not attained age 65, 
as of the first day of such calendar year,
(2) in the case of an alien, who is an eligible alien, as 
defined in section 36B(e)(2)(B) of such Code (as in effect for 
taxable years beginning after December 31, 2026, applied by 
substituting ``for which the payment under section 102(a) of 
the Health Care Freedom for Patients Act of 2025 is made'' for 
``for which the credit under this section is being claimed''), 
and
(3) whose household income, expressed as a percent of the 
poverty line for the family size involved, does not exceed 700 
percent.
(e) Determination of Eligibility.--
(1) In general.--Upon election pursuant to paragraph (2) by 
an individual enrolling in a plan described in subsection 
(b)(2), the Secretary of Health and Human Services shall make a 
determination of the individual's status as an eligible 
enrollee on the basis of the latest determination pursuant to 
section 1412 of the Patient Protection and Affordable Care Act 
(42 U.S.C. 18082) of the individual's eligibility for the 
advance payment of the premium tax credits under section 36B of 
the Internal Revenue Code of 1986 and cost-sharing reductions 
under section 1402 of such Act (42 U.S.C. 18071).
(2) Election.--At such time and in such manner as the 
Secretary of Health and Human Services shall provide, an 
eligible enrollee shall notify the Secretary of such enrollee's 
election to receive the payments under subsection (a) and shall 
provide--
(A) the social security number of such eligible 
enrollee,
(B) in the case of an alien, an attestation that 
the individual is an eligible alien, and
(C) sufficient information to allow for the 
identification of, and deposit of the payments under 
subsection (a) into, the Exchange plan HSA of the 
eligible enrollee.
(3) Reporting by exchange.--The Exchange through which an 
individual is enrolling in a plan described in subsection 
(b)(2) shall provide to the Secretary of Health and Human 
Services the information provided by the individual which is 
necessary for the determination under paragraph (1).
(4) Timing of payments.--The payments under subsection (a) 
with respect to any eligible months occurring before the 
determination under paragraph (1) is completed shall be made as 
early as possible after the completion of such determination.
(f) Tax Treatment of Contributions.--For purposes of the Internal 
Revenue Code of 1986, payments under subsection (a) shall not be 
included in gross income of an eligible enrollee.
(g) Definitions.--For purposes of this section--
(1) Exchange plan hsa.--The term ``Exchange plan HSA'' has 
the meaning given such term in section 223(i) of the Internal 
Revenue Code of 1986.
(2) Household income; poverty line.--The terms ``household 
income'', ``poverty line'', and ``family size'' have the same 
respective meanings and shall be determined in the same manner 
as for purposes of section 36B of the Internal Revenue Code of 
1986.
(3) Bronze level qualified health plan.--The term ``bronze 
level qualified health plan'' means a qualified health plan, as 
defined in section 1301(a) of the Patient Protection and 
Affordable Care Act (42 U.S.C. 18021(a)), in the bronze level, 
as defined in section 1302(d)(1)(A) of such Act (42 U.S.C. 
18022(d)(1)(A)).
(4) Catastrophic plan.--The term ``catastrophic plan'' 
means a plan described in section 1302(e) of such Act (42 
U.S.C. 18022(e)).
(h) Regulatory Authority.--The Secretary of Health and Human 
Services shall prescribe such regulations or other guidance as are 
necessary to carry out the purposes of this section.
(i) Funding.--In addition to amounts otherwise available, there is 
appropriated to the Secretary of Health and Human Services, out of any 
money in the Treasury not otherwise appropriated, $10,000,000,000 for 
each of fiscal years 2026 and 2027, to remain available until September 
30, 2028, to carry out the purposes of this section.
(j) Information Sharing.--Paragraph (21) of section 6103(l) of the 
Internal Revenue Code of 1986 is amended--
(1) by striking ``or a basic health program under section 
1331 of Patient Protection and Affordable Care Act'' in 
subparagraph (A) and inserting ``a basic health program under 
section 1331 of the Patient Protection and Affordable Care Act, 
or a payment under section 102(a) of the Health Care Freedom 
for Patients Act of 2025'',
(2) by inserting ``, program, or payment'' after ``(and the 
amount thereof)'' in subparagraph (A)(v), and
(3) by striking ``State programs'' in subparagraph (C)(ii) 
and inserting ``State programs or payment''.

SEC. 103. FUNDING COST-SHARING REDUCTION PAYMENTS.

Section 1402 of the Patient Protection and Affordable Care Act (42 
U.S.C. 18071) is amended by adding at the end the following:
``(h) Funding.--
``(1) In general.--There are appropriated, out of any 
monies in the Treasury not otherwise appropriated, such sums as 
may be necessary for purposes of making payments under this 
section for plan years beginning on or after January 1, 2027.
``(2) Use of funds.--
``(A) In general.--The amounts appropriated under 
paragraph (1) may not be used for purposes of making 
payments under this section for a qualified health plan 
that provides health benefit coverage that includes 
coverage of abortion.
``(B) Exception.--Subparagraph (A) shall not apply 
to payments for a qualified health plan that provides 
coverage of abortion only if necessary to save the life 
of the mother or if the pregnancy is a result of an act 
of rape or incest.''.

SEC. 104. ALLOWING ALL INDIVIDUALS PURCHASING HEALTH INSURANCE IN THE 
INDIVIDUAL MARKET THE OPTION TO PURCHASE A LOWER PREMIUM 
PLAN.

(a) In General.--Section 1302(e) of the Patient Protection and 
Affordable Care Act (42 U.S.C. 18022(e)) is amended--
(1) in paragraph (1)--
(A) by redesignating clauses (i) and (ii) of 
subparagraph (B) as subparagraphs (A) and (B), 
respectively, and adjusting the margins accordingly;
(B) by striking ``plan year if--'' and all that 
follows through ``the plan provides--'' and inserting 
``plan year if the plan provides--''; and
(C) in subparagraph (A), as redesignated by 
paragraph (1), by striking ``clause (ii)'' and 
inserting ``subparagraph (B)'';
(2) by striking paragraph (2); and
(3) by redesignating paragraph (3) as paragraph (2).
(b) Risk Pools.--Section 1312(c)(1) of the Patient Protection and 
Affordable Care Act (42 U.S.C. 18032(c)(1)) is amended by inserting 
``and including enrollees in catastrophic plans described in section 
1302(e)'' after ``Exchange''.
(c) Conforming Amendment.--Section 1312(d)(3)(C) of the Patient 
Protection and Affordable Care Act (42 U.S.C. 18032(d)(3)(C)) is 
amended by striking ``, except that in the case of a catastrophic plan 
described in section 1302(e), a qualified individual may enroll in the 
plan only if the individual is eligible to enroll in the plan under 
section 1302(e)(2)''.
(d) Effective Date.--The amendments made by subsections (a), (b), 
and (c) shall apply with respect to plan years beginning on or after 
January 1, 2027.

TITLE II--PUTTING AMERICAN PATIENTS FIRST

SEC. 201. EXPANSION FMAP FOR CERTAIN STATES PROVIDING PAYMENTS FOR 
HEALTH CARE FURNISHED TO CERTAIN INDIVIDUALS.

Section 1905 of the Social Security Act (42 U.S.C. 1396d) is 
amended--
(1) in subsection (y)--
(A) in paragraph (1)(E), by inserting ``(or, for 
calendar quarters beginning on or after October 1, 
2027, in the case such State is a specified State with 
respect to such calendar quarter, 80 percent)'' after 
``thereafter''; and
(B) in paragraph (2), by adding at the end the 
following new subparagraph:
``(C) Specified state.--The term `specified State' 
means, with respect to a quarter, a State that--
``(i) provides any form of financial 
assistance from a State general fund during 
such quarter, in whole or in part, whether or 
not made under a State plan (or waiver of such 
plan) under this title or under another program 
established by the State, to or on behalf of an 
alien who is not a qualified alien and is not a 
child or pregnant woman who is lawfully 
residing in the United States and eligible for 
medical assistance pursuant to section 
1903(v)(4) or for child health assistance or 
pregnancy-related assistance pursuant to 
section 2107(e)(1)(Q), for the purchasing of 
health insurance coverage (as defined in 
section 2791(b)(1) of the Public Health Service 
Act) for an alien who is not a qualified alien 
and is not such a child or pregnant woman; or
``(ii) provides any form of comprehensive 
health benefits coverage, except such coverage 
required by Federal law, during such quarter, 
whether or not under a State plan (or waiver of 
such plan) under this title or under another 
program established by the State, and 
regardless of the source of funding for such 
coverage, to an alien who is not a qualified 
alien and is not such a child or pregnant 
woman.
``(D) Immigration terms.--
``(i) Alien.--The term `alien' has the 
meaning given such term in section 101(a) of 
the Immigration and Nationality Act.
``(ii) Qualified alien.--The term 
`qualified alien' has the meaning given such 
term in section 431 of the Personal 
Responsibility and Work Opportunity 
Reconciliation Act of 1996, except that the 
references to `(in the opinion of the agency 
providing such benefits)' in subsection (c) of 
such section 431 shall be treated as references 
to `(in the opinion of the State in which such 
comprehensive health benefits coverage or such 
financial assistance is provided, as 
applicable)'.''; and
(2) in subsection (z)(2)--
(A) in subparagraph (A), by striking ``for such 
year'' and inserting ``for such quarter''; and
(B) in subparagraph (B)(i)--
(i) in the matter preceding subclause (I), 
by striking ``for a year'' and inserting ``for 
a calendar quarter in a year''; and
(ii) in subclause (II), by striking ``for 
the year'' and inserting ``for the quarter for 
the State''.

SEC. 202. PROHIBITING FEDERAL FINANCIAL PARTICIPATION UNDER MEDICAID 
AND CHIP FOR INDIVIDUALS WITHOUT VERIFIED CITIZENSHIP, 
NATIONALITY, OR SATISFACTORY IMMIGRATION STATUS.

(a) In General.--
(1) Medicaid.--Section 1903(i)(22) of the Social Security 
Act (42 U.S.C. 1396b(i)(22)) is amended--
(A) by adding ``and'' at the end;
(B) by striking ``to amounts'' and inserting "to-- 
``
``(A) amounts''; and
(C) by adding at the end the following new 
subparagraph:
``(B) in the case that the State elects under 
section 1902(a)(46)(C) to provide for making medical 
assistance available to an individual during--
``(i) the period in which the individual is 
provided the reasonable opportunity to present 
satisfactory documentary evidence of 
citizenship or nationality under section 
1902(ee)(2)(C) or subsection (x)(4);
``(ii) the 90-day period described in 
section 1902(ee)(1)(B)(ii)(II); or
``(iii) the period in which the individual 
is provided the reasonable opportunity to 
submit evidence indicating a satisfactory 
immigration status under section 1137(d)(4),
amounts expended for such medical assistance, unless 
the citizenship or nationality of such individual or 
the satisfactory immigration status of such individual 
(as applicable) is verified by the end of such 
period;''.
(2) CHIP.--Section 2107(e)(1)(O) of the Social Security Act 
(42 U.S.C. 1397gg(e)(1)(O)) is amended by striking ``and (17)'' 
and inserting ``(17), and (22)''.
(b) Eliminating State Requirement to Provide Medical Assistance 
During Reasonable Opportunity Period.--
(1) Documentary evidence of citizenship or nationality.--
Section 1903(x)(4) of the Social Security Act (42 U.S.C. 
1396b(x)) is amended--
(A) by striking ``under clauses (i) and (ii) of 
section 1137(d)(4)(A)'' and inserting ``under section 
1137(d)(4)''; and
(B) by inserting ``, except that the State shall 
not be required to make medical assistance available to 
such individual during the period in which such 
individual is provided such reasonable opportunity if 
the State has not elected the option under section 
1902(a)(46)(C)'' before the period at the end.
(2) Social security data match.--Section 1902(ee) of the 
Social Security Act (42 U.S.C. 1396a(ee)) is amended--
(A) in paragraph (1)(B)(ii)--
(i) in subclause (II), by striking ``(and 
continues to provide the individual with 
medical assistance during such 90-day period)'' 
and inserting ``and, if the State has elected 
the option under subsection (a)(46)(C), 
continues to provide the individual with 
medical assistance during such 90-day period''; 
and
(ii) in subclause (III), by inserting ``, 
or denies eligibility for medical assistance 
under this title for such individual, as 
applicable'' after ``under this title''; and
(B) in paragraph (2)(C)--
(i) by striking ``under clauses (i) and 
(ii) of section 1137(d)(4)(A)'' and inserting 
``under section 1137(d)(4)''; and
(ii) by inserting ``, except that the State 
shall not be required to make medical 
assistance available to such individual during 
the period in which such individual is provided 
such reasonable opportunity if the State has 
not elected the option under section 
1902(a)(46)(C)'' before the period at the end.
(3) Individuals with satisfactory immigration status.--
Section 1137(d)(4) of the Social Security Act (42 U.S.C. 1320b-
7(d)(4)) is amended--
(A) in subparagraph (A)(ii), by inserting ``(except 
that such prohibition on delay, denial, reduction, or 
termination of eligibility for benefits under the 
Medicaid program under title XIX shall apply only if 
the State has elected the option under section 
1902(a)(46)(C))'' after ``has been provided''; and
(B) in subparagraph (B)(ii), by inserting ``(except 
that such prohibition on delay, denial, reduction, or 
termination of eligibility for benefits under the 
Medicaid program under title XIX shall apply only if 
the State has elected the option under section 
1902(a)(46)(C))'' after ``status''.
(c) Option to Continue Providing Medical Assistance During 
Reasonable Opportunity Period.--
(1) Medicaid.--Section 1902(a)(46) of the Social Security 
Act (42 U.S.C. 1396a(a)(46)) is amended--
(A) in subparagraph (A), by striking ``and'' at the 
end;
(B) in subparagraph (B)(ii), by adding ``and'' at 
the end; and
(C) by inserting after subparagraph (B)(ii) the 
following new subparagraph:
``(C) provide, at the option of the State, for making 
medical assistance available--
``(i) to an individual described in subparagraph 
(B) during the period in which such individual is 
provided the reasonable opportunity to present 
satisfactory documentary evidence of citizenship or 
nationality under subsection (ee)(2)(C) or section 
1903(x)(4), or during the 90-day period described in 
subsection (ee)(1)(B)(ii)(II); or
``(ii) to an individual who is not a citizen or 
national of the United States during the period in 
which such individual is provided the reasonable 
opportunity to submit evidence indicating a 
satisfactory immigration status under section 
1137(d)(4);''.
(2) CHIP.--Section 2105(c)(9) of the Social Security Act 
(42 U.S.C. 1397ee(c)(9)) is amended by adding at the end the 
following new subparagraph:
``(C) Option to continue providing child health 
assistance during reasonable opportunity period.--
Section 1902(a)(46)(C) shall apply to States under this 
title in the same manner as it applies to a State under 
title XIX.''.
(d) Effective Date.--The amendments made by this section shall 
apply beginning on October 1, 2026.

TITLE III--PREVENTING WASTEFUL SPENDING

SEC. 301. PROHIBITING COVERAGE OF GENDER TRANSITION PROCEDURES AS AN 
ESSENTIAL HEALTH BENEFIT UNDER PLANS OFFERED BY 
EXCHANGES.

(a) In General.--Section 1302(b)(2) of the Patient Protection and 
Affordable Care Act (42 U.S.C. 18022(b)(2)) is amended by adding at the 
end the following new subparagraph:
``(C) Gender transition procedures.--For plan years 
beginning on or after January 1, 2027, the essential 
health benefits defined pursuant to paragraph (1) may 
not include items and services furnished for a gender 
transition procedure.''.
(b) Gender Transition Procedure Defined.--Section 1304 of the 
Patient Protection and Affordable Care Act (42 U.S.C. 18024) is amended 
by adding at the end the following new subsection:
``(f) Gender Transition Procedure.--
``(1) In general.--In this title, except as provided in 
paragraph (2), the term `gender transition procedure' 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:
``(A) 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 body features of an individual.
``(B) Any placement of chest implants to create 
feminine breasts or any placement of erection or 
testicular prosthesis.
``(C) Any placement of fat or artificial implants 
in the gluteal region.
``(D) Administering, prescribing, or dispensing 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, or other 
androgens to an individual at doses that are 
supraphysiologic than would normally be 
produced endogenously in a healthy individual 
of the same age and sex.
``(2) Exception.--Paragraph (1) shall not apply to the 
following:
``(A) Puberty suppression or blocking prescription 
drugs for the purpose of normalizing puberty for an 
individual experiencing precocious puberty.
``(B) Medically necessary procedures or treatments 
to correct for--
``(i) a medically verifiable disorder of 
sex development, including--
``(I) 46,XX chromosomes with 
virilization;
``(II) 46,XY chromosomes with 
undervirilization; and
``(III) both ovarian and testicular 
tissue;
``(ii) sex chromosome structure, sex 
steroid hormone production, or sex hormone 
action, if determined to be abnormal by a 
physician through genetic or biochemical 
testing;
``(iii) infection, disease, injury, or 
disorder caused or exacerbated by a previous 
procedure described in paragraph (1), 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 paragraph 
(1), which may include the removal of a pseudo 
phallus or breast augmentation.
``(3) Sex.--For purposes of this subsection, the term `sex' 
means either male or female, as biologically determined and 
defined by subparagraph (A) and subparagraph (B).
``(A) 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.
``(B) 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.''.

SEC. 302. PROHIBITING FEDERAL MEDICAID AND CHIP FUNDING FOR CERTAIN 
ITEMS AND SERVICES.

(a) Medicaid.--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'';
(3) by inserting after paragraph (27) the following new 
paragraph:
``(28) with respect to any amount expended for specified 
gender transition procedures (as defined in section 1905(ll)) 
furnished to an individual enrolled in a State plan (or waiver 
of such plan).''; and
(4) in the flush left matter at the end, by striking ``and 
(18),'' and inserting ``(18), and (28)''.
(b) CHIP.--Section 2107(e)(1)(O) of the Social Security Act (42 
U.S.C. 1397gg(e)(1)(O)), as amended by this Act, is further amended by 
striking ``and (22)'' and inserting ``(22), and (28)''.
(c) Specified Gender Transition Procedures Defined.--Section 1905 
of the Social Security Act (42 U.S.C. 1396d) is amended by adding at 
the end the following new subsection:
``(ll) Specified Gender Transition Procedures.--
``(1) In general.--For purposes of section 1903(i)(28), 
except as provided in paragraph (2) , the term `specified 
gender transition procedure' 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:
``(A) 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 body features of an individual.
``(B) Any placement of chest implants to create 
feminine breasts or any placement of erection or 
testicular prosthesis.
``(C) Any placement of fat or artificial implants 
in the gluteal region.
``(D) Administering, prescribing, or dispensing 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, or other 
androgens to an individual at doses that are 
supraphysiologic than would normally be 
produced endogenously in a healthy individual 
of the same age and sex.
``(2) Exception.--Paragraph (1) shall not apply to the 
following when furnished to an individual by a health care 
provider if the individual is a minor with the consent of such 
individual's parent or legal guardian:
``(A) Puberty suppression or blocking prescription 
drugs for the purpose of normalizing puberty for an 
individual experiencing precocious puberty.
``(B) Medically necessary procedures or treatments 
to correct for--
``(i) a medically verifiable disorder of 
sex development, including--
``(I) 46,XX chromosomes with 
virilization;
``(II) 46,XY chromosomes with 
undervirilization; and
``(III) both ovarian and testicular 
tissue;
``(ii) sex chromosome structure, sex 
steroid hormone production, or sex hormone 
action, if determined to be abnormal by a 
physician through genetic or biochemical 
testing;
``(iii) infection, disease, injury, or 
disorder caused or exacerbated by a previous 
procedure described in paragraph (1), or a 
physical disorder, physical injury, or physical 
illness that would, as certified by a 
physician, place the individual in 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 paragraph 
(1), which may include the removal of a pseudo 
phallus or breast augmentation.
``(3) Sex.--For purposes of paragraph (1), the term `sex' 
means either male or female, as biologically determined and 
defined in paragraphs (4) and (5), respectively.
``(4) Female.--For purposes of paragraph (3), 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.
``(5) Male.--For purposes of paragraph (3), 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.''.
Calendar No. 285

119th CONGRESS

1st Session

S. 3386

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A BILL

To provide a health savings account contribution to certain enrollees, 
to reduce health care costs, and for other purposes.

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December 8, 2025

Read the second time and placed on the calendar