Text of US HB 498 (2025)

I 119TH CONGRESS 1ST SESSION H. R. 498 To amend title XIX of the Social Security Act to prohibit Federal Medicaid funding for gender transition procedures for minors. IN THE HOUSE OF REPRESENTATIVES JANUARY 16, 2025 Mr. CRENSHAW (for himself and Ms. GREENE of Georgia) introduced the following bill; which was referred to the Committee on Energy and Commerce A BILL To amend title XIX of the Social Security Act to prohibit Federal Medicaid funding for gender transition proce- dures for minors. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Do No Harm in Med- 4 icaid Act’’. 5 SEC. 2. PROHIBITING FEDERAL MEDICAID FUNDING FOR 6 GENDER TRANSITION FOR MINORS. 7 (a) IN GENERAL.—Section 1903(i) of the Social Se- 8 curity Act (42 U.S.C. 1396b(i)) is amended— 9 VerDate Sep 11 2014 21:54 Feb 19, 2025 Jkt 059200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H498.IH H498 ssavage on LAPJG3WLY3PROD with BILLS 2 •HR 498 IH (1) in paragraph (26), by striking ‘‘; or’’ and 1 inserting a semicolon; 2 (2) in paragraph (27), by striking the period at 3 the end and inserting ‘‘; or’’; and 4 (3) by inserting after paragraph (27) the fol- 5 lowing new paragraph: ‘‘(28) with respect to any 6 amount expended for specified gender procedures 7 under section 1905(kk) to an individual under 18 8 years of age enrolled in a State plan (or waiver of 9 such plan), including any amounts expended for the 10 administration of a State program that furnishes 11 specified procedures and drugs to individuals under 12 18 years of age.’’. 13 (4) in the flush left matter at the end, by strik- 14 ing ‘‘and (18),’’ and inserting ‘‘(18), and (28)’’. 15 (b) PROHIBITING FEDERAL MEDICAID FUNDING FOR 16 GENDER TRANSITIONS FOR MINORS.—Section 1905 of 17 the Social Security Act (42 U.S.C. 1396d) is amended by 18 adding at the end the following new subsection: 19 ‘‘(KK) PROHIBITING FEDERAL MEDICAID 20 FUNDING FOR GENDER TRANSITIONS FOR MI- 21 NORS.— 22 ‘‘(A) For purposes of section 1903(i)(28), 23 except as provided in subparagraph (B), the 24 term ‘specified gender transition procedures’ 25 VerDate Sep 11 2014 21:54 Feb 19, 2025 Jkt 059200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H498.IH H498 ssavage on LAPJG3WLY3PROD with BILLS 3 •HR 498 IH means, with respect to an individual, any of the 1 following when performed for the purpose of in- 2 tentionally changing the body of such individual 3 (including by disrupting the body’s develop- 4 ment, inhibiting its natural functions, or modi- 5 fying its appearance) to no longer correspond to 6 the individual’s sex: 7 ‘‘(i) Performing any surgery, includ- 8 ing— 9 ‘‘(I) castration; 10 ‘‘(II) sterilization; 11 ‘‘(III) orchiectomy; 12 ‘‘(IV) scrotoplasty; 13 ‘‘(V) vasectomy; 14 ‘‘(VI) tubal ligation; 15 ‘‘(VII) hysterectomy; 16 ‘‘(VIII) oophorectomy; 17 ‘‘(IX) ovariectomy; 18 ‘‘(X) metoidioplasty; 19 ‘‘(XI) clitoroplasty; 20 ‘‘(XII) reconstruction of the fixed 21 part of the urethra with or without a 22 metoidioplasty or a phalloplasty; 23 ‘‘(XIII) penectomy; 24 ‘‘(XIV) phalloplasty; 25 VerDate Sep 11 2014 21:54 Feb 19, 2025 Jkt 059200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H498.IH H498 ssavage on LAPJG3WLY3PROD with BILLS 4 •HR 498 IH ‘‘(XV) vaginoplasty; 1 ‘‘(XVI) vaginectomy; 2 ‘‘(XVII) vulvoplasty; 3 ‘‘(XVIII) reduction 4 thyrochondroplasty; 5 ‘‘(XIX) chondrolaryngoplasty; 6 ‘‘(XX) mastectomy; and 7 ‘‘(XXI) any plastic, cosmetic, or 8 aesthetic surgery that feminizes or 9 masculinizes the facial or other phys- 10 iological features of an individual. 11 ‘‘(ii) Any placement of chest implants 12 to create feminine breasts or any place- 13 ment of erection or testicular prosetheses. 14 ‘‘(iii) Any placement of fat or artifi- 15 cial implants in the gluteal region. 16 ‘‘(iv) Administering, supplying, pre- 17 scribing, dispensing, distributing, or other- 18 wise conveying to an individual medica- 19 tions, including— 20 ‘‘(I) gonadotropin-releasing hor- 21 mone (GnRH) analogues or other pu- 22 berty-blocking drugs to stop or delay 23 normal puberty; and 24 VerDate Sep 11 2014 21:54 Feb 19, 2025 Jkt 059200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H498.IH H498 ssavage on LAPJG3WLY3PROD with BILLS 5 •HR 498 IH ‘‘(II) testosterone, estrogen, pro- 1 gesterone or other androgens to an in- 2 dividual at doses that are 3 supraphysiologic, greater or more po- 4 tent than would normally be produced 5 endogenously in a healthy individual 6 of the same age and sex. 7 ‘‘(B) EXCEPTION.—Subparagraph (A) 8 shall not apply to the following when furnished 9 to an individual by a health care provider with 10 the consent of such individual’s parent or legal 11 guardian: 12 ‘‘(i) Puberty suppression or blocking 13 prescription drugs for the purpose of nor- 14 malizing puberty for an individual experi- 15 encing precocious puberty. 16 ‘‘(ii) Appropriate and medically nec- 17 essary procedures or treatments to correct 18 for— 19 ‘‘(I) a medically verifiable genetic 20 disorder of sex development, includ- 21 ing— 22 ‘‘(aa) 46,XX chromosomes 23 with virilization; 24 VerDate Sep 11 2014 21:54 Feb 19, 2025 Jkt 059200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H498.IH H498 ssavage on LAPJG3WLY3PROD with BILLS 6 •HR 498 IH ‘‘(bb) 46,XY chromosome 1 with undervirilization; and 2 ‘‘(cc) both ovarian and tes- 3 ticular tissue; 4 ‘‘(II) sex chromosome structure, 5 sexsteroid hormone production, or sex 6 hormone action, if determined to be 7 abnormal for a healthy individual of 8 the same sex and age by a physician 9 through genetic or biochemical test- 10 ing; 11 ‘‘(III) infection, disease, injury, 12 or disorder caused or exacerbated by a 13 previous procedure described in sub- 14 paragraph (A), or a physical disorder, 15 physical injury, or physical illness that 16 would, as certified by a physician, 17 place the individual in imminent dan- 18 ger of death or impairment of a major 19 bodily function unless the procedure is 20 performed, not including procedures 21 performed for the alleviation of men- 22 tal distress; or 23 ‘‘(IV) procedures to restore or re- 24 construct the body of the individual in 25 VerDate Sep 11 2014 21:54 Feb 19, 2025 Jkt 059200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H498.IH H498 ssavage on LAPJG3WLY3PROD with BILLS 7 •HR 498 IH order to correspond to the individual’s 1 sex after one or more previous proce- 2 dures described in subparagraph (A), 3 which may include the removal of a 4 pseudo phallus or breast augmenta- 5 tion. 6 ‘‘(C) SEX.—For purposes of subpara- 7 graph(A), the term ‘sex’ means either male or 8 female, as biologically determined and defined 9 by clause (i) and clause (ii). 10 ‘‘(i) FEMALE.—The term ‘female’ 11 means an individual who naturally has, 12 had, will have, or would have, but for a de- 13 velopmental or genetic anomaly or histor- 14 ical accident, the reproductive system that 15 at some point produces, transports, and 16 utilizes eggs for fertilization. 17 ‘‘(ii) MALE.—The term ‘male’ means 18 an individual who naturally has, had, will 19 have, or would have, but for a develop- 20 mental or genetic anomaly or historical ac- 21 cident, the reproductive system that at 22 some point produces, transports, and uti- 23 lizes sperm for fertilization.’’. 24 Æ VerDate Sep 11 2014 21:54 Feb 19, 2025 Jkt 059200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6301 E:\BILLS\H498.IH H498 ssavage on LAPJG3WLY3PROD with BILLS