Text of US SB 3386 (2025)

II 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 Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 3 (a) SHORT TITLE.—This Act may be cited as the 4 ‘‘Health Care Freedom for Patients Act of 2025’’. 5 (b) TABLE OF CONTENTS.—The table of contents for 6 this Act is as follows: 7 Sec. 1. Short title; table of contents. VerDate Sep 11 2014 23:33 Dec 08, 2025 Jkt 069200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6211 E:\BILLS\S3386.PCS S3386 kjohnson on DSK7ZCZBW3PROD with $$_JOB 2 •S 3386 PCS TITLE I—INCREASING CHOICE AND REDUCING PREMIUMS Sec. 101. Exchange plan HSAs. Sec. 102. Exchange plan HSA contribution program. Sec. 103. Funding cost-sharing reduction payments. Sec. 104. Allowing all individuals purchasing health insurance in the individual market the option to purchase a lower premium plan. TITLE II—PUTTING AMERICAN PATIENTS FIRST Sec. 201. Expansion FMAP for certain States providing payments for health care furnished to certain individuals. Sec. 202. Prohibiting Federal financial participation under Medicaid and CHIP for individuals without verified citizenship, nationality, or satis- factory immigration status. TITLE III—PREVENTING WASTEFUL SPENDING Sec. 301. Prohibiting coverage of gender transition procedures as an essential health benefit under plans offered by Exchanges. Sec. 302. Prohibiting Federal Medicaid and CHIP funding for certain items and services. TITLE I—INCREASING CHOICE 1 AND REDUCING PREMIUMS 2 SEC. 101. EXCHANGE PLAN HSAS. 3 (a) IN GENERAL.—Section 223 of the Internal Rev- 4 enue Code of 1986 is amended by adding at the end the 5 following new subsection: 6 ‘‘(i) EXCHANGE PLAN HSAS.—For purposes of this 7 section— 8 ‘‘(1) IN GENERAL.—In the case of an Exchange 9 plan HSA, this section shall be applied as provided 10 in paragraphs (3) through (4). 11 ‘‘(2) EXCHANGE PLAN HSA.—The term ‘Ex- 12 change plan HSA’ means a health savings account 13 which is designated as an Exchange plan HSA upon 14 the establishment of such account. 15 VerDate Sep 11 2014 23:33 Dec 08, 2025 Jkt 069200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S3386.PCS S3386 kjohnson on DSK7ZCZBW3PROD with $$_JOB 3 •S 3386 PCS ‘‘(3) NO ROLLOVERS PERMITTED.—Except in 1 the case of a contribution from one Exchange plan 2 HSA to another Exchange plan HSA, subsection 3 (f)(5) shall not apply. 4 ‘‘(4) RESTRICTION ON USE OF AMOUNTS.—For 5 purposes of subsection (d)(2)(A), amounts paid 6 for— 7 ‘‘(A) abortion, other than— 8 ‘‘(i) if the pregnancy is the result of 9 an act of rape or incest, or 10 ‘‘(ii) in the case where a woman suf- 11 fers from a physical disorder, physical in- 12 jury, or physical illness, including a life-en- 13 dangering physical condition caused by or 14 arising from the pregnancy itself, that 15 would, as certified by a physician, place 16 the woman in danger of death unless an 17 abortion is performed, or 18 ‘‘(B) any sex trait modification procedure 19 or service (as defined in section 156.400 of title 20 45, Code of Federal Regulations, as in effect on 21 the date of the enactment of this subsection), 22 shall not be treated as paid for medical care.’’. 23 (b) TREATMENT OF GOVERNMENTAL CONTRIBU- 24 TIONS.—Paragraph (4) of section 223(b) of the Internal 25 VerDate Sep 11 2014 23:33 Dec 08, 2025 Jkt 069200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S3386.PCS S3386 kjohnson on DSK7ZCZBW3PROD with $$_JOB 4 •S 3386 PCS Revenue Code of 1986 is amended by striking ‘‘and’’ at 1 the end of subparagraph (B), by striking the period at 2 the end of subparagraph (C) and inserting ‘‘, and’’, and 3 by inserting after subparagraph (C) the following new sub- 4 paragraph: 5 ‘‘(D) the aggregate amount contributed to 6 an Exchange plan HSA pursuant to section 7 102(a) of the Health Care Freedom for Pa- 8 tients Act of 2025 which is excludable from the 9 taxpayer’s gross income for the taxable year 10 under section 102(f) of such Act (and such 11 amount shall not be allowed as a deduction 12 under subsection (a)).’’. 13 (c) EFFECTIVE DATE.—The amendments made by 14 this section shall apply to taxable years beginning after 15 December 31, 2025. 16 SEC. 102. EXCHANGE PLAN HSA CONTRIBUTION PROGRAM. 17 (a) IN GENERAL.—As soon as administratively fea- 18 sible, the Secretary of Health and Human Services shall 19 make payments to the Exchange plan HSA of each indi- 20 vidual who is an eligible enrollee, for each month which 21 is an eligible month with respect to such individual, in the 22 amount described in subsection (c). 23 VerDate Sep 11 2014 23:33 Dec 08, 2025 Jkt 069200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S3386.PCS S3386 kjohnson on DSK7ZCZBW3PROD with $$_JOB 5 •S 3386 PCS (b) ELIGIBLE MONTH.—For purposes of this section, 1 the term ‘‘eligible month’’ with respect to an individual 2 means a calendar month— 3 (1) occurring in calendar year 2026 or 2027, 4 and 5 (2) for which the individual is enrolled in a 6 bronze level qualified health plan or a catastrophic 7 plan through an Exchange established under subtitle 8 D of title I of the Patient Protection and Affordable 9 Care Act (42 U.S.C. 18021 et seq.). 10 (c) PAYMENT AMOUNT.—The amount of each pay- 11 ment under subsection (a) for any individual for an eligible 12 month is 1⁄12 of— 13 (1) $1,000, in the case of an eligible enrollee 14 who has attained age 18, and has not attained age 15 50, as of the first day of the calendar year which in- 16 cludes such month, and 17 (2) $1,500, in the case of an eligible enrollee 18 who has attained age 50, and has not attained age 19 65, as of the first day of such calendar year. 20 (d) ELIGIBLE ENROLLEE.—For purposes of this sec- 21 tion, with respect to months occurring during a calendar 22 year, the term ‘‘eligible enrollee’’ means an eligible indi- 23 vidual (as defined in section 223(c)(1) of the Internal Rev- 24 enue Code of 1986)— 25 VerDate Sep 11 2014 23:33 Dec 08, 2025 Jkt 069200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S3386.PCS S3386 kjohnson on DSK7ZCZBW3PROD with $$_JOB 6 •S 3386 PCS (1) who has attained age 18, and has not at- 1 tained age 65, as of the first day of such calendar 2 year, 3 (2) in the case of an alien, who is an eligible 4 alien, as defined in section 36B(e)(2)(B) of such 5 Code (as in effect for taxable years beginning after 6 December 31, 2026, applied by substituting ‘‘for 7 which the payment under section 102(a) of the 8 Health Care Freedom for Patients Act of 2025 is 9 made’’ for ‘‘for which the credit under this section 10 is being claimed’’), and 11 (3) whose household income, expressed as a 12 percent of the poverty line for the family size in- 13 volved, does not exceed 700 percent. 14 (e) DETERMINATION OF ELIGIBILITY.— 15 (1) IN GENERAL.—Upon election pursuant to 16 paragraph (2) by an individual enrolling in a plan 17 described in subsection (b)(2), the Secretary of 18 Health and Human Services shall make a deter- 19 mination of the individual’s status as an eligible en- 20 rollee on the basis of the latest determination pursu- 21 ant to section 1412 of the Patient Protection and 22 Affordable Care Act (42 U.S.C. 18082) of the indi- 23 vidual’s eligibility for the advance payment of the 24 premium tax credits under section 36B of the Inter- 25 VerDate Sep 11 2014 23:33 Dec 08, 2025 Jkt 069200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S3386.PCS S3386 kjohnson on DSK7ZCZBW3PROD with $$_JOB 7 •S 3386 PCS nal Revenue Code of 1986 and cost-sharing reduc- 1 tions under section 1402 of such Act (42 U.S.C. 2 18071). 3 (2) ELECTION.—At such time and in such man- 4 ner as the Secretary of Health and Human Services 5 shall provide, an eligible enrollee shall notify the 6 Secretary of such enrollee’s election to receive the 7 payments under subsection (a) and shall provide— 8 (A) the social security number of such eli- 9 gible enrollee, 10 (B) in the case of an alien, an attestation 11 that the individual is an eligible alien, and 12 (C) sufficient information to allow for the 13 identification of, and deposit of the payments 14 under subsection (a) into, the Exchange plan 15 HSA of the eligible enrollee. 16 (3) REPORTING BY EXCHANGE.—The Exchange 17 through which an individual is enrolling in a plan 18 described in subsection (b)(2) shall provide to the 19 Secretary of Health and Human Services the infor- 20 mation provided by the individual which is necessary 21 for the determination under paragraph (1). 22 (4) TIMING OF PAYMENTS.—The payments 23 under subsection (a) with respect to any eligible 24 months occurring before the determination under 25 VerDate Sep 11 2014 23:33 Dec 08, 2025 Jkt 069200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S3386.PCS S3386 kjohnson on DSK7ZCZBW3PROD with $$_JOB 8 •S 3386 PCS paragraph (1) is completed shall be made as early 1 as possible after the completion of such determina- 2 tion. 3 (f) TAX TREATMENT OF CONTRIBUTIONS.—For pur- 4 poses of the Internal Revenue Code of 1986, payments 5 under subsection (a) shall not be included in gross income 6 of an eligible enrollee. 7 (g) DEFINITIONS.—For purposes of this section— 8 (1) EXCHANGE PLAN HSA.—The term ‘‘Ex- 9 change plan HSA’’ has the meaning given such term 10 in section 223(i) of the Internal Revenue Code of 11 1986. 12 (2) HOUSEHOLD INCOME; POVERTY LINE.—The 13 terms ‘‘household income’’, ‘‘poverty line’’, and 14 ‘‘family size’’ have the same respective meanings and 15 shall be determined in the same manner as for pur- 16 poses of section 36B of the Internal Revenue Code 17 of 1986. 18 (3) BRONZE LEVEL QUALIFIED HEALTH 19 PLAN.—The term ‘‘bronze level qualified health 20 plan’’ means a qualified health plan, as defined in 21 section 1301(a) of the Patient Protection and Af- 22 fordable Care Act (42 U.S.C. 18021(a)), in the 23 bronze level, as defined in section 1302(d)(1)(A) of 24 such Act (42 U.S.C. 18022(d)(1)(A)). 25 VerDate Sep 11 2014 23:33 Dec 08, 2025 Jkt 069200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S3386.PCS S3386 kjohnson on DSK7ZCZBW3PROD with $$_JOB 9 •S 3386 PCS (4) CATASTROPHIC PLAN.—The term ‘‘cata- 1 strophic plan’’ means a plan described in section 2 1302(e) of such Act (42 U.S.C. 18022(e)). 3 (h) REGULATORY AUTHORITY.—The Secretary of 4 Health and Human Services shall prescribe such regula- 5 tions or other guidance as are necessary to carry out the 6 purposes of this section. 7 (i) FUNDING.—In addition to amounts otherwise 8 available, there is appropriated to the Secretary of Health 9 and Human Services, out of any money in the Treasury 10 not otherwise appropriated, $10,000,000,000 for each of 11 fiscal years 2026 and 2027, to remain available until Sep- 12 tember 30, 2028, to carry out the purposes of this section. 13 (j) INFORMATION SHARING.—Paragraph (21) of sec- 14 tion 6103(l) of the Internal Revenue Code of 1986 is 15 amended— 16 (1) by striking ‘‘or a basic health program 17 under section 1331 of Patient Protection and Af- 18 fordable Care Act’’ in subparagraph (A) and insert- 19 ing ‘‘a basic health program under section 1331 of 20 the Patient Protection and Affordable Care Act, or 21 a payment under section 102(a) of the Health Care 22 Freedom for Patients Act of 2025’’, 23 VerDate Sep 11 2014 23:33 Dec 08, 2025 Jkt 069200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S3386.PCS S3386 kjohnson on DSK7ZCZBW3PROD with $$_JOB 10 •S 3386 PCS (2) by inserting ‘‘, program, or payment’’ after 1 ‘‘(and the amount thereof)’’ in subparagraph (A)(v), 2 and 3 (3) by striking ‘‘State programs’’ in subpara- 4 graph (C)(ii) and inserting ‘‘State programs or pay- 5 ment’’. 6 SEC. 103. FUNDING COST-SHARING REDUCTION PAYMENTS. 7 Section 1402 of the Patient Protection and Afford- 8 able Care Act (42 U.S.C. 18071) is amended by adding 9 at the end the following: 10 ‘‘(h) FUNDING.— 11 ‘‘(1) IN GENERAL.—There are appropriated, 12 out of any monies in the Treasury not otherwise ap- 13 propriated, such sums as may be necessary for pur- 14 poses of making payments under this section for 15 plan years beginning on or after January 1, 2027. 16 ‘‘(2) USE OF FUNDS.— 17 ‘‘(A) IN GENERAL.—The amounts appro- 18 priated under paragraph (1) may not be used 19 for purposes of making payments under this 20 section for a qualified health plan that provides 21 health benefit coverage that includes coverage 22 of abortion. 23 ‘‘(B) EXCEPTION.—Subparagraph (A) 24 shall not apply to payments for a qualified 25 VerDate Sep 11 2014 23:33 Dec 08, 2025 Jkt 069200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S3386.PCS S3386 kjohnson on DSK7ZCZBW3PROD with $$_JOB 11 •S 3386 PCS health plan that provides coverage of abortion 1 only if necessary to save the life of the mother 2 or if the pregnancy is a result of an act of rape 3 or incest.’’. 4 SEC. 104. ALLOWING ALL INDIVIDUALS PURCHASING 5 HEALTH INSURANCE IN THE INDIVIDUAL 6 MARKET THE OPTION TO PURCHASE A 7 LOWER PREMIUM PLAN. 8 (a) IN GENERAL.—Section 1302(e) of the Patient 9 Protection and Affordable Care Act (42 U.S.C. 18022(e)) 10 is amended— 11 (1) in paragraph (1)— 12 (A) by redesignating clauses (i) and (ii) of 13 subparagraph (B) as subparagraphs (A) and 14 (B), respectively, and adjusting the margins ac- 15 cordingly; 16 (B) by striking ‘‘plan year if—’’ and all 17 that follows through ‘‘the plan provides—’’ and 18 inserting ‘‘plan year if the plan provides—’’; 19 and 20 (C) in subparagraph (A), as redesignated 21 by paragraph (1), by striking ‘‘clause (ii)’’ and 22 inserting ‘‘subparagraph (B)’’; 23 (2) by striking paragraph (2); and 24 VerDate Sep 11 2014 23:33 Dec 08, 2025 Jkt 069200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S3386.PCS S3386 kjohnson on DSK7ZCZBW3PROD with $$_JOB 12 •S 3386 PCS (3) by redesignating paragraph (3) as para- 1 graph (2). 2 (b) RISK POOLS.—Section 1312(c)(1) of the Patient 3 Protection and Affordable Care Act (42 U.S.C. 4 18032(c)(1)) is amended by inserting ‘‘and including en- 5 rollees in catastrophic plans described in section 1302(e)’’ 6 after ‘‘Exchange’’. 7 (c) CONFORMING AMENDMENT.—Section 8 1312(d)(3)(C) of the Patient Protection and Affordable 9 Care Act (42 U.S.C. 18032(d)(3)(C)) is amended by strik- 10 ing ‘‘, except that in the case of a catastrophic plan de- 11 scribed in section 1302(e), a qualified individual may en- 12 roll in the plan only if the individual is eligible to enroll 13 in the plan under section 1302(e)(2)’’. 14 (d) EFFECTIVE DATE.—The amendments made by 15 subsections (a), (b), and (c) shall apply with respect to 16 plan years beginning on or after January 1, 2027. 17 TITLE II—PUTTING AMERICAN 18 PATIENTS FIRST 19 SEC. 201. EXPANSION FMAP FOR CERTAIN STATES PRO- 20 VIDING PAYMENTS FOR HEALTH CARE FUR- 21 NISHED TO CERTAIN INDIVIDUALS. 22 Section 1905 of the Social Security Act (42 U.S.C. 23 1396d) is amended— 24 (1) in subsection (y)— 25 VerDate Sep 11 2014 23:33 Dec 08, 2025 Jkt 069200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\S3386.PCS S3386 kjohnson on DSK7ZCZBW3PROD with $$_JOB 13 •S 3386 PCS (A) in paragraph (1)(E), by inserting ‘‘(or, 1 for calendar quarters beginning on or after Oc- 2 tober 1, 2027, in the case such State is a speci- 3 fied State with respect to such calendar quar- 4 ter, 80 percent)’’ after ‘‘thereafter’’; and 5 (B) in paragraph (2), by adding at the end 6 the following new subparagraph: 7 ‘‘(C) SPECIFIED STATE.—The term ‘speci- 8 fied State’ means, with respect to a quarter, a 9 State that— 10 ‘‘(i) provides any form of financial as- 11 sistance from a State general fund during 12 such quarter, in whole or in part, whether 13 or not made under a State plan (or waiver 14 of such plan) under this title or under an- 15 other program established by the State, to 16 or on behalf of an alien who is not a quali- 17 fied alien and is not a child or pregnant 18 woman who is lawfully residing in the 19 United States and eligible for medical as- 20 sistance pursuant to section 1903(v)(4) or 21 for child health assistance or pregnancy-re- 22 lated assistance pursuant to section 23 2107(e)(1)(Q), for the purchasing of 24 health insurance coverage (as defined in 25 VerDate Sep 11 2014 23:33 Dec 08, 2025 Jkt 069200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\S3386.PCS S3386 kjohnson on DSK7ZCZBW3PROD with $$_JOB 14 •S 3386 PCS section 2791(b)(1) of the Public Health 1 Service Act) for an alien who is not a 2 qualified alien and is not such a child or 3 pregnant woman; or 4 ‘‘(ii) provides any form of comprehen- 5 sive health benefits coverage, except such 6 coverage required by Federal law, during 7 such quarter, whether or not under a State 8 plan (or waiver of such plan) under this 9 title or under another program established 10 by the State, and regardless of the source 11 of funding for such coverage, to an alien 12 who is not a qualified alien and is not such 13 a child or pregnant woman. 14 ‘‘(D) IMMIGRATION TERMS.— 15 ‘‘(i) ALIEN.—The term ‘alien’ has the 16 meaning given such term in section 101(a) 17 of the Immigration and Nationality Act. 18 ‘‘(ii) QUALIFIED ALIEN.—The term 19 ‘qualified alien’ has the meaning given 20 such term in section 431 of the Personal 21 Responsibility and Work Opportunity Rec- 22 onciliation Act of 1996, except that the 23 references to ‘(in the opinion of the agency 24 providing such benefits)’ in subsection (c) 25 VerDate Sep 11 2014 23:33 Dec 08, 2025 Jkt 069200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\S3386.PCS S3386 kjohnson on DSK7ZCZBW3PROD with $$_JOB 15 •S 3386 PCS of such section 431 shall be treated as ref- 1 erences to ‘(in the opinion of the State in 2 which such comprehensive health benefits 3 coverage or such financial assistance is 4 provided, as applicable)’.’’; and 5 (2) in subsection (z)(2)— 6 (A) in subparagraph (A), by striking ‘‘for 7 such year’’ and inserting ‘‘for such quarter’’; 8 and 9 (B) in subparagraph (B)(i)— 10 (i) in the matter preceding subclause 11 (I), by striking ‘‘for a year’’ and inserting 12 ‘‘for a calendar quarter in a year’’; and 13 (ii) in subclause (II), by striking ‘‘for 14 the year’’ and inserting ‘‘for the quarter 15 for the State’’. 16 SEC. 202. PROHIBITING FEDERAL FINANCIAL PARTICIPA- 17 TION UNDER MEDICAID AND CHIP FOR INDI- 18 VIDUALS WITHOUT VERIFIED CITIZENSHIP, 19 NATIONALITY, OR SATISFACTORY IMMIGRA- 20 TION STATUS. 21 (a) IN GENERAL.— 22 (1) MEDICAID.—Section 1903(i)(22) of the So- 23 cial Security Act (42 U.S.C. 1396b(i)(22)) is amend- 24 ed— 25 VerDate Sep 11 2014 23:33 Dec 08, 2025 Jkt 069200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 E:\BILLS\S3386.PCS S3386 kjohnson on DSK7ZCZBW3PROD with $$_JOB 16 •S 3386 PCS (A) by adding ‘‘and’’ at the end; 1 (B) by striking ‘‘to amounts’’ and inserting 2 ″to— ‘‘ 3 ‘‘(A) amounts’’; and 4 (C) by adding at the end the following new 5 subparagraph: 6 ‘‘(B) in the case that the State elects 7 under section 1902(a)(46)(C) to provide for 8 making medical assistance available to an indi- 9 vidual during— 10 ‘‘(i) the period in which the individual 11 is provided the reasonable opportunity to 12 present satisfactory documentary evidence 13 of citizenship or nationality under section 14 1902(ee)(2)(C) or subsection (x)(4); 15 ‘‘(ii) the 90-day period described in 16 section 1902(ee)(1)(B)(ii)(II); or 17 ‘‘(iii) the period in which the indi- 18 vidual is provided the reasonable oppor- 19 tunity to submit evidence indicating a sat- 20 isfactory immigration status under section 21 1137(d)(4), 22 amounts expended for such medical assistance, 23 unless the citizenship or nationality of such in- 24 dividual or the satisfactory immigration status 25 VerDate Sep 11 2014 23:33 Dec 08, 2025 Jkt 069200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\S3386.PCS S3386 kjohnson on DSK7ZCZBW3PROD with $$_JOB 17 •S 3386 PCS of such individual (as applicable) is verified by 1 the end of such period;’’. 2 (2) CHIP.—Section 2107(e)(1)(O) of the Social 3 Security Act (42 U.S.C. 1397gg(e)(1)(O)) is amend- 4 ed by striking ‘‘and (17)’’ and inserting ‘‘(17), and 5 (22)’’. 6 (b) ELIMINATING STATE REQUIREMENT TO PROVIDE 7 MEDICAL ASSISTANCE DURING REASONABLE OPPOR- 8 TUNITY PERIOD.— 9 (1) DOCUMENTARY EVIDENCE OF CITIZENSHIP 10 OR NATIONALITY.—Section 1903(x)(4) of the Social 11 Security Act (42 U.S.C. 1396b(x)) is amended— 12 (A) by striking ‘‘under clauses (i) and (ii) 13 of section 1137(d)(4)(A)’’ and inserting ‘‘under 14 section 1137(d)(4)’’; and 15 (B) by inserting ‘‘, except that the State 16 shall not be required to make medical assist- 17 ance available to such individual during the pe- 18 riod in which such individual is provided such 19 reasonable opportunity if the State has not 20 elected the option under section 21 1902(a)(46)(C)’’ before the period at the end. 22 (2) SOCIAL SECURITY DATA MATCH.—Section 23 1902(ee) of the Social Security Act (42 U.S.C. 24 1396a(ee)) is amended— 25 VerDate Sep 11 2014 23:33 Dec 08, 2025 Jkt 069200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6201 E:\BILLS\S3386.PCS S3386 kjohnson on DSK7ZCZBW3PROD with $$_JOB 18 •S 3386 PCS (A) in paragraph (1)(B)(ii)— 1 (i) in subclause (II), by striking ‘‘(and 2 continues to provide the individual with 3 medical assistance during such 90-day pe- 4 riod)’’ and inserting ‘‘and, if the State has 5 elected the option under subsection 6 (a)(46)(C), continues to provide the indi- 7 vidual with medical assistance during such 8 90-day period’’; and 9 (ii) in subclause (III), by inserting ‘‘, 10 or denies eligibility for medical assistance 11 under this title for such individual, as ap- 12 plicable’’ after ‘‘under this title’’; and 13 (B) in paragraph (2)(C)— 14 (i) by striking ‘‘under clauses (i) and 15 (ii) of section 1137(d)(4)(A)’’ and insert- 16 ing ‘‘under section 1137(d)(4)’’; and 17 (ii) by inserting ‘‘, except that the 18 State shall not be required to make med- 19 ical assistance available to such individual 20 during the period in which such individual 21 is provided such reasonable opportunity if 22 the State has not elected the option under 23 section 1902(a)(46)(C)’’ before the period 24 at the end. 25 VerDate Sep 11 2014 23:33 Dec 08, 2025 Jkt 069200 PO 00000 Frm 00018 Fmt 6652 Sfmt 6201 E:\BILLS\S3386.PCS S3386 kjohnson on DSK7ZCZBW3PROD with $$_JOB 19 •S 3386 PCS (3) INDIVIDUALS WITH SATISFACTORY IMMI- 1 GRATION STATUS.—Section 1137(d)(4) of the Social 2 Security Act (42 U.S.C. 1320b–7(d)(4)) is amend- 3 ed— 4 (A) in subparagraph (A)(ii), by inserting 5 ‘‘(except that such prohibition on delay, denial, 6 reduction, or termination of eligibility for bene- 7 fits under the Medicaid program under title 8 XIX shall apply only if the State has elected 9 the option under section 1902(a)(46)(C))’’ after 10 ‘‘has been provided’’; and 11 (B) in subparagraph (B)(ii), by inserting 12 ‘‘(except that such prohibition on delay, denial, 13 reduction, or termination of eligibility for bene- 14 fits under the Medicaid program under title 15 XIX shall apply only if the State has elected 16 the option under section 1902(a)(46)(C))’’ after 17 ‘‘status’’. 18 (c) OPTION TO CONTINUE PROVIDING MEDICAL AS- 19 SISTANCE DURING REASONABLE OPPORTUNITY PE- 20 RIOD.— 21 (1) MEDICAID.—Section 1902(a)(46) of the So- 22 cial Security Act (42 U.S.C. 1396a(a)(46)) is 23 amended— 24 VerDate Sep 11 2014 23:33 Dec 08, 2025 Jkt 069200 PO 00000 Frm 00019 Fmt 6652 Sfmt 6201 E:\BILLS\S3386.PCS S3386 kjohnson on DSK7ZCZBW3PROD with $$_JOB 20 •S 3386 PCS (A) in subparagraph (A), by striking 1 ‘‘and’’ at the end; 2 (B) in subparagraph (B)(ii), by adding 3 ‘‘and’’ at the end; and 4 (C) by inserting after subparagraph (B)(ii) 5 the following new subparagraph: 6 ‘‘(C) provide, at the option of the State, for 7 making medical assistance available— 8 ‘‘(i) to an individual described in subpara- 9 graph (B) during the period in which such indi- 10 vidual is provided the reasonable opportunity to 11 present satisfactory documentary evidence of 12 citizenship or nationality under subsection 13 (ee)(2)(C) or section 1903(x)(4), or during the 14 90-day period described in subsection 15 (ee)(1)(B)(ii)(II); or 16 ‘‘(ii) to an individual who is not a citizen 17 or national of the United States during the pe- 18 riod in which such individual is provided the 19 reasonable opportunity to submit evidence indi- 20 cating a satisfactory immigration status under 21 section 1137(d)(4);’’. 22 (2) CHIP.—Section 2105(c)(9) of the Social 23 Security Act (42 U.S.C. 1397ee(c)(9)) is amended 24 VerDate Sep 11 2014 23:33 Dec 08, 2025 Jkt 069200 PO 00000 Frm 00020 Fmt 6652 Sfmt 6201 E:\BILLS\S3386.PCS S3386 kjohnson on DSK7ZCZBW3PROD with $$_JOB 21 •S 3386 PCS by adding at the end the following new subpara- 1 graph: 2 ‘‘(C) OPTION TO CONTINUE PROVIDING 3 CHILD HEALTH ASSISTANCE DURING REASON- 4 ABLE OPPORTUNITY PERIOD.—Section 5 1902(a)(46)(C) shall apply to States under this 6 title in the same manner as it applies to a State 7 under title XIX.’’. 8 (d) EFFECTIVE DATE.—The amendments made by 9 this section shall apply beginning on October 1, 2026. 10 TITLE III—PREVENTING 11 WASTEFUL SPENDING 12 SEC. 301. PROHIBITING COVERAGE OF GENDER TRANSI- 13 TION PROCEDURES AS AN ESSENTIAL 14 HEALTH BENEFIT UNDER PLANS OFFERED 15 BY EXCHANGES. 16 (a) IN GENERAL.—Section 1302(b)(2) of the Patient 17 Protection and Affordable Care Act (42 U.S.C. 18 18022(b)(2)) is amended by adding at the end the fol- 19 lowing new subparagraph: 20 ‘‘(C) GENDER TRANSITION PROCE- 21 DURES.—For plan years beginning on or after 22 January 1, 2027, the essential health benefits 23 defined pursuant to paragraph (1) may not in- 24 VerDate Sep 11 2014 23:33 Dec 08, 2025 Jkt 069200 PO 00000 Frm 00021 Fmt 6652 Sfmt 6201 E:\BILLS\S3386.PCS S3386 kjohnson on DSK7ZCZBW3PROD with $$_JOB 22 •S 3386 PCS clude items and services furnished for a gender 1 transition procedure.’’. 2 (b) GENDER TRANSITION PROCEDURE DEFINED.— 3 Section 1304 of the Patient Protection and Affordable 4 Care Act (42 U.S.C. 18024) is amended by adding at the 5 end the following new subsection: 6 ‘‘(f) GENDER TRANSITION PROCEDURE.— 7 ‘‘(1) IN GENERAL.—In this title, except as pro- 8 vided in paragraph (2), the term ‘gender transition 9 procedure’ means, with respect to an individual, any 10 of the following when performed for the purpose of 11 intentionally changing the body of such individual 12 (including by disrupting the body’s development, in- 13 hibiting its natural functions, or modifying its ap- 14 pearance) to no longer correspond to the individual’s 15 sex: 16 ‘‘(A) Performing any surgery, including— 17 ‘‘(i) castration; 18 ‘‘(ii) sterilization; 19 ‘‘(iii) orchiectomy; 20 ‘‘(iv) scrotoplasty; 21 ‘‘(v) vasectomy; 22 ‘‘(vi) tubal ligation; 23 ‘‘(vii) hysterectomy; 24 ‘‘(viii) oophorectomy; 25 VerDate Sep 11 2014 23:33 Dec 08, 2025 Jkt 069200 PO 00000 Frm 00022 Fmt 6652 Sfmt 6201 E:\BILLS\S3386.PCS S3386 kjohnson on DSK7ZCZBW3PROD with $$_JOB 23 •S 3386 PCS ‘‘(ix) ovariectomy; 1 ‘‘(x) metoidioplasty; 2 ‘‘(xi) clitoroplasty; 3 ‘‘(xii) reconstruction of the fixed part 4 of the urethra with or without a 5 metoidioplasty or a phalloplasty; 6 ‘‘(xiii) penectomy; 7 ‘‘(xiv) phalloplasty; 8 ‘‘(xv) vaginoplasty; 9 ‘‘(xvi) vaginectomy; 10 ‘‘(xvii) vulvoplasty; 11 ‘‘(xviii) reduction thyrochondroplasty; 12 ‘‘(xix) chondrolaryngoplasty; 13 ‘‘(xx) mastectomy; and 14 ‘‘(xxi) any plastic, cosmetic, or aes- 15 thetic surgery that feminizes or 16 masculinizes the facial or other body fea- 17 tures of an individual. 18 ‘‘(B) Any placement of chest implants to 19 create feminine breasts or any placement of 20 erection or testicular prosthesis. 21 ‘‘(C) Any placement of fat or artificial im- 22 plants in the gluteal region. 23 VerDate Sep 11 2014 23:33 Dec 08, 2025 Jkt 069200 PO 00000 Frm 00023 Fmt 6652 Sfmt 6201 E:\BILLS\S3386.PCS S3386 kjohnson on DSK7ZCZBW3PROD with $$_JOB 24 •S 3386 PCS ‘‘(D) Administering, prescribing, or dis- 1 pensing to an individual medications, includ- 2 ing— 3 ‘‘(i) gonadotropin-releasing hormone 4 (GnRH) analogues or other puberty-block- 5 ing drugs to stop or delay normal puberty; 6 and 7 ‘‘(ii) testosterone, estrogen, or other 8 androgens to an individual at doses that 9 are supraphysiologic than would normally 10 be produced endogenously in a healthy in- 11 dividual of the same age and sex. 12 ‘‘(2) EXCEPTION.—Paragraph (1) shall not 13 apply to the following: 14 ‘‘(A) Puberty suppression or blocking pre- 15 scription drugs for the purpose of normalizing 16 puberty for an individual experiencing pre- 17 cocious puberty. 18 ‘‘(B) Medically necessary procedures or 19 treatments to correct for— 20 ‘‘(i) a medically verifiable disorder of 21 sex development, including— 22 ‘‘(I) 46,XX chromosomes with 23 virilization; 24 VerDate Sep 11 2014 23:33 Dec 08, 2025 Jkt 069200 PO 00000 Frm 00024 Fmt 6652 Sfmt 6201 E:\BILLS\S3386.PCS S3386 kjohnson on DSK7ZCZBW3PROD with $$_JOB 25 •S 3386 PCS ‘‘(II) 46,XY chromosomes with 1 undervirilization; and 2 ‘‘(III) both ovarian and testicular 3 tissue; 4 ‘‘(ii) sex chromosome structure, sex 5 steroid hormone production, or sex hor- 6 mone action, if determined to be abnormal 7 by a physician through genetic or bio- 8 chemical testing; 9 ‘‘(iii) infection, disease, injury, or dis- 10 order caused or exacerbated by a previous 11 procedure described in paragraph (1), or a 12 physical disorder, physical injury, or phys- 13 ical illness that would, as certified by a 14 physician, place the individual in imminent 15 danger of death or impairment of a major 16 bodily function unless the procedure is per- 17 formed, not including procedures per- 18 formed for the alleviation of mental dis- 19 tress; or 20 ‘‘(iv) procedures to restore or recon- 21 struct the body of the individual in order 22 to correspond to the individual’s sex after 23 one or more previous procedures described 24 in paragraph (1), which may include the 25 VerDate Sep 11 2014 23:33 Dec 08, 2025 Jkt 069200 PO 00000 Frm 00025 Fmt 6652 Sfmt 6201 E:\BILLS\S3386.PCS S3386 kjohnson on DSK7ZCZBW3PROD with $$_JOB 26 •S 3386 PCS removal of a pseudo phallus or breast aug- 1 mentation. 2 ‘‘(3) SEX.—For purposes of this subsection, the 3 term ‘sex’ means either male or female, as bio- 4 logically determined and defined by subparagraph 5 (A) and subparagraph (B). 6 ‘‘(A) FEMALE.—The term ‘female’ means 7 an individual who naturally has, had, will have, 8 or would have, but for a developmental or ge- 9 netic anomaly or historical accident, the repro- 10 ductive system that at some point produces, 11 transports, and utilizes eggs for fertilization. 12 ‘‘(B) MALE.—The term ‘male’ means an 13 individual who naturally has, had, will have, or 14 would have, but for a developmental or genetic 15 anomaly or historical accident, the reproductive 16 system that at some point produces, transports, 17 and utilizes sperm for fertilization.’’. 18 SEC. 302. PROHIBITING FEDERAL MEDICAID AND CHIP 19 FUNDING FOR CERTAIN ITEMS AND SERV- 20 ICES. 21 (a) MEDICAID.—Section 1903(i) of the Social Secu- 22 rity Act (42 U.S.C. 1396b(i)) is amended— 23 (1) in paragraph (26), by striking ‘‘; or’’ and 24 inserting a semicolon; 25 VerDate Sep 11 2014 23:33 Dec 08, 2025 Jkt 069200 PO 00000 Frm 00026 Fmt 6652 Sfmt 6201 E:\BILLS\S3386.PCS S3386 kjohnson on DSK7ZCZBW3PROD with $$_JOB 27 •S 3386 PCS (2) in paragraph (27), by striking the period at 1 the end and inserting ‘‘; or’’; 2 (3) by inserting after paragraph (27) the fol- 3 lowing new paragraph: 4 ‘‘(28) with respect to any amount expended for 5 specified gender transition procedures (as defined in 6 section 1905(ll)) furnished to an individual enrolled 7 in a State plan (or waiver of such plan).’’; and 8 (4) in the flush left matter at the end, by strik- 9 ing ‘‘and (18),’’ and inserting ‘‘(18), and (28)’’. 10 (b) CHIP.—Section 2107(e)(1)(O) of the Social Se- 11 curity Act (42 U.S.C. 1397gg(e)(1)(O)), as amended by 12 this Act, is further amended by striking ‘‘and (22)’’ and 13 inserting ‘‘(22), and (28)’’. 14 (c) SPECIFIED GENDER TRANSITION PROCEDURES 15 DEFINED.—Section 1905 of the Social Security Act (42 16 U.S.C. 1396d) is amended by adding at the end the fol- 17 lowing new subsection: 18 ‘‘(ll) SPECIFIED GENDER TRANSITION PROCE- 19 DURES.— 20 ‘‘(1) IN GENERAL.—For purposes of section 21 1903(i)(28), except as provided in paragraph (2) , 22 the term ‘specified gender transition procedure’ 23 means, with respect to an individual, any of the fol- 24 lowing when performed for the purpose of inten- 25 VerDate Sep 11 2014 23:33 Dec 08, 2025 Jkt 069200 PO 00000 Frm 00027 Fmt 6652 Sfmt 6201 E:\BILLS\S3386.PCS S3386 kjohnson on DSK7ZCZBW3PROD with $$_JOB 28 •S 3386 PCS tionally changing the body of such individual (in- 1 cluding by disrupting the body’s development, inhib- 2 iting its natural functions, or modifying its appear- 3 ance) to no longer correspond to the individual’s sex: 4 ‘‘(A) Performing any surgery, including— 5 ‘‘(i) castration; 6 ‘‘(ii) sterilization; 7 ‘‘(iii) orchiectomy; 8 ‘‘(iv) scrotoplasty; 9 ‘‘(v) vasectomy; 10 ‘‘(vi) tubal ligation; 11 ‘‘(vii) hysterectomy; 12 ‘‘(viii) oophorectomy; 13 ‘‘(ix) ovariectomy; 14 ‘‘(x) metoidioplasty; 15 ‘‘(xi) clitoroplasty; 16 ‘‘(xii) reconstruction of the fixed part 17 of the urethra with or without a 18 metoidioplasty or a phalloplasty; 19 ‘‘(xiii) penectomy; 20 ‘‘(xiv) phalloplasty; 21 ‘‘(xv) vaginoplasty; 22 ‘‘(xvi) vaginectomy; 23 ‘‘(xvii) vulvoplasty; 24 ‘‘(xviii) reduction thyrochondroplasty; 25 VerDate Sep 11 2014 23:33 Dec 08, 2025 Jkt 069200 PO 00000 Frm 00028 Fmt 6652 Sfmt 6201 E:\BILLS\S3386.PCS S3386 kjohnson on DSK7ZCZBW3PROD with $$_JOB 29 •S 3386 PCS ‘‘(xix) chondrolaryngoplasty; 1 ‘‘(xx) mastectomy; and 2 ‘‘(xxi) any plastic, cosmetic, or aes- 3 thetic surgery that feminizes or 4 masculinizes the facial or other body fea- 5 tures of an individual. 6 ‘‘(B) Any placement of chest implants to 7 create feminine breasts or any placement of 8 erection or testicular prosthesis. 9 ‘‘(C) Any placement of fat or artificial im- 10 plants in the gluteal region. 11 ‘‘(D) Administering, prescribing, or dis- 12 pensing to an individual medications, includ- 13 ing— 14 ‘‘(i) gonadotropin-releasing hormone 15 (GnRH) analogues or other puberty-block- 16 ing drugs to stop or delay normal puberty; 17 and 18 ‘‘(ii) testosterone, estrogen, or other 19 androgens to an individual at doses that 20 are supraphysiologic than would normally 21 be produced endogenously in a healthy in- 22 dividual of the same age and sex. 23 ‘‘(2) EXCEPTION.—Paragraph (1) shall not 24 apply to the following when furnished to an indi- 25 VerDate Sep 11 2014 23:33 Dec 08, 2025 Jkt 069200 PO 00000 Frm 00029 Fmt 6652 Sfmt 6201 E:\BILLS\S3386.PCS S3386 kjohnson on DSK7ZCZBW3PROD with $$_JOB 30 •S 3386 PCS vidual by a health care provider if the individual is 1 a minor with the consent of such individual’s parent 2 or legal guardian: 3 ‘‘(A) Puberty suppression or blocking pre- 4 scription drugs for the purpose of normalizing 5 puberty for an individual experiencing pre- 6 cocious puberty. 7 ‘‘(B) Medically necessary procedures or 8 treatments to correct for— 9 ‘‘(i) a medically verifiable disorder of 10 sex development, including— 11 ‘‘(I) 46,XX chromosomes with 12 virilization; 13 ‘‘(II) 46,XY chromosomes with 14 undervirilization; and 15 ‘‘(III) both ovarian and testicular 16 tissue; 17 ‘‘(ii) sex chromosome structure, sex 18 steroid hormone production, or sex hor- 19 mone action, if determined to be abnormal 20 by a physician through genetic or bio- 21 chemical testing; 22 ‘‘(iii) infection, disease, injury, or dis- 23 order caused or exacerbated by a previous 24 procedure described in paragraph (1), or a 25 VerDate Sep 11 2014 23:33 Dec 08, 2025 Jkt 069200 PO 00000 Frm 00030 Fmt 6652 Sfmt 6201 E:\BILLS\S3386.PCS S3386 kjohnson on DSK7ZCZBW3PROD with $$_JOB 31 •S 3386 PCS physical disorder, physical injury, or phys- 1 ical illness that would, as certified by a 2 physician, place the individual in danger of 3 death or impairment of a major bodily 4 function unless the procedure is performed, 5 not including procedures performed for the 6 alleviation of mental distress; or 7 ‘‘(iv) procedures to restore or recon- 8 struct the body of the individual in order 9 to correspond to the individual’s sex after 10 one or more previous procedures described 11 in paragraph (1), which may include the 12 removal of a pseudo phallus or breast aug- 13 mentation. 14 ‘‘(3) SEX.—For purposes of paragraph (1), the 15 term ‘sex’ means either male or female, as bio- 16 logically determined and defined in paragraphs (4) 17 and (5), respectively. 18 ‘‘(4) FEMALE.—For purposes of paragraph (3), 19 the term ‘female’ means an individual who naturally 20 has, had, will have, or would have, but for a develop- 21 mental or genetic anomaly or historical accident, the 22 reproductive system that at some point produces, 23 transports, and utilizes eggs for fertilization. 24 VerDate Sep 11 2014 23:33 Dec 08, 2025 Jkt 069200 PO 00000 Frm 00031 Fmt 6652 Sfmt 6201 E:\BILLS\S3386.PCS S3386 kjohnson on DSK7ZCZBW3PROD with $$_JOB 32 •S 3386 PCS ‘‘(5) MALE.—For purposes of paragraph (3), 1 the term ‘male’ means an individual who naturally 2 has, had, will have, or would have, but for a develop- 3 mental or genetic anomaly or historical accident, the 4 reproductive system that at some point produces, 5 transports, and utilizes sperm for fertilization.’’. 6 VerDate Sep 11 2014 23:33 Dec 08, 2025 Jkt 069200 PO 00000 Frm 00032 Fmt 6652 Sfmt 6201 E:\BILLS\S3386.PCS S3386 kjohnson on DSK7ZCZBW3PROD with $$_JOB VerDate Sep 11 2014 23:33 Dec 08, 2025 Jkt 069200 PO 00000 Frm 00033 Fmt 6652 Sfmt 6201 E:\BILLS\S3386.PCS S3386 kjohnson on DSK7ZCZBW3PROD with $$_JOB Calendar No. 285 119TH CONGRESS 1ST SESSION S. 3386 A BILL To provide a health savings account contribution to certain enrollees, to reduce health care costs, and for other purposes. DECEMBER 8, 2025 Read the second time and placed on the calendar VerDate Sep 11 2014 23:33 Dec 08, 2025 Jkt 069200 PO 00000 Frm 00034 Fmt 6651 Sfmt 6651 E:\BILLS\S3386.PCS S3386 kjohnson on DSK7ZCZBW3PROD with $$_JOB