Text of US SB 4426 (2026)

II 119TH CONGRESS 2D SESSION S. 4426 To prohibit gender transition procedures on minors, to authorize the Secretary of Health and Human Services to impose civil penalties on persons who perform gender transition procedures on minors, and for other purposes. IN THE SENATE OF THE UNITED STATES APRIL 29, 2026 Mr. MARSHALL (for himself and Mr. LEE) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions A BILL To prohibit gender transition procedures on minors, to au- thorize the Secretary of Health and Human Services to impose civil penalties on persons who perform gender transition procedures on minors, 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. 3 This Act may be cited as the ‘‘Safeguarding The 4 Overall Protection of Minors Act’’ or the ‘‘STOP Act’’. 5 SEC. 2. DEFINITIONS. 6 In this Act: 7 VerDate Sep 11 2014 00:53 Apr 30, 2026 Jkt 069200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S4426.IS S4426 ssavage on LAPJG3WLY3PROD with BILLS 2 •S 4426 IS (1) CARETAKER.—The term ‘‘caretaker’’ means 1 an adult, who is not a parent of a child, with whom 2 a child resides and who provides that child with the 3 care, maintenance, and supervision consistent with 4 the duties and responsibilities of a parent of the 5 child. 6 (2) DETRANSITION TREATMENT.—The term 7 ‘‘detransition treatment’’ means any treatment, in- 8 cluding mental health services, medical intervention, 9 or surgery, that does any of the following: 10 (A) Stops or reverses the effects of a gen- 11 der transition procedure. 12 (B) Helps an individual cope with the ef- 13 fects of a prior gender transition procedure. 14 (3) FEMALE.—The term ‘‘female’’, when used 15 to refer to a natural person, means an individual 16 who naturally has, had, will have, or would have, but 17 for a congenital anomaly or intentional or uninten- 18 tional disruption, the reproductive system that at 19 some point produces, transports, and utilizes eggs 20 for fertilization. 21 (4) GENDER TRANSITION.—The term ‘‘gender 22 transition’’ means the process, which may be accom- 23 panied with social, legal, or physical changes— 24 (A) in which an individual— 25 VerDate Sep 11 2014 00:53 Apr 30, 2026 Jkt 069200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S4426.IS S4426 ssavage on LAPJG3WLY3PROD with BILLS 3 •S 4426 IS (i) intentionally halts the natural de- 1 velopment of the individual’s body so that 2 the body no longer corresponds to the indi- 3 vidual’s sex; or 4 (ii) intentionally transforms the indi- 5 vidual’s physical appearance to confirm the 6 individual’s physical appearance to be of 7 the alternate sex; or 8 (B) that alters or removes sexual organs as 9 part of chemical or surgical mutilation. 10 (5) GENDER TRANSITION PROCEDURE.— 11 (A) IN GENERAL.—The term ‘‘gender tran- 12 sition procedure’’ means any hormonal, phar- 13 maceutical, or surgical intervention for the pur- 14 pose of gender transition, including— 15 (i) gonadotropin-releasing hormone 16 (GnRH) agonists or other puberty-blocking 17 or suppressing drugs to stop or delay nor- 18 mally timed puberty; 19 (ii) testosterone, estrogen, progester- 20 one, androgen blockers, or other sex hor- 21 mones to an individual at doses that are 22 supraphysiologic to what would normally 23 be produced endogenously in a healthy in- 24 dividual of the same age and sex; 25 VerDate Sep 11 2014 00:53 Apr 30, 2026 Jkt 069200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S4426.IS S4426 ssavage on LAPJG3WLY3PROD with BILLS 4 •S 4426 IS (iii) procedures that attempt to trans- 1 form an individual’s physical appearance to 2 confirm the individual’s physical appear- 3 ance to be of the alternate sex, or that 4 alter or remove sexual organs as part of 5 chemical or surgical mutilation; 6 (iv) castration; 7 (v) orchiectomy; 8 (vi) scrotoplasty; 9 (vii) implantation of erection or testic- 10 ular prostheses; 11 (viii) vasectomy; 12 (ix) hysterectomy; 13 (x) oophorectomy; 14 (xi) ovariectomy; 15 (xii) reconstruction of the fixed part 16 of the urethra with or without a 17 metoidioplasty or a phalloplasty; 18 (xiii) metoidioplasty; 19 (xiv) penectomy; 20 (xv) phalloplasty; 21 (xvi) vaginoplasty; 22 (xvii) clitoroplasty; 23 (xviii) vaginectomy; 24 (xix) vulvoplasty; 25 VerDate Sep 11 2014 00:53 Apr 30, 2026 Jkt 069200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S4426.IS S4426 ssavage on LAPJG3WLY3PROD with BILLS 5 •S 4426 IS (xx) reduction thyrochondroplasty; 1 (xxi) chondrolaryngoplasty; 2 (xxii) mastectomy; 3 (xxiii) tubal ligation; 4 (xxiv) sterilization; 5 (xxv) any plastic, cosmetic, or aes- 6 thetic surgery that feminizes or 7 masculinizes the facial or other physio- 8 logical features of an individual; 9 (xxvi) any placement of chest implants 10 to create feminine breasts; 11 (xxvii) any placement of fat or artifi- 12 cial implants in the gluteal region; 13 (xxviii) augmentation mammoplasty; 14 (xxix) liposuction; 15 (xxx) lipofilling; 16 (xxxi) voice surgery; 17 (xxxii) hair reconstruction; 18 (xxxiii) pectoral implants; and 19 (xxxiv) the removal of any otherwise 20 healthy or non-diseased body part or tis- 21 sue. 22 (B) EXCLUSIONS.—The term ‘‘gender 23 transition procedure’’ does not include the fol- 24 lowing when furnished to an individual by a 25 VerDate Sep 11 2014 00:53 Apr 30, 2026 Jkt 069200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S4426.IS S4426 ssavage on LAPJG3WLY3PROD with BILLS 6 •S 4426 IS health care provider with the consent of such 1 individual or, if applicable, such individual’s 2 parents or legal guardian: 3 (i) Services to individuals who have 4 been diagnosed with a disorder of sex de- 5 velopment by a licensed health care pro- 6 vider operating within their scope of prac- 7 tice, including an individual with external 8 sex characteristics that are irresolvably 9 ambiguous, such as an individual born with 10 46 XX chromosomes with virilization, an 11 individual born with 46 XY chromosomes 12 with undervirilization, or an individual 13 born having both ovarian and testicular 14 tissue. 15 (ii) Services provided when a health 16 care professional has otherwise diagnosed a 17 disorder of sexual development in which 18 the health care professional has determined 19 through genetic or biochemical testing that 20 the individual does not have normal sex 21 chromosome structure, sex steroid hormone 22 production, or sex steroid hormone action 23 for a healthy individual of the same sex 24 and age. 25 VerDate Sep 11 2014 00:53 Apr 30, 2026 Jkt 069200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S4426.IS S4426 ssavage on LAPJG3WLY3PROD with BILLS 7 •S 4426 IS (iii) The treatment of any infection, 1 injury, disease, or disorder that has been 2 caused by or exacerbated by the perform- 3 ance of gender transition procedures, 4 whether or not the gender transition proce- 5 dure was performed in accordance with 6 State and Federal law or whether or not 7 funding for the gender transition proce- 8 dure is permissible under this section. 9 (iv) Any procedure undertaken be- 10 cause the individual suffers from a physical 11 disorder, physical injury, or physical illness 12 (but not mental, behavioral, or emotional 13 distress or a mental, behavioral, or emo- 14 tional disorder) that would, as certified by 15 a health care professional, place the indi- 16 vidual in imminent danger of death or im- 17 pairment of major bodily function, unless 18 the procedure is performed, which may in- 19 clude the following: 20 (I) Traumatic bodily injuries 21 (such as fractures, organ rupture, or 22 penetrating trauma). 23 (II) Congenital structural anoma- 24 lies of major organs or systems, in- 25 VerDate Sep 11 2014 00:53 Apr 30, 2026 Jkt 069200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S4426.IS S4426 ssavage on LAPJG3WLY3PROD with BILLS 8 •S 4426 IS cluding the cardiovascular, res- 1 piratory, renal, hepatic, neurological, 2 or musculoskeletal systems. 3 (III) Acute illnesses with a high 4 probability of imminent mortality. 5 (v) Any procedure to restore or recon- 6 struct the body of the individual in order 7 to correspond to the individual’s sex after 8 one or more previous gender transition 9 procedures, which may include the removal 10 of a pseudo phallus or breast augmenta- 11 tion. 12 (vi) Puberty suppression or blocking 13 prescription drugs for the purpose of nor- 14 malizing puberty for a minor experiencing 15 precocious puberty. 16 (vii) Male circumcision. 17 (6) MALE.—The term ‘‘male’’, when used to 18 refer to a natural person, means an individual who 19 naturally has, had, will have, or would have, but for 20 a congenital anomaly or intentional or unintentional 21 disruption, the reproductive system that at some 22 point produces, transports, and utilizes sperm for 23 fertilization. 24 VerDate Sep 11 2014 00:53 Apr 30, 2026 Jkt 069200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S4426.IS S4426 ssavage on LAPJG3WLY3PROD with BILLS 9 •S 4426 IS (7) MINOR.—The term ‘‘minor’’ means an indi- 1 vidual under the age of 18. 2 (8) SECRETARY.—The term ‘‘Secretary’’ means 3 the Secretary of Health and Human Services. 4 (9) SEX.—The term ‘‘sex’’, when referring to a 5 natural person’s sex, means the person’s immutable 6 biological classification as either male or female, as 7 biologically determined and defined by this section. 8 SEC. 3. GENDER TRANSITION PROCEDURES ON MINORS. 9 (a) PROHIBITION.— 10 (1) IN GENERAL.—No person may, in any cir- 11 cumstance described in paragraph (2), knowingly 12 perform, attempt to perform, conspire to perform, or 13 otherwise aid or abet the performance of any gender 14 transition procedure on a minor. 15 (2) CIRCUMSTANCES DESCRIBED.—A cir- 16 cumstance referred to in paragraph (1) is any of the 17 following: 18 (A) The person, or the minor on whom the 19 gender transition procedure was performed, at- 20 tempted to be performed, or conspired to be 21 performed or on whom the performance of any 22 gender transition procedure was aided or abet- 23 ted, traveled in interstate or foreign commerce, 24 or traveled using a means, channel, facility, or 25 VerDate Sep 11 2014 00:53 Apr 30, 2026 Jkt 069200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S4426.IS S4426 ssavage on LAPJG3WLY3PROD with BILLS 10 •S 4426 IS instrumentality of interstate or foreign com- 1 merce, in furtherance of or in connection with 2 the conduct described in paragraph (1). 3 (B) The person, or the minor on whom the 4 gender transition procedure was performed, at- 5 tempted to be performed, or conspired to be 6 performed or on whom the performance of any 7 gender transition procedure was aided or abet- 8 ted, used a means, channel, facility, or instru- 9 mentality of interstate or foreign commerce in 10 furtherance of or in connection with the con- 11 duct described in paragraph (1). 12 (C) A payment of any kind was made, di- 13 rectly or indirectly, in furtherance of or in con- 14 nection with the conduct described in paragraph 15 (1), using any means, channel, facility, or in- 16 strumentality of interstate or foreign commerce 17 or in interstate or foreign commerce. 18 (D) The person, or the minor on whom the 19 gender transition procedure was performed, at- 20 tempted to be performed, or conspired to be 21 performed or on whom the performance of any 22 gender transition procedure was aided or abet- 23 ted, transmitted in interstate or foreign com- 24 merce any communication relating to or in fur- 25 VerDate Sep 11 2014 00:53 Apr 30, 2026 Jkt 069200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S4426.IS S4426 ssavage on LAPJG3WLY3PROD with BILLS 11 •S 4426 IS therance of the conduct described in paragraph 1 (1) using any means, channel, facility, or in- 2 strumentality of interstate or foreign commerce 3 or in interstate or foreign commerce by any 4 means or in manner, including by computer, 5 mail, wire, or electromagnetic transmission. 6 (E) Any instrument, item, substance, or 7 other object that has traveled in interstate or 8 foreign commerce was used to perform the con- 9 duct described in paragraph (1). 10 (F) The conduct described in paragraph 11 (1) occurred within the special maritime and 12 territorial jurisdiction of the United States or 13 any territory or possession of the United States. 14 (G) The conduct described in paragraph 15 (1) otherwise occurred in interstate or foreign 16 commerce. 17 (3) KNOWINGLY.—For purposes of paragraph 18 (1), a person acts knowingly when— 19 (A) the person has actual knowledge of the 20 facts giving rise to the violation of the prohibi- 21 tion described in paragraph (1); or 22 (B) a reasonable person acting in the cir- 23 cumstances and exercising reasonable care 24 would have that knowledge. 25 VerDate Sep 11 2014 00:53 Apr 30, 2026 Jkt 069200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S4426.IS S4426 ssavage on LAPJG3WLY3PROD with BILLS 12 •S 4426 IS (4) APPLICATION TO WORK ARRANGEMENTS.— 1 (A) IN GENERAL.—A violation of para- 2 graph (1)— 3 (i) by an employee acting in the scope 4 of their employment for an employer shall 5 also be considered a violation of such para- 6 graph by such employer; or 7 (ii) by any other individual who is en- 8 gaged by a person for the performance of 9 labor or services for remuneration and who 10 is acting in the scope of their performance 11 of such labor or services for such person 12 shall also be considered a violation of such 13 paragraph by such person. 14 (B) LIABILITY.— 15 (i) EMPLOYEE VIOLATIONS.—In the 16 case of a violation that is described in sub- 17 paragraph (A)(i), the employee and the 18 employer described in such subparagraph 19 shall be jointly and severally liable for any 20 civil penalty under subsection (b) and any 21 private right of action under subsection 22 (c). 23 (ii) OTHER WORKER VIOLATIONS.—In 24 the case of a violation that is described in 25 VerDate Sep 11 2014 00:53 Apr 30, 2026 Jkt 069200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\S4426.IS S4426 ssavage on LAPJG3WLY3PROD with BILLS 13 •S 4426 IS subparagraph (A)(ii), the individual and 1 person described in such subparagraph 2 shall be jointly and severally liable for any 3 civil penalty under subsection (b) and any 4 private right of action under subsection 5 (c). 6 (b) CIVIL MONETARY PENALTIES.— 7 (1) IN GENERAL.—The Secretary may impose a 8 civil monetary penalty on any person upon making 9 a determination, after written notice and an oppor- 10 tunity for a hearing, that the person has violated a 11 requirement of subsection (a)(1). 12 (2) AMOUNT OF CIVIL MONETARY PEN- 13 ALTIES.— 14 (A) IN GENERAL.—The amount of a civil 15 monetary penalty under paragraph (1) shall be 16 not less than $100,000 for each violation. 17 (B) PENALTY CONSIDERATIONS.—In de- 18 termining the amount of a civil monetary pen- 19 alty under this subsection, the Secretary shall 20 consider— 21 (i) the nature, circumstances, extent, 22 and gravity of the violation; and 23 (ii) with respect to the violator, the 24 degree of culpability, any history of prior 25 VerDate Sep 11 2014 00:53 Apr 30, 2026 Jkt 069200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\S4426.IS S4426 ssavage on LAPJG3WLY3PROD with BILLS 14 •S 4426 IS violations, and any effect on the ability to 1 continue to do business. 2 (3) CIVIL ACTION TO COLLECT.— 3 (A) IN GENERAL.—The Attorney General 4 may bring a civil action in an appropriate dis- 5 trict court of the United States to collect a civil 6 monetary penalty under this subsection and any 7 accrued interest on the civil monetary penalty 8 as assessed by the Secretary. In such a civil ac- 9 tion, the amount and appropriateness of the 10 civil monetary penalty shall not be subject to 11 review. 12 (B) COMPROMISE.—The Secretary may 13 compromise the amount of a civil monetary 14 penalty imposed under this subsection before 15 referral to the Attorney General under subpara- 16 graph (A), on the condition that such amount 17 shall be not less than $100,000. 18 (4) LIABILITY FOR PROCEDURES REQUIRED AS 19 A MATTER OF STANDARD PRACTICE.—It shall not be 20 a defense in a hearing under this subsection that 21 gender transition procedures are required as a mat- 22 ter of standard practice. 23 (5) PROHIBITION ON IMPOSITION OF CIVIL 24 MONETARY PENALTY ON A PERSON ON WHOM PRO- 25 VerDate Sep 11 2014 00:53 Apr 30, 2026 Jkt 069200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\S4426.IS S4426 ssavage on LAPJG3WLY3PROD with BILLS 15 •S 4426 IS CEDURES ARE PERFORMED.—No person on whom a 1 gender transition procedure is performed, attempted 2 to be performed, or conspired to be performed or on 3 whom the performance of any gender transition pro- 4 cedure was aided or abetted in violation of sub- 5 section (a)(1), and no parent, guardian, or caretaker 6 of such a person, may be held liable for a civil mone- 7 tary penalty under this subsection. 8 (6) DEPOSITING AMOUNTS COLLECTED.— 9 (A) IN GENERAL.—Amounts collected 10 under this subsection shall be deposited in the 11 fund established under subparagraph (B). 12 (B) ESTABLISHMENT OF FUND.— 13 (i) IN GENERAL.—There is established 14 in the Treasury of the United States a 15 fund, to be known as the ‘‘Victims of Gen- 16 der Transition Procedures Compensation 17 Fund’’, which shall consist of amounts de- 18 posited in the fund pursuant to subpara- 19 graph (A). 20 (ii) AVAILABILITY OF FUNDS.— 21 Amounts in the fund established under 22 clause (i) shall be made available for ex- 23 penditure for fiscal year 2026 and each fis- 24 cal year thereafter, without further appro- 25 VerDate Sep 11 2014 00:53 Apr 30, 2026 Jkt 069200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 E:\BILLS\S4426.IS S4426 ssavage on LAPJG3WLY3PROD with BILLS 16 •S 4426 IS priation or fiscal year limitation for ex- 1 penditure by the Secretary to carry out 2 section 4. 3 (c) PRIVATE CIVIL ACTION.— 4 (1) IN GENERAL.—An individual on whom a 5 gender transition procedure is performed in violation 6 of subsection (a)(1), or the parent, guardian, or 7 caretaker of such an individual if such individual is 8 a minor, may bring a civil action in an appropriate 9 district court of the United States against any per- 10 son in violation of subsection (a)(1) for damages, in- 11 cluding damages described in paragraph (3). 12 (2) AVAILABILITY.—A cause of action described 13 in paragraph (1) shall be available regardless of 14 whether the alleged violation occurred before, on, or 15 after the date of enactment of this Act. 16 (3) DAMAGES.—Damages referred to in para- 17 graph (1) include— 18 (A) compensatory damages, including all 19 economic damages associated with undoing, cor- 20 recting, or ameliorating the effects or results of 21 any gender transition procedure; 22 (B) non-economic damages for emotional 23 distress and pain and suffering; and 24 VerDate Sep 11 2014 00:53 Apr 30, 2026 Jkt 069200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\S4426.IS S4426 ssavage on LAPJG3WLY3PROD with BILLS 17 •S 4426 IS (C) punitive damages, if the claimant 1 proves by clear and convincing evidence that the 2 defendant against whom punitive damages are 3 sought acted maliciously, intentionally, fraudu- 4 lently, or recklessly. 5 (d) PENALTY FOR OBSTRUCTION OF INVESTIGA- 6 TIONS.— 7 (1) IN GENERAL.—The Secretary may impose a 8 civil penalty on any person who obstructs or pre- 9 vents the Secretary from carrying out an investiga- 10 tion into an alleged violation of subsection (a)(1). 11 (2) DEFINITION OF OBSTRUCT.—In this sub- 12 section, the term ‘‘obstruct’’ means to take an action 13 that was known, or reasonably should have been 14 known, to prevent, hinder, or impede an investiga- 15 tion. 16 (e) RULES OF CONSTRUCTION.— 17 (1) IN GENERAL.—In any proceeding described 18 in subsection (b) or (c) any ambiguities shall be re- 19 solved against any person found to be in violation of 20 subsection (a)(1). 21 (2) HEALTH CARE PROFESSIONALS.—In any 22 proceeding described in subsection (b) or (c) against 23 a health care professional, if a gender transition pro- 24 cedure of a minor is shown to have occurred before 25 VerDate Sep 11 2014 00:53 Apr 30, 2026 Jkt 069200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6201 E:\BILLS\S4426.IS S4426 ssavage on LAPJG3WLY3PROD with BILLS 18 •S 4426 IS the date of enactment of this Act, limited deference 1 shall be given to prevailing standards of care in ef- 2 fect at such time, to the extent that such standards 3 of care contradict the intent of this Act and it is 4 shown that such health care professional knew or 5 should have known that such standards of care were 6 in serious, scientific, and medical dispute at the time 7 of the gender transition procedure. 8 (3) NO LIABILITY FOR MINORS.—Nothing in 9 this Act shall be construed to impose any liability 10 whatsoever on a minor who is the individual on 11 whom a gender transition procedure is performed, 12 attempted to be performed, or conspired to be per- 13 formed or on whom the performance of any gender 14 transition procedure was aided or abetted. 15 (f) EFFECT.—Nothing in this Act— 16 (1) establishes a private right of action based 17 on counseling, referrals to mental health profes- 18 sionals, or discussions of treatment options (includ- 19 ing counseling, referrals, or options available upon 20 reaching adulthood) provided by health care profes- 21 sionals or mental health professionals or against 22 health care professionals or mental health profes- 23 sionals based on circumstances not described in sub- 24 section (a)(2), on the condition that such actions do 25 VerDate Sep 11 2014 00:53 Apr 30, 2026 Jkt 069200 PO 00000 Frm 00018 Fmt 6652 Sfmt 6201 E:\BILLS\S4426.IS S4426 ssavage on LAPJG3WLY3PROD with BILLS 19 •S 4426 IS not constitute participation in a gender transition 1 procedure; 2 (2) prohibits a health care professional or men- 3 tal health professional from providing information 4 about all available treatment options, discussing 5 risks and benefits, or expressing professional medical 6 opinions, so long as such actions do not constitute 7 participation in a gender transition procedure; or 8 (3) waives liability for a health care profes- 9 sional. 10 (g) STATUTE OF LIMITATIONS.—An action under 11 subsection (c) may be brought within 25 years from the 12 date of the eighteenth birthday of an individual on whom 13 a gender transition procedure is performed as a minor or 14 within 4 years from the time the cost of a detransition 15 treatment is incurred, whichever date is later. 16 (h) SEVERABILITY.—If any provision of this Act, or 17 the application of such provision to any person or cir- 18 cumstance, is held to be or made invalid, the remainder 19 of this Act, and the application of the provision to any 20 other person or circumstance, shall not be affected. 21 SEC. 4. OPENING AVENUES FOR VICTIMS. 22 (a) PURPOSE.—The purpose of this section is to sup- 23 port, encourage, and assist individuals in their efforts to 24 reverse gender transition procedures. 25 VerDate Sep 11 2014 00:53 Apr 30, 2026 Jkt 069200 PO 00000 Frm 00019 Fmt 6652 Sfmt 6201 E:\BILLS\S4426.IS S4426 ssavage on LAPJG3WLY3PROD with BILLS 20 •S 4426 IS (b) ESTABLISHMENT OF GRANT PROGRAM.—The 1 Secretary shall establish a grant program under which the 2 Secretary shall award grants to eligible entities to carry 3 out the activities described in subsection (d). 4 (c) ELIGIBILITY.— 5 (1) ELIGIBLE ENTITIES.—To be eligible for a 6 grant under this section, an entity— 7 (A) shall be a private nonprofit entity; 8 (B) shall submit to the Secretary an appli- 9 cation at such time, in such manner, and con- 10 taining such information and assurances as the 11 Secretary may require, including an assurance 12 that such entity will— 13 (i) submit to the Secretary such re- 14 ports of deidentified data, information, and 15 metrics as the Secretary may require to as- 16 sess the entity’s performance in carrying 17 out activities under the grant and ensure 18 the entity is in compliance with the terms 19 and conditions of such grant; 20 (ii) not charge individuals for services 21 provided through the grant; and 22 (iii) provide each individual counseled 23 through the grant with accurate informa- 24 tion on the appropriate medical procedures 25 VerDate Sep 11 2014 00:53 Apr 30, 2026 Jkt 069200 PO 00000 Frm 00020 Fmt 6652 Sfmt 6201 E:\BILLS\S4426.IS S4426 ssavage on LAPJG3WLY3PROD with BILLS 21 •S 4426 IS to reverse gender transition procedures; 1 and 2 (C) shall agree to have a privacy policy 3 and procedures in place to ensure that— 4 (i) the name, address, telephone num- 5 ber, or any other information that might 6 identify any individual seeking services 7 supported through the grant is not made 8 public or shared with any other entity 9 without the written consent of the indi- 10 vidual; and 11 (ii) the grantee adheres to require- 12 ments comparable to those applicable 13 under the HIPAA privacy regulation (as 14 defined in section 1180(b)(3) of the Social 15 Security Act (42 U.S.C. 1320d–9(b)(3))) 16 to covered entities (as defined for purposes 17 of such regulation). 18 (2) INELIGIBLE ENTITIES.—An entity shall be 19 ineligible to receive a grant under this section if the 20 entity or any affiliate, subsidiary, successor, or clinic 21 thereof— 22 (A) performs, induces, refers for, or coun- 23 sels in favor of gender transition procedures; 24 VerDate Sep 11 2014 00:53 Apr 30, 2026 Jkt 069200 PO 00000 Frm 00021 Fmt 6652 Sfmt 6201 E:\BILLS\S4426.IS S4426 ssavage on LAPJG3WLY3PROD with BILLS 22 •S 4426 IS (B) performs, induces, refers for, or coun- 1 sels in favor of an abortion, except— 2 (i) if the pregnancy is the result of an 3 act of rape or incest; or 4 (ii) in the case where a woman suffers 5 from a physical disorder, physical injury, 6 or physical illness, including a life-endan- 7 gering physical condition caused by or aris- 8 ing from the pregnancy itself, that would, 9 as certified by a physician, place the 10 woman in danger of death unless an abor- 11 tion is performed; or 12 (C) provides financial support to any other 13 entity that conducts any activity described in 14 subparagraph (A) or (B). 15 (d) USE OF GRANT FUNDS.— 16 (1) REQUIRED INFORMATION AND REFER- 17 RAL.—For the purpose described in subsection (a), 18 an eligible entity receiving a grant under this section 19 shall use the grant funds to provide to individuals 20 who are exploring detransition information on, and 21 referral to, 1 or more of the following services: 22 (A) Medical advice and care to reverse a 23 gender transition procedure. 24 VerDate Sep 11 2014 00:53 Apr 30, 2026 Jkt 069200 PO 00000 Frm 00022 Fmt 6652 Sfmt 6201 E:\BILLS\S4426.IS S4426 ssavage on LAPJG3WLY3PROD with BILLS 23 •S 4426 IS (B) Education and employment assistance, 1 including services that support the continuation 2 and completion of high school. 3 (C) Voluntary mental health and substance 4 use disorder services. 5 (2) PERMISSIBLE DIRECT PROVISION OF SERV- 6 ICES.—For the purpose described in subsection (a), 7 in addition to using grant funds under this section 8 as described in paragraph (1), an eligible entity re- 9 ceiving a grant under this section may use the grant 10 funds for the direct provision of one or more services 11 described in paragraph (1). 12 (e) PROHIBITED USES OF FUNDS.—None of the 13 funds made available under this section shall be used for— 14 (1) gender transition procedures; 15 (2) payment for an abortion, except— 16 (A) if the pregnancy is the result of an act 17 of rape or incest; or 18 (B) in the case where a woman suffers 19 from a physical disorder, physical injury, or 20 physical illness, including a life-endangering 21 physical condition caused by or arising from the 22 pregnancy itself, that would, as certified by a 23 physician, place the woman in danger of death 24 unless an abortion is performed; or 25 VerDate Sep 11 2014 00:53 Apr 30, 2026 Jkt 069200 PO 00000 Frm 00023 Fmt 6652 Sfmt 6201 E:\BILLS\S4426.IS S4426 ssavage on LAPJG3WLY3PROD with BILLS 24 •S 4426 IS (3) requiring any person to perform, or facili- 1 tate in any way the performance of, any abortion. 2 (f) CONSIDERATION.—In selecting the recipients of 3 grants under this section, the Secretary shall consider 4 each applicant’s demonstrated capacity in providing serv- 5 ices to assist individuals who are exploring and seeking 6 medical advice in their efforts to reverse gender transition 7 procedures. 8 (g) MONITORING AND REVIEW.—The Secretary 9 shall— 10 (1) monitor and review each program funded 11 through a grant under this section to ensure that 12 the grantee carefully adheres to— 13 (A) the purpose described in subsection 14 (a); and 15 (B) the requirements of this section; and 16 (2) cease to fund a program under this section 17 if the grantee fails to adhere to such purpose and re- 18 quirements. 19 Æ VerDate Sep 11 2014 00:53 Apr 30, 2026 Jkt 069200 PO 00000 Frm 00024 Fmt 6652 Sfmt 6301 E:\BILLS\S4426.IS S4426 ssavage on LAPJG3WLY3PROD with BILLS