IIB 
119TH CONGRESS 
1ST SESSION 
H. R. 498 
IN THE SENATE OF THE UNITED STATES 
DECEMBER 18, 2025 
Received; read twice and referred to the Committee on Finance 
AN ACT 
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-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Do No Harm in Med-
icaid Act’’. 
SEC. 2. PROHIBITING FEDERAL MEDICAID FUNDING FOR 
GENDER TRANSITION FOR MINORS. 
(a) IN GENERAL.—Section 1903(i) of the Social Se-
curity Act (42 U.S.C. 1396b(i)) is amended— 
(1) in paragraph (26), by striking ‘‘; or’’ and 
inserting a semicolon; 
(2) in paragraph (27), by striking the period at 
the end and inserting ‘‘; or’’; and 
(3) by inserting after paragraph (27) the fol-
lowing new paragraph: ‘‘(28) with respect to any 
amount expended for specified gender procedures 
under section 1905(kk) to an individual under 18 
years of age enrolled in a State plan (or waiver of 
such plan), including any amounts expended for the 
administration of a State program that furnishes 
specified procedures and drugs to individuals under 
18 years of age.’’. 
(4) in the flush left matter at the end, by strik-
ing ‘‘and (18),’’ and inserting ‘‘(18), and (28)’’. 
(b) PROHIBITING FEDERAL MEDICAID FUNDING FOR 
GENDER TRANSITIONS FOR MINORS.—Section 1905 of 
the Social Security Act (42 U.S.C. 1396d) is amended by 
adding at the end the following new subsection: 
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‘‘(KK) PROHIBITING FEDERAL MEDICAID 
FUNDING FOR GENDER TRANSITIONS FOR MI-
NORS.— 
‘‘(A) For purposes of section 1903(i)(28), 
except as provided in subparagraph (B), the 
term ‘specified gender transition procedures’ 
means, with respect to an individual, any of the 
following when performed for the purpose of in-
tentionally changing the body of such individual 
(including by disrupting the body’s develop-
ment, inhibiting its natural functions, or modi-
fying its appearance) to no longer correspond to 
the individual’s sex: 
‘‘(i) Performing any surgery, includ-
ing— 
‘‘(I) castration; 
‘‘(II) sterilization; 
‘‘(III) orchiectomy; 
‘‘(IV) scrotoplasty; 
‘‘(V) vasectomy; 
‘‘(VI) tubal ligation; 
‘‘(VII) hysterectomy; 
‘‘(VIII) oophorectomy; 
‘‘(IX) ovariectomy; 
‘‘(X) metoidioplasty; 
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‘‘(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 phys-
iological features of an individual. 
‘‘(ii) Any placement of chest implants 
to create feminine breasts or any place-
ment of erection or testicular prosetheses. 
‘‘(iii) Any placement of fat or artifi-
cial implants in the gluteal region. 
‘‘(iv) Administering, supplying, pre-
scribing, dispensing, distributing, or other-
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wise conveying to an individual medica-
tions, including— 
‘‘(I) gonadotropin-releasing hor-
mone (GnRH) analogues or other pu-
berty-blocking drugs to stop or delay 
normal puberty; and 
‘‘(II) testosterone, estrogen, pro-
gesterone or other androgens to an in-
dividual 
at 
doses 
that 
are 
supraphysiologic, greater or more po-
tent than would normally be produced 
endogenously in a healthy individual 
of the same age and sex. 
‘‘(B) 
EXCEPTION.—Subparagraph 
(A) 
shall not apply to the following when furnished 
to an individual by a health care provider with 
the consent of such individual’s parent or legal 
guardian: 
‘‘(i) Puberty suppression or blocking 
prescription drugs for the purpose of nor-
malizing puberty for an individual experi-
encing precocious puberty. 
‘‘(ii) Appropriate and medically nec-
essary procedures or treatments to correct 
for— 
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performed, not including procedures 
performed for the alleviation of men-
tal distress; or 
‘‘(IV) procedures to restore or re-
construct the body of the individual in 
order to correspond to the individual’s 
sex after one or more previous proce-
dures described in subparagraph (A), 
which may include the removal of a 
pseudo phallus or breast augmenta-
tion. 
‘‘(C) SEX.—For purposes of subpara-
graph(A), the term ‘sex’ means either male or 
female, as biologically determined and defined 
by clause (i) and clause (ii). 
‘‘(i) FEMALE.—The term ‘female’ 
means an individual who naturally has, 
had, will have, or would have, but for a de-
velopmental or genetic anomaly or histor-
ical accident, the reproductive system that 
at some point produces, transports, and 
utilizes eggs for fertilization. 
‘‘(ii) MALE.—The term ‘male’ means 
an individual who naturally has, had, will 
have, or would have, but for a develop-
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mental or genetic anomaly or historical ac-
cident, the reproductive system that at 
some point produces, transports, and uti-
lizes sperm for fertilization.’’. 
Passed the House of Representatives December 18, 
2025. 
Attest: 
KEVIN F. MCCUMBER, 
Clerk. 
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