unless the procedure is performed 
to alleviate said physical disorder, 
physical injury, or physical ill-
ness, 
‘‘(ee) procedures to restore 
or reconstruct the body of the in-
dividual in order to correspond to 
the individual’s sex after one or 
more previous gender transition 
procedures, which may include 
the removal of a pseudo phallus 
or breast augmentation, 
‘‘(ff) puberty suppression or 
puberty-blocking 
prescription 
drugs for the purpose of normal-
izing puberty for a minor experi-
encing precocious puberty, or 
‘‘(gg) male circumcision. 
‘‘(ii) 
GENDER
TRANSITION.—The 
term ‘gender transition’ means the process 
by which an individual goes from identi-
fying with or presenting as his or her sex 
to identifying with or presenting as a self- 
proclaimed identity which does not cor-
respond with or is different from his or her 
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sex, and may be accompanied by social, 
legal, or physical changes. 
‘‘(iii) SEX.—The term ‘sex’, when re-
ferring to an individual’s sex, means either 
male or female, as biologically determined. 
‘‘(iv) FEMALE.—The term ‘female’, 
when used to refer to a natural person, 
means a person belonging, at conception, 
to the sex characterized by a reproductive 
system with the biological function of pro-
ducing eggs (ova). 
‘‘(v) MALE.—The term ‘male’, when 
used to refer to a natural person, means a 
person belonging, at conception, to the bio-
logical sex characterized by a reproductive 
system with the biological function of pro-
ducing sperm.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
this section shall apply to taxable years beginning after 
the date of the enactment of this Act. 
SEC. 3. PROHIBITING FEDERAL MEDICAID FUNDING FOR 
GENDER TRANSITION PROCEDURES. 
(a) IN GENERAL.—Section 1903(i) of the Social Se-
curity Act (42 U.S.C. 1396b(i)) is amended— 
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(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 fol-
lowing new paragraph: 
‘‘(28) with respect to any amounts expended for 
any specified gender transition procedure (as defined 
in section 1905(kk)) to an individual enrolled in a 
State plan under this title (or a waiver of such 
plan), including any amounts expended for the ad-
ministration of a State program that furnishes any 
such procedure.’’; and 
(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 TRANSITION PROCEDURES.—Section 1905 of 
the Social Security Act (42 U.S.C. 1396d) is amended by 
adding at the end the following new subsection: 
‘‘(kk) PROHIBITING FEDERAL MEDICAID FUNDING 
FOR SPECIFIED GENDER TRANSITION PROCEDURES.— 
‘‘(1) SPECIFIED GENDER TRANSITION PROCE-
DURES
DEFINED.—For 
purposes 
of 
section 
1903(i)(28), except as provided in paragraph (2), 
the term ‘specified gender transition procedure’ 
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means, with respect to an individual, any hormonal 
or surgical intervention for the purpose of gender 
transition, including— 
‘‘(A) the provision of gonadotropin-releas-
ing hormone agonists or other puberty suppres-
sion drugs or puberty-blocking drugs to stop or 
delay normally timed puberty in an individual 
who does not identify as his or her sex; 
‘‘(B) the provision of testosterone, estro-
gen, progesterone, or other androgen blockers 
to 
an 
individual 
at 
doses 
which 
are 
supraphysiologic to what would normally be 
produced endogenously in a healthy individual 
of the same age and sex, with the intent to 
align an individual’s physical appearance with 
an identity that differs from his or her sex; 
‘‘(C) surgical procedures that attempt to 
transform an individual’s physical appearance 
to align with an identity that differs from his 
or her sex or that attempt to alter or remove 
an individual’s sexual organs to minimize or de-
stroy their natural biological functions; or 
‘‘(D) castration, vasectomy, penectomy, 
orchiectomy, 
vaginoplasty, 
clitoroplasty, 
vulvoplasty, 
mastectomy, 
hysterectomy, 
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oophorectomy, ovariectomy, reconstruction of 
the fixed part of the urethra with or without 
metoidioplasty or phalloplasty, metoidioplasty, 
phalloplasty, vaginectomy, scrotoplasty, implan-
tation of erection or testicular prostheses, re-
duction 
thyrochondroplasty, 
chondrolaryngoplasty, tubal ligation, steriliza-
tion, augmentation mammoplasty, placement of 
chest implants to create feminine breasts, place-
ment of fat or artificial implants in the gluteal 
region, liposuction, lipofilling, voice surgery, 
hair reconstruction, pectoral implants, any plas-
tic, cosmetic, or aesthetic surgery which femi-
nizes or masculinizes the facial or other physio-
logical features of an individual, and any re-
moval of any otherwise healthy or non-diseased 
body part or tissue. 
‘‘(2) EXCLUSIONS.—The term ‘specified gender 
transition procedure’ shall not include, when fur-
nished to an individual by a health care provider 
with the consent of such individual (or, if applicable, 
the parents or legal guardian of such individual)— 
‘‘(A) services to individuals born with a 
medically verifiable disorder of sex development, 
including an individual with external sex char-
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acteristics which are irresolvably ambiguous, 
such as an individual born with 46 XX chro-
mosomes with virilization, an individual born 
with 46 XY chromosomes with undervirilization, 
or an individual born having both ovarian and 
testicular tissue; 
‘‘(B) services relating to any other physi-
cian-diagnosed disorder of sexual development 
with respect to which the physician has deter-
mined through genetic or biochemical testing 
that the individual does not have normal sex 
chromosome structure, sex steroid hormone pro-
duction, or sex steroid hormone action for a 
healthy male or female of the same age; 
‘‘(C) the treatment of any infection, injury, 
disease, or disorder caused or exacerbated by 
the performance of gender transition proce-
dures, without regard to whether the gender 
transition procedure was performed in accord-
ance with State and Federal law or whether the 
gender transition procedure is treated as med-
ical care under this section; 
‘‘(D) any procedure undertaken because 
the individual suffers from a physical disorder, 
physical injury, or physical illness (but not 
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mental, behavioral, or emotional distress or a 
mental, behavioral, or emotional disorder) which 
would, as certified by a physician, place the in-
dividual in imminent danger of death or impair-
ment of major bodily function unless the proce-
dure is performed to alleviate said physical dis-
order, physical injury, or physical illness; 
‘‘(E) any procedure to restore or recon-
struct the body of the individual in order to cor-
respond to the individual’s sex after 1 or more 
previous gender transition procedures, which 
may include the removal of a pseudo phallus or 
breast augmentation; 
‘‘(F) puberty suppression or puberty-block-
ing prescription drugs for the purpose of nor-
malizing puberty for an individual experiencing 
precocious puberty; or 
‘‘(G) male circumcision. 
‘‘(3) ADDITIONAL DEFINITIONS.—For purposes 
of this subsection: 
‘‘(A) GENDER
TRANSITION.—The term 
‘gender transition’ means the process by which 
an individual goes from identifying with or pre-
senting as his or her sex to identifying with or 
presenting as a self-proclaimed identity which 
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does not correspond with or is different from 
his or her sex, and may be accompanied by so-
cial, legal, or physical changes. 
‘‘(B) SEX.—The term ‘sex’, when referring 
to an individual’s sex, means either male or fe-
male, as biologically determined, including as 
described in subparagraphs (C) and (D). 
‘‘(C) FEMALE.—The term ‘female’, when 
used to refer to a natural person, means an in-
dividual belonging, at conception, to the sex 
characterized by a reproductive system with the 
biological function of producing eggs (ova). 
‘‘(D) MALE.—The term ‘male’, when used 
to refer to a natural person, means an indi-
vidual belonging, at conception, to the biological 
sex characterized by a reproductive system with 
the biological function of producing sperm.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to services furnished on or after 
the date of the enactment of this Act. 
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SEC. 4. PROHIBITING FEDERAL CHILDREN’S HEALTH IN-
SURANCE PROGRAM FUNDING FOR GENDER 
TRANSITION PROCEDURES ON MINORS. 
(a) IN GENERAL.—Section 2105(c) of the Social Se-
curity Act (42 U.S.C. 1397ee(c)) is amended by adding 
at the end the following new paragraph: 
‘‘(13) LIMITATION ON PAYMENT FOR SPECIFIED 
GENDER TRANSITION PROCEDURES FOR MINORS.— 
Payment shall not be made to a State under this 
section for any amount expended under the State 
plan to pay for specified gender transition proce-
dures (as defined in section 1905(kk)) or to assist 
in the purchase, in whole or in part, of health ben-
efit coverage that includes coverage of any such pro-
cedure.’’. 
(b) 
CONFORMING
AMENDMENT.—Section 
2107(e)(1)(N) of the Social Security Act (42 U.S.C. 
1397gg(e)(1)(N)) is amended by striking ‘‘and (17)’’ and 
inserting ‘‘(17), and (28)’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to services furnished on or after 
the date of the enactment of this Act. 
SEC. 5. PROHIBITING FEDERAL MEDICARE FUNDING FOR 
GENDER TRANSITION PROCEDURES. 
(a) IN GENERAL.—Section 1862(a) of the Social Se-
curity Act (42 U.S.C. 1395y(a)) is amended— 
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(1) in paragraph (24), by striking ‘‘or’’ at the 
end; 
(2) in paragraph (25), by striking the period at 
the end and inserting ‘‘; or’’; and 
(3) by inserting after paragraph (25) the fol-
lowing new paragraph: 
‘‘(26) which are specified gender transition pro-
cedures (as defined in section 1905(kk)).’’. 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall apply to items and services furnished 
on or after the date of the enactment of this Act. 
SEC. 6. EXCLUSION OF GENDER TRANSITION PROCEDURES 
FROM ESSENTIAL HEALTH BENEFITS. 
Section 1302(b)(2) of the Patient Protection and Af-
fordable Care Act (42 U.S.C. 18022(b)(2)) is amended— 
(1) in the paragraph heading, by striking ‘‘LIM-
ITATION’’ and inserting ‘‘LIMITATIONS’’; 
(2) by redesignating subparagraph (B) as sub-
paragraph (C); 
(3) by inserting after subparagraph (A) the fol-
lowing: 
‘‘(B) EXCLUSIONS.—In defining the essen-
tial health benefits under paragraph (1), or in 
revising essential health benefits under para-
graph (4)(H), the Secretary shall not include 
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the category of gender transition procedures (as 
defined in section 213(d)(12)(B) of the Internal 
Revenue Code of 1986) or any items or services 
covered within such a category.’’; and 
(4) in subparagraph (C) (as so redesignated), 
by striking ‘‘paragraph (2)’’ and inserting ‘‘subpara-
graph (A)’’. 
Æ 
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