‘‘§ 302. Prohibition on funding for health benefits 
plans that cover gender-affirming care 
‘‘No funds authorized or appropriated by Federal 
law, and none of the funds in any trust fund to which 
funds are authorized or appropriated by Federal law, shall 
be expended for health benefits coverage that includes cov-
erage of gender-affirming care. 
‘‘§ 303. Limitation on Federal facilities and employ-
ees, Federal lands and territories, and 
Tribal territories 
‘‘No health care service furnished— 
‘‘(1) by or in a health care facility owned or op-
erated by the Federal Government, Federal land or 
territory, or a Tribal territory; or 
‘‘(2) by any physician or other individual em-
ployed by the Federal Government, Federal land or 
territory, or a Tribal territory to provide health care 
services within the scope of the physician’s or indi-
vidual’s employment, 
may include gender-affirming care. 
‘‘§ 304. Construction relating to separate coverage 
‘‘Nothing in this chapter shall be construed as pro-
hibiting any individual, entity, or State or locality from 
purchasing separate coverage for gender-affirming care or 
health benefits coverage that includes gender-affirming 
care so long as such coverage is paid for entirely using 
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only funds not authorized or appropriated by Federal law, 
federal programs, platforms, or infrastructure, such cov-
erage does not cover any practice that would be subject 
to penalty under section 2260B of title 18, United States 
Code, and such coverage shall not be purchased using 
matching funds required for a federally subsidized pro-
gram, including a State’s or locality’s contribution of Med-
icaid matching funds. 
‘‘§ 305. Construction relating to the use of non-Fed-
eral funds for health coverage 
‘‘Nothing in this chapter shall be construed as re-
stricting the ability of any non-Federal health benefits cov-
erage provider from offering coverage for gender-affirming 
care, or the ability of a State or locality to contract sepa-
rately with such a provider for such coverage, so long as 
only funds not authorized or appropriated by Federal law 
are used, such coverage does not cover any practice that 
would be subject to penalty under section 2260B of title 
18, United States Code, and such coverage shall not be 
purchased using matching funds required for a federally 
subsidized program, including a State’s or locality’s con-
tribution of Medicaid matching funds. 
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‘‘§ 306. Construction relating to complications arising 
from gender-affirming care 
‘‘Nothing in this chapter shall be construed to apply 
to the treatment of any infection, injury, disease, or dis-
order that has been caused by or exacerbated by the per-
formance of a gender-affirming care. This rule of con-
struction shall be applicable without regard to whether the 
gender-affirming care was performed in accord with Fed-
eral or State law, and without regard to whether funding 
for the gender-affirming care is permissible under section 
307. 
‘‘§ 307. Treatment of individuals born with medically 
verifiable disorder of sex development 
‘‘The limitations established in sections 301, 302, 
and 303 shall not apply with respect to an individual de-
scribed in section 2260B(d)(1)(B) of title 18, United 
States Code. 
‘‘§ 308. Gender-affirming care defined 
‘‘For purposes of this chapter, the term ‘gender-af-
firming care’ has the meaning given such term in section 
2260B(d)(1) of title 18, United States Code. 
‘‘§ 309. Rule of construction 
‘‘Nothing in this chapter shall be construed as pro-
hibiting provision of the medical services described in sec-
tion 2260B(d)(1)(A) of title 18, United States Code, to 
address any male or female reproductive cancers, apart 
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from changing the body to correspond to a sex that differs 
from one’s biological sex.’’. 
SEC. 202. AMENDMENT TO TABLE OF CHAPTERS. 
The table of chapters for title 1, United States Code, 
is amended by adding at the end the following new item: 
‘‘4. Prohibiting taxpayer-funded gender-affirming care ...
301’’. 
TITLE III—APPLICATION UNDER 
THE AFFORDABLE CARE ACT 
SEC. 301. CLARIFYING APPLICATION OF PROHIBITION TO 
PREMIUM CREDITS AND COST-SHARING RE-
DUCTIONS UNDER ACA. 
(a) IN GENERAL.— 
(1) DISALLOWANCE OF REFUNDABLE CREDIT 
AND
COST-SHARING
REDUCTIONS
FOR
COVERAGE 
UNDER QUALIFIED HEALTH PLAN WHICH PROVIDES 
COVERAGE FOR GENDER-AFFIRMING CARE.— 
(A) IN
GENERAL.—Subparagraph (A) of 
section 36B(c)(3) of the Internal Revenue Code 
of 1986 is amended by inserting before the pe-
riod at the end the following: ‘‘or any health 
plan that includes coverage for gender-affirming 
care (other than any gender-affirming care or 
treatment described in section 306 or 307 of 
title 1, United States Code)’’. 
(B) OPTION TO PURCHASE OR OFFER SEP-
ARATE COVERAGE OR PLAN.—Paragraph (3) of 
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section 36B(c) of such Code is amended by 
adding at the end the following new subpara-
graph: 
‘‘(C) SEPARATE COVERAGE OR PLAN FOR 
GENDER-AFFIRMING CARE ALLOWED.— 
‘‘(i) OPTION TO PURCHASE SEPARATE 
COVERAGE OR PLAN.—Nothing in subpara-
graph (A) shall be construed as prohibiting 
any individual from purchasing separate 
coverage for gender-affirming care de-
scribed in such subparagraph, or a health 
plan that includes such gender-affirming 
care, so long as no credit is allowed under 
this section with respect to the premiums 
for such coverage or plan and such cov-
erage or plan does not cover any practice 
that would be subject to penalty under sec-
tion 2260B of title 18, United States 
Code. 
‘‘(ii) OPTION TO OFFER COVERAGE OR 
PLAN.—Nothing in subparagraph (A) shall 
restrict any non-Federal health insurance 
issuer offering a health plan from offering 
separate coverage for gender-affirming 
care described in such subparagraph, or a 
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plan that includes such gender-affirming 
care, so long as premiums for such sepa-
rate coverage or plan are not paid for with 
any amount attributable to the credit al-
lowed under this section (or the amount of 
any advance payment of the credit under 
section 1412 of the Patient Protection and 
Affordable Care Act) and such coverage or 
plan does not cover any practice that 
would be subject to penalty under section 
2260B of title 18, United States Code.’’. 
(2) DISALLOWANCE
OF
SMALL
EMPLOYER 
HEALTH
INSURANCE
EXPENSE
CREDIT
FOR
PLAN 
WHICH INCLUDES COVERAGE FOR GENDER-AFFIRM-
ING CARE.—Subsection (h) of section 45R of the In-
ternal Revenue Code of 1986 is amended— 
(A) by striking ‘‘Any term’’ and inserting 
the following: 
‘‘(1) IN GENERAL.—Any term’’; and 
(B) by adding at the end the following new 
paragraph: 
‘‘(2) EXCLUSION OF HEALTH PLANS INCLUDING 
COVERAGE FOR GENDER-AFFIRMING CARE.— 
‘‘(A) IN
GENERAL.—The term ‘qualified 
health plan’ does not include any health plan 
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that includes coverage for gender-affirming care 
(other than any gender-affirming care or treat-
ment described in section 306 or 307 of title 1, 
United States Code). 
‘‘(B) SEPARATE COVERAGE OR PLAN FOR 
GENDER-AFFIRMING CARE ALLOWED.— 
‘‘(i) OPTION TO PURCHASE SEPARATE 
COVERAGE OR PLAN.—Nothing in subpara-
graph (A) shall be construed as prohibiting 
any employer from purchasing for its em-
ployees separate coverage for gender-af-
firming care described in such subpara-
graph, or a health plan that includes such 
gender-affirming care, so long as no credit 
is allowed under this section with respect 
to the employer contributions for such cov-
erage or plan and such coverage does not 
cover any practice that would be subject to 
penalty under section 2260B of title 18, 
United States Code. 
‘‘(ii) OPTION TO OFFER COVERAGE OR 
PLAN.—Nothing in subparagraph (A) shall 
restrict any non-Federal health insurance 
issuer offering a health plan from offering 
separate coverage for gender-affirming 
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care described in such subparagraph, or a 
plan that includes such gender-affirming 
care, so long as such separate coverage or 
plan is not paid for with any employer con-
tribution eligible for the credit allowed 
under this section and such coverage or 
plan does not cover any practice that 
would be subject to penalty under section 
2260B of title 18, United States Code.’’. 
(b) APPLICATION TO MULTI-STATE PLANS.—Section 
1334(a) of Public Law 111–148 (42 U.S.C. 18054(a)) is 
amended by adding at the end the following new para-
graph: 
‘‘(8) COVERAGE
CONSISTENT
WITH
FEDERAL 
POLICY REGARDING GENDER-AFFIRMING CARE.—In 
entering into contracts under this subsection, the 
Director shall ensure that no multi-State qualified 
health plan offered in an Exchange provides health 
benefits coverage for which the expenditure of Fed-
eral funds is prohibited under chapter 4 of title 1, 
United States Code.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall apply to taxable years ending after 
the date that is one year after the date of enactment of 
this Act, but only with respect to plan years beginning 
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after such date, and the amendment made by subsection 
(b) shall apply to plan years beginning after such date. 
TITLE IV—ADDITIONAL 
PROVISIONS 
SEC. 401. PROHIBITION ON INSTITUTIONS OF HIGHER EDU-
CATION AND ACCREDITING AGENCIES OR AS-
SOCIATIONS. 
(a) PROHIBITION
ON INSTITUTIONS
OF HIGHER 
EDUCATION.—Section 487(a) of the Higher Education 
Act of 1965 (20 U.S.C. 1094(a)) is amended by adding 
at the end the following: 
‘‘(30) The institution will not offer instruction 
in gender-affirming care (as defined in section 
2260B(d) of title 18, United States Code).’’. 
(b) PROHIBITION ON ACCREDITING AGENCIES OR AS-
SOCIATIONS.—Section 496(a) of the Higher Education 
Act of 1965 (20 U.S.C. 1099b(a)) is amended— 
(1) by striking ‘‘and’’ at the end of paragraph 
(7); 
(2) by striking the period at the end of para-
graph (8) and inserting ‘‘; and’’; and 
(3) by adding at the end the following: 
‘‘(9) such agency or association does not ac-
credit any institution that offers instruction in gen-
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der-affirming care (as defined in section 2260B(d) 
of title 18, United States Code).’’. 
SEC. 402. IMMIGRATION CONSEQUENCES WITH RESPECT 
TO PROVIDING GENDER-AFFIRMING CARE. 
(a) DEFINITIONS.—Section 101(a) of the Immigra-
tion and Nationality Act (8 U.S.C. 1101(a)) is amended 
by adding at the end the following: 
‘‘(53) The term ‘gender-affirming care’ shall 
have the meaning given such term in section 
2260B(d) of title 18, United States Code.’’. 
(b) CLASSES OF ALIENS INELIGIBLE FOR VISAS OR 
ADMISSION.—Section 212(a)(1)(A) of the Immigration 
and Nationality Act (8 U.S.C. 1182(a)(1)(A)) is amend-
ed— 
(1) in clause (iii)(II), strike ‘‘or’’ at the end; 
(2) in clause (iv), strike the comma at the end 
and insert ‘‘, or’’; and 
(3) by adding at the end the following: 
‘‘(v) who is determined to have per-
formed gender-affirming care on a child 
that has not attained the age of 18 years 
old,’’. 
(c) CLASSES
OF DEPORTABLE ALIENS.—Section 
237(a) of the Immigration and Nationality Act (8 U.S.C. 
1227(a)) is amended by adding at the end the following: 
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‘‘(8) GENDER-AFFIRMING
CARE.—Any alien 
who has performed gender-affirming care on a child 
that has not attained the age of 18 years old is de-
portable.’’. 
Æ 
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