I 
117TH CONGRESS 
2D SESSION 
H. R. 8731 
To amend chapter 110 of title 18, United States Code, to prohibit gender 
affirming care on minors, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
AUGUST 19, 2022 
Mrs. GREENE of Georgia (for herself, Mrs. MILLER of Illinois, Mr. DUNCAN, 
Mr. GOOD of Virginia, Mr. NORMAN, Mr. GAETZ, Mr. TONY GONZALES 
of Texas, Mr. HIGGINS of Louisiana, Mr. OWENS, Ms. TENNEY, Mr. 
CLYDE, Mrs. HARSHBARGER, and Mr. GOODEN of Texas) introduced the 
following bill; which was referred to the Committee on the Judiciary, and 
in addition to the Committees on Ways and Means, Energy and Com-
merce, and Education and Labor, for a period to be subsequently deter-
mined by the Speaker, in each case for consideration of such provisions 
as fall within the jurisdiction of the committee concerned 
A BILL 
To amend chapter 110 of title 18, United States Code, 
to prohibit gender affirming care on minors, and for 
other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Protect Children’s In-
nocence Act’’. 
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TITLE I—GENDER AFFIRMING 
CARE FOR MINORS PROHIBITED 
SEC. 101. GENDER AFFIRMING CARE ON MINORS PROHIB-
ITED. 
Chapter 110 of title 18, United States Code, is 
amended— 
(1) by adding at the end the following: 
‘‘§ 2260B. Gender affirming care for minors 
‘‘(a) IN GENERAL.—Whoever, in any circumstance 
described in subsection (e), knowingly performs any gen-
der affirming care on a minor is guilty of a class C felony. 
‘‘(b) PROHIBITION ON PROSECUTION OF PERSON ON 
WHOM INTERVENTION IS PERFORMED.—No person on 
whom the gender affirming care under subsection (a) is 
performed may be arrested or prosecuted for an offense 
under this section. 
‘‘(c) CIVIL ACTION.—A person on whom gender af-
firming care is performed under this section may bring 
a civil action for appropriate relief, including compen-
satory and punitive damages, against each person who 
performed the gender affirming care. 
‘‘(d) DEFINITIONS.—In this section: 
‘‘(1) GENDER AFFIRMING CARE.— 
‘‘(A) IN GENERAL.—For purposes of this 
chapter, except as provided in subparagraph 
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(B), the term ‘gender affirming care’ means, 
with respect to an individual, any of the fol-
lowing: 
‘‘(i) Performing any surgery for the 
purpose of changing the body of such indi-
vidual to correspond to a sex that differs 
from their biological sex, including— 
‘‘(I) castration; 
‘‘(II) orchiectomy; 
‘‘(III) scrotoplasty; 
‘‘(IV) vasectomy; 
‘‘(V) hysterectomy; 
‘‘(VI) oophorectomy; 
‘‘(VII) ovariectomy; 
‘‘(VIII) metoidioplasty; 
‘‘(IX) penectomy; 
‘‘(X) phalloplasty; 
‘‘(XI) vaginoplasty; 
‘‘(XII) vaginectomy; 
‘‘(XIII) vulvoplasty; 
‘‘(XIV) 
reduction 
thyrochondroplasty; 
‘‘(XV) chondrolaryngoplasty; and 
‘‘(XVI) mastectomy. 
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‘‘(ii) Any plastic surgery that femi-
nizes or masculinizes the facial features for 
the purposes described in clause (i). 
‘‘(iii) Any placement of chest implants 
to create feminine breasts for the purposes 
described in clause (i). 
‘‘(iv) Any placement of fat or artificial 
implants in the gluteal region for the pur-
poses described in clause (i). 
‘‘(v) Administering, supplying, pre-
scribing, dispensing, distributing, or other-
wise conveying to an individual medications 
for the purposes described in clause (i), in-
cluding— 
‘‘(I) gonadotropin-releasing hor-
mone (GnRH) analogues or other pu-
berty-blocking drugs to stop or delay 
normal puberty; 
‘‘(II) 
testosterone 
or 
other 
androgens to biological females at 
doses that are supraphysiologic to the 
female sex; and 
‘‘(III) 
estrogen 
to 
biological 
males 
at 
doses 
that 
are 
supraphysiologic to the male sex. 
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‘‘(B) 
EXCEPTION.—Subparagraph 
(A) 
shall not apply to the following individuals: 
‘‘(i) An individual with both ovarian 
and testicular tissue. 
‘‘(ii) An individual with respect to 
whom a physician has determined through 
genetic or biochemical testing that the in-
dividual does not have normal sex chro-
mosome structure, sex steroid hormone 
production, or sex steroid hormone action. 
‘‘(iii) An individual experiencing infec-
tion, disease, injury, or disorder caused or 
exacerbated by previous gender transition 
procedures. 
‘‘(iv) An individual suffering from a 
physical disorder, physical injury, or phys-
ical illness that would, as certified by a 
physician, place the individual in imminent 
danger of death or impairment of a major 
bodily function unless the procedure is per-
formed. 
‘‘(2) BIOLOGICAL
SEX.—The term ‘biological 
sex’ means the indication of male or female sex by 
reproductive potential or capacity, sex chromosomes, 
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naturally occurring sex hormones, gonads, or inter-
nal or external genitalia present at birth. 
‘‘(3) MINOR.—The term ‘minor’ means any per-
son under the age of eighteen years. 
‘‘(e) CIRCUMSTANCES DESCRIBED.—For purposes of 
subsection (a), the circumstances described in this sub-
section are that— 
‘‘(1) the defendant or victim traveled in inter-
state or foreign commerce, or traveled using a 
means, channel, facility, or instrumentality of inter-
state or foreign commerce, in furtherance of or in 
connection with the conduct described in subsection 
(a); 
‘‘(2) the defendant used a means, channel, fa-
cility, or instrumentality of interstate or foreign 
commerce in furtherance of or in connection with 
the conduct described in subsection (a); 
‘‘(3) any payment of any kind was made, di-
rectly or indirectly, in furtherance of or in connec-
tion with the conduct described in subsection (a) 
using any means, channel, facility, or instrumen-
tality of interstate or foreign commerce or in or af-
fecting interstate or foreign commerce; 
‘‘(4) the defendant transmitted in interstate or 
foreign commerce any communication relating to or 
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in furtherance of the conduct described in subsection 
(a) using any means, channel, facility, or instrumen-
tality of interstate or foreign commerce or in or af-
fecting interstate or foreign commerce by any means 
or in manner, including by computer, mail, wire, or 
electromagnetic transmission; 
‘‘(5) any instrument, item, substance, or other 
object that has traveled in interstate or foreign com-
merce was used to perform the conduct described in 
subsection (a); 
‘‘(6) the conduct described in subsection (a) oc-
curred within the special maritime and territorial ju-
risdiction of the United States, or any territory or 
possession of the United States; or 
‘‘(7) the conduct described in subsection (a) 
otherwise occurred in or affected interstate or for-
eign commerce. 
‘‘(f) RULE OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed as prohibiting provision of the med-
ical services described in subsection (d)(1)(A) to address 
legitimate health issues, such as any male or female repro-
ductive cancers, apart from changing the body to cor-
respond to a sex that differs from one’s biological sex.’’; 
and 
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(2) by amending the table of sections for such 
chapter by adding at the end the following: 
‘‘2260B. Gender affirming care on minors.’’. 
TITLE II—PROHIBITING FEDER-
ALLY FUNDED GENDER AF-
FIRMING CARE 
SEC. 201. PROHIBITING TAXPAYER-FUNDED GENDER AF-
FIRMING CARE. 
Title 1, United States Code, is amended by adding 
at the end the following new chapter: 
‘‘CHAPTER 4—PROHIBITING TAXPAYER- 
FUNDED GENDER AFFIRMING CARE 
‘‘301. Prohibition on funding for gender affirming care. 
‘‘302. Prohibition on funding for health benefits plans that cover gender affirm-
ing care. 
‘‘303. Limitation on Federal facilities and employees, Federal lands and terri-
tories, and Tribal territories. 
‘‘304. Construction relating to separate coverage. 
‘‘305. Construction relating to the use of non-Federal funds for health coverage. 
‘‘306. Construction relating to complications arising from gender affirming care. 
‘‘307. Treatment of individuals born with medically verifiable disorder of sex de-
velopment. 
‘‘308. Gender affirming care defined. 
‘‘309. Rule of construction. 
‘‘§ 301. Prohibition on funding for 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, in-
cluding funds provided under titles XVIII, XIX, and XXI 
of the Social Security Act, shall be expended for any gen-
der affirming care. 
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‘‘§ 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: 
‘‘(7) 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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