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HR 498119th CongressIn Committee

Do No Harm in Medicaid Act

Introduced: Jan 16, 2025
Sponsor: Rep. Crenshaw, Dan [R-TX-2] (R-Texas)
Standard Summary
Comprehensive overview in 1-2 paragraphs

The Do No Harm in Medicaid Act would bar all federal Medicaid funding for gender transition procedures for minors. It amends the Social Security Act to add a new funding prohibition (under section 1903(i)(28)) for any amount spent on specified gender transition procedures for individuals under 18 in state Medicaid plans or waivers. It also adds a new subsection (KK) to section 1905 that defines “specified gender transition procedures” in detail and lays out limited exceptions. Under the bill, gender transition procedures include a broad range of surgical, implant, and medical treatments (including puberty-blocking drugs and hormone therapies) intended to make a minor’s body align with a gender different from their biological sex. Exceptions are allowed when a health care provider, with a parent or guardian’s consent, determines the procedure is not covered by the prohibition (e.g., certain medical conditions, reconstructive procedures after prior surgeries, or treatments for disorders of sex development). In short, federal Medicaid would not cover most gender-affirming care for minors, with narrowly defined medical exemptions.

Key Points

  • 1Prohibits federal Medicaid funding for gender transition procedures for minors by adding a new funding category (1903(i)(28)) to cover expenditures on specified procedures for individuals under 18.
  • 2Establishes a broad, detailed definition of “specified gender transition procedures,” including many surgeries, implants, and medications (such as puberty blockers and high-dose hormone therapies) aimed at aligning anatomy with a gender different from biological sex.
  • 3Maintains limited exceptions where a health care provider, with parental consent, may furnish certain treatments (e.g., puberty suppression for precocious puberty; medically necessary treatments for certain disorders of sex development; reconstructive procedures after prior gender procedures).
  • 4Defines “sex” biologically as male or female, with explicit definitions to guide what counts as aligning with or differ­ing from biological sex.
  • 5The policy targets federal Medicaid dollars specifically, leaving open the possibility of state or private funding for these services outside federal Medicaid dollars.

Impact Areas

Primary group/area affected: Minors who are Medicaid-eligible and seeking gender-affirming care; states administering Medicaid programs will need to adjust which services are billable to federal funds.Secondary group/area affected: Families and guardians of transgender or gender-nonconforming minors; health care providers who perform gender-transition surgeries, implants, or prescribe related medications; Medicaid managed care organizations.Additional impacts: Potential shifts in access to gender-affirming care for minors funded by state dollars or private sources; possible administrative and reimbursement changes within state Medicaid programs; broader policy and legal debate around coverage for gender-affirming care for minors.
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