HR498-119

What This Bill Does

The Do No Harm in Medicaid Act amends section 1903(i) of the Social Security Act to prohibit federal Medicaid payments for specified gender-transition procedures furnished to an individual under age 18 who is enrolled in Medicaid or a Medicaid waiver. Covered procedures include surgeries that sterilize or alter physical appearance, implants, puberty blockers or other GnRH analogues, and testosterone, estrogen, progesterone, or other hormones provided at supraphysiologic doses for sex-development-altering purposes.

The bill builds in medical exceptions. The payment bar does not apply to puberty-blocker treatment for central precocious puberty, treatment for verifiable disorders of sex development, treatment of infection, disease, injury, or disorder caused or exacerbated by a prior specified procedure or posing imminent danger to a major bodily function unless surgery is performed, or medically necessary treatment to restore or reconstruct a person's body to correspond to the person's sex after a prior specified procedure. The bill defines sex biologically based on reproductive systems at birth, with female and male definitions tied to ova or sperm production systems.

Who Benefits and How

Federal taxpayers, state Medicaid budget officials who oppose coverage of pediatric gender-transition care, opponents of pediatric gender-transition procedures, and policymakers seeking federal restrictions on Medicaid coverage benefit because the bill blocks federal matching funds for the covered procedures and creates a statutory definition of the prohibited services. State Medicaid agencies also receive a clear federal payment rule, although they must implement and police it.

Who Bears the Burden and How

Medicaid-enrolled transgender minors, families seeking pediatric gender-transition care, healthcare providers offering pediatric gender-transition care, clinics offering pediatric gender-transition care, pharmaceutical manufacturers of puberty blockers, pharmaceutical manufacturers of hormone therapies, state Medicaid agencies, Medicaid managed care plans, and hospital compliance teams must comply with the coverage exclusion. Affected families can lose federal Medicaid payment support, providers and clinics can lose reimbursement, manufacturers can lose Medicaid-funded demand, and agencies and plans must distinguish barred procedures from statutory medical exceptions.

Key Provisions

• Amends Social Security Act section 1903(i) to prohibit federal Medicaid payments for specified gender-transition procedures for individuals under 18.
• Defines covered procedures to include specified surgeries, implants, puberty blockers, GnRH analogues, and supraphysiologic hormone treatments.
• Provides exceptions for central precocious puberty and verifiable disorders of sex development.
• Provides exceptions for treatment of infection, disease, injury, disorder, imminent danger to a major bodily function, and reconstruction after prior procedures.
• Defines sex, female, and male by reference to reproductive biology at birth.