HR498-119

2. Prohibiting federal medicaid funding for gender transition for minors Section 1903(i) of the Social Security Act (42 U.S.C. 1396b(i)) is amended— in paragraph (26), by striking ; or and inserting a semicolon; in paragraph (27), by striking the period at the end and inserting ; or; and by inserting after paragraph (27) the following new paragraph: (28) with respect to any amount expended for specified gender procedures under section 1905(kk) to an individual under 18 years of age enrolled in a State plan (or waiver of such plan), including any amounts expended for the administration of a State program that furnishes specified procedures and drugs to individuals under 18 years of age.. in the flush left matter at the end, by striking and (18), and inserting (18), and (28). Section 1905 of the Social Security Act (42 U.S.C. 1396d) is amended by adding at the end the following new subsection: For purposes of section 1903(i)(28), except as provided in subparagraph (B), the term specified gender transition procedures means, with respect to an individual, any of the following when performed for the purpose of intentionally changing the body of such individual (including by disrupting the body’s development, inhibiting its natural functions, or modifying its appearance) to no longer correspond to the individual’s sex: Performing any surgery, including— castration; sterilization; orchiectomy; scrotoplasty; vasectomy; tubal ligation; hysterectomy; oophorectomy; ovariectomy; metoidioplasty; clitoroplasty; reconstruction of the fixed part of the urethra with or without a metoidioplasty or a phalloplasty; penectomy; phalloplasty; vaginoplasty; vaginectomy; vulvoplasty; reduction thyrochondroplasty; chondrolaryngoplasty; mastectomy; and any plastic, cosmetic, or aesthetic surgery that feminizes or masculinizes the facial or other physiological features of an individual. Any placement of chest implants to create feminine breasts or any placement of erection or testicular prosetheses. Any placement of fat or artificial implants in the gluteal region. Administering, supplying, prescribing, dispensing, distributing, or otherwise conveying to an individual medications, including— gonadotropin-releasing hormone (GnRH) analogues or other puberty-blocking drugs to stop or delay normal puberty; and testosterone, estrogen, progesterone or other androgens to an individual at doses that are supraphysiologic, greater or more potent than would normally be produced endogenously in a healthy individual of the same age and sex. Subparagraph (A) shall not apply to the following when furnished to an individual by a health care provider with the consent of such individual’s parent or legal guardian: Puberty suppression or blocking prescription drugs for the purpose of normalizing puberty for an individual experiencing precocious puberty. Appropriate and medically necessary procedures or treatments to correct for— a medically verifiable genetic disorder of sex development, including— 46,XX chromosomes with virilization; 46,XY chromosome with undervirilization; and both ovarian and testicular tissue; sex chromosome structure, sexsteroid hormone production, or sex hormone action, if determined to be abnormal for a healthy individual of the same sex and age by a physician through genetic or biochemical testing; infection, disease, injury, or disorder caused or exacerbated by a previous procedure described in subparagraph (A), or a physical disorder, physical injury, or physical 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 performed, not including procedures performed for the alleviation of mental distress; or procedures to restore or reconstruct the body of the individual in order to correspond to the individual’s sex after one or more previous procedures described in subparagraph (A), which may include the removal of a pseudo phallus or breast augmentation. For purposes of subparagraph(A), the term sex means either male or female, as biologically determined and defined by clause (i) and clause (ii). The term female means an individual who naturally has, had, will have, or would have, but for a developmental or genetic anomaly or historical accident, the reproductive system that at some point produces, transports, and utilizes eggs for fertilization. The term male means an individual who naturally has, had, will have, or would have, but for a developmental or genetic anomaly or historical accident, the reproductive system that at some point produces, transports, and utilizes sperm for fertilization. (KK)Prohibiting federal medicaid funding for gender transitions for minors (A)For purposes of section 1903(i)(28), except as provided in subparagraph (B), the term specified gender transition procedures means, with respect to an individual, any of the following when performed for the purpose of intentionally changing the body of such individual (including by disrupting the body’s development, inhibiting its natural functions, or modifying its appearance) to no longer correspond to the individual’s sex: (i)Performing any surgery, including— (I)castration; (II)sterilization; (III)orchiectomy; (IV)scrotoplasty; (V)vasectomy; (VI)tubal ligation; (VII)hysterectomy; (VIII)oophorectomy; (IX)ovariectomy; (X)metoidioplasty; (XI)clitoroplasty; (XII)reconstruction of the fixed part of the urethra with or without a metoidioplasty or a phalloplasty; (XIII)penectomy; (XIV)phalloplasty; (XV)vaginoplasty; (XVI)vaginectomy; (XVII)vulvoplasty; (XVIII)reduction thyrochondroplasty; (XIX)chondrolaryngoplasty; (XX)mastectomy; and (XXI)any plastic, cosmetic, or aesthetic surgery that feminizes or masculinizes the facial or other physiological features of an individual. (ii)Any placement of chest implants to create feminine breasts or any placement of erection or testicular prosetheses. (iii)Any placement of fat or artificial implants in the gluteal region. (iv)Administering, supplying, prescribing, dispensing, distributing, or otherwise conveying to an individual medications, including— (I)gonadotropin-releasing hormone (GnRH) analogues or other puberty-blocking drugs to stop or delay normal puberty; and (II)testosterone, estrogen, progesterone or other androgens to an individual at doses that are supraphysiologic, greater or more potent than would normally be produced endogenously in a healthy individual of the same age and sex. (B)ExceptionSubparagraph (A) shall not apply to the following when furnished to an individual by a health care provider with the consent of such individual’s parent or legal guardian: (i)Puberty suppression or blocking prescription drugs for the purpose of normalizing puberty for an individual experiencing precocious puberty. (ii)Appropriate and medically necessary procedures or treatments to correct for— (I)a medically verifiable genetic disorder of sex development, including— (aa)46,XX chromosomes with virilization; (bb)46,XY chromosome with undervirilization; and (cc)both ovarian and testicular tissue; (II)sex chromosome structure, sexsteroid hormone production, or sex hormone action, if determined to be abnormal for a healthy individual of the same sex and age by a physician through genetic or biochemical testing; (III)infection, disease, injury, or disorder caused or exacerbated by a previous procedure described in subparagraph (A), or a physical disorder, physical injury, or physical 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 performed, not including procedures performed for the alleviation of mental distress; or (IV)procedures to restore or reconstruct the body of the individual in order to correspond to the individual’s sex after one or more previous procedures described in subparagraph (A), which may include the removal of a pseudo phallus or breast augmentation. (C)SexFor purposes of subparagraph(A), the term sex means either male or female, as biologically determined and defined by clause (i) and clause (ii). (i)FemaleThe term female means an individual who naturally has, had, will have, or would have, but for a developmental or genetic anomaly or historical accident, the reproductive system that at some point produces, transports, and utilizes eggs for fertilization. (ii)MaleThe term male means an individual who naturally has, had, will have, or would have, but for a developmental or genetic anomaly or historical accident, the reproductive system that at some point produces, transports, and utilizes sperm for fertilization..