Do No Harm in Medicaid Act
Officially: “Do No Harm in Medicaid Act” Read the full text
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1Short title
This section would allow the Act to be called the "Do No Harm in Medicaid Act."
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1. Short title This Act may be cited as the Do No Harm in Medicaid Act .
2Prohibiting federal Medicaid funding for gender transition for minors
This section would add a new category of state spending that the federal government will not help pay for under Medicaid. Under current law, section 1903(i) of the Social Security Act lists types of spending for which no federal Medicaid matching payment is made. This section would add to that list any amount a state spends on "specified gender transition procedures" (defined in a new section 1905(kk), described below) that are provided to an individual under 18 years old who is enrolled in a state Medicaid plan or a waiver of that plan. It would also bar federal matching funds for any amount spent administering a state program that furnishes these specified procedures and drugs to people under 18. States would remain free to pay for these procedures and drugs with their own money; only the federal share would be barred.
This section would also add a new subsection (kk) to section 1905 of the Social Security Act that defines "specified gender transition procedures" for purposes of this funding ban. Except for the exception described below, the term covers any of the following when performed for the purpose of intentionally changing an individual's body, including by disrupting the body's development, inhibiting its natural functions, or modifying its appearance, so that the body no longer corresponds to the individual's sex: - Surgeries, 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 physical features of an individual. - Placing chest implants to create feminine breasts, or placing erection or testicular prostheses. - Placing 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 used to stop or delay normal puberty, and testosterone, estrogen, progesterone, or other androgens given at doses that are higher or more potent than a healthy individual of the same age and sex would normally produce on their own.
This section would carve out an exception: none of the above counts as a "specified gender transition procedure," and federal funding is not barred for it, when a health care provider furnishes it with the consent of the individual's parent or legal guardian and it is one of the following: - A puberty-suppressing or puberty-blocking prescription drug given for the purpose of normalizing puberty for an individual experiencing precocious (early) puberty. - An appropriate and medically necessary procedure or treatment to correct a medically verifiable genetic disorder of sex development, including 46,XX chromosomes with virilization, 46,XY chromosomes with undervirilization, or the presence of both ovarian and testicular tissue. - An appropriate and medically necessary procedure or treatment to correct a sex chromosome structure, sex-steroid hormone production, or sex hormone action that a physician determines, through genetic or biochemical testing, to be abnormal for a healthy individual of the same sex and age. - An appropriate and medically necessary procedure or treatment for an infection, disease, injury, or disorder that was caused or made worse by a previous gender transition procedure described above, or for a physical disorder, physical injury, or physical illness that a physician certifies would place the individual in imminent danger of death or impairment of a major bodily function unless the procedure is performed; this part of the exception does not cover procedures performed to relieve mental distress. - An appropriate and medically necessary procedure to restore or reconstruct the individual's body so that it corresponds to the individual's sex after one or more earlier gender transition procedures described above, which may include removing a pseudo phallus or breast augmentation.
Finally, this section would define "sex," for purposes of the definition above, as either male or female, as biologically determined. It would define "female" as an individual who naturally has, had, will have, or would have, but for a developmental or genetic anomaly or historical accident, a reproductive system that at some point produces, transports, and uses eggs for fertilization. It would define "male" the same way, but for a reproductive system that produces, transports, and uses sperm for fertilization.
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2. Prohibiting federal medicaid funding for gender transition for minors (a) In general Section 1903(i) of the Social Security Act ( 42 U.S.C. 1396b(i) ) is amended— (1) in paragraph (26), by striking ; or and inserting a semicolon; (2) in paragraph (27), by striking the period at the end and inserting ; or ; and (3) 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. . (4) in the flush left matter at the end, by striking and (18), and inserting (18), and (28) . (b) Prohibiting federal medicaid funding for gender transitions for minors Section 1905 of the Social Security Act ( 42 U.S.C. 1396d ) is amended by adding at the end the following new subsection: (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) Exception 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: (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) Sex For purposes of subparagraph(A), the term sex means either male or female, as biologically determined and defined by clause (i) and clause (ii). (i) Female 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. (ii) Male 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. .
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In the House.