WHAT THE LAW DOINCongress, in plain words

H.R. 498 · 119th Congress

Do No Harm in Medicaid Act

Passed HouseHealth
IntroducedJan 16, 2025
Passed HouseDec 18, 2025
Passed SenateNot yet
To PresidentNot yet
Became lawNot yet

Where it stands

Passed House. Latest step, Dec 18, 2025: Received in the Senate and Read twice and referred to the Committee on Finance. The House passed it 215–201. All 4 of Iowa's representatives voted yes in the House. It would change 2 sections of existing law.

How this bill changes the law

Sourced

H.R. 498 would change 2 sections of existing law. Read from the bill text as passed by the House (Dec 18, 2025).

42 U.S.C. 1396b Payment to States

  • (i) Payment for organ transplants; item or service furnished by excluded individual, entity, or physician; other restrictions added to · Sec. 2(a) · see the words

42 U.S.C. 1396d Definitions

What the words would change: every change, in place (5)

Today's wording of each part of the law, with what would be struck out and added. Each change also gives the bill's own instruction, word for word.

  1. 42 U.S.C. 1396b(i)(26)changedby H.R. 498 Sec. 2(a)

    (26) with respect to any amounts expended for medical assistance for individuals described in subclause (VIII) of subsection (a)(10)(A)(i) 6 other than medical assistance provided through benchmark coverage described in section 1396u–7(b)(1) of this title or benchmark equivalent coverage described in section 1396u–7(b)(2) of this title; or

    The bill says: in paragraph (26), by striking "; or" and inserting a semicolon;

  2. 42 U.S.C. 1396b(i)(27)changedby H.R. 498 Sec. 2(a)

    (27) with respect to any amounts expended by the State on the basis of a fee schedule for items described in section 1395x(n) of this title and furnished on or after January 1, 2018, as determined in the aggregate with respect to each class of such items as defined by the Secretary, in excess of the aggregate amount, if any, that would be paid for such items within such class on a fee-for-service basis under the program under part B of subchapter XVIII, including, as applicable, under a competitive acquisition program under section 1395w–3 of this title in an area of the State.; or

    The bill says: in paragraph (27), by striking the period at the end and inserting "; or"; and

  3. 42 U.S.C. 1396b(i)addedby H.R. 498 Sec. 2(a)

    The bill says: 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. 42 U.S.C. 1396b(i)changedby H.R. 498 Sec. 2(a)

    The bill says: in the flush left matter at the end, by striking "and (18)," and inserting "(18), and (28)".

  5. 42 U.S.C. 1396dadded (KK)by H.R. 498 Sec. 2(b)

    (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.

    The bill says: Section 1905 of the Social Security Act (42 U.S.C. 1396d) is amended by adding at the end the following new subsection:

From the bill's official text on GovInfo and the U.S. Code, 2024 edition, which may not yet show changes made since.

What it does

Sourced

Do No Harm in Medicaid Act

This bill prohibits federal Medicaid payment for specified gender transition procedures for individuals under the age of 18. The bill defines these procedures to mean those that are intended to change the body of an individual to no longer correspond to the individual's biological sex (male or female), including specified surgeries, implants, and medications (e.g., hormones).

The bill excludes procedures that are provided to an individual under the age of 18 with the consent of a parent or legal guardian and that are intended to (1) rectify early puberty, genetic disorders, or chromosomal abnormalities; (2) reverse prior gender transition procedures; or (3) prevent imminent death or impairment of a major bodily function.

Official summary by the Congressional Research Service (Introduced in House, Jan 16, 2025).

Our plain-language breakdown, with what it means for you and the case for and against, is written once a bill starts to move.

What has happened

Sourced
  1. Dec 18, 2025Passed/agreed to in House: On passage Passed by the Yeas and Nays: 215 - 201 (Roll no. 362). Roll call recordLibrary of Congress
  2. Jan 16, 2025Introduced in HouseLibrary of Congress

Show all 17 recorded actions

Recorded votes

Sourced
  1. Dec 18, 2025 · HousePassed 215–201
    On Passage · needed a majority
    R 211 yes, 0 noD 4 yes, 201 noEach member · Record
1 other recorded vote (procedure and amendments)
  1. Dec 18, 2025 · HouseFailed 204–212
    On Motion to Recommit · needed a majority
    R 0 yes, 212 noD 204 yes, 0 noEach member · Record

Cosponsors

  • Warren Davidson R-OH-8
  • Rep. Marjorie Taylor Greene R-GA-14
  • Glenn Grothman R-WI-6
  • Anna Paulina Luna R-FL-13
  • W. Gregory Steube R-FL-17
  • Randy K. Weber, Sr. R-TX-14