26 U.S.C. 223added (i)by S. 3386 Sec. 101(a)
(i) Exchange plan HSAs.— For purposes of this section—(1) In general.— In the case of an Exchange plan HSA, this section shall be applied as provided in paragraphs (3) through (4).(2) Exchange plan HSA.— The term Exchange plan HSA means a health savings account which is designated as an Exchange plan HSA upon the establishment of such account.(3) No rollovers permitted.— Except in the case of a contribution from one Exchange plan HSA to another Exchange plan HSA, subsection (f)(5) shall not apply.(4) Restriction on use of amounts.— For purposes of subsection (d)(2)(A), amounts paid for—shall not be treated as paid for medical care.(A) abortion, other than—(i) if the pregnancy is the result of an act of rape or incest, or(ii) in the case where a woman suffers from a physical disorder, physical injury, or physical illness, including a life-endangering physical condition caused by or arising from the pregnancy itself, that would, as certified by a physician, place the woman in danger of death unless an abortion is performed, or(B) any sex trait modification procedure or service (as defined in section 156.400 of title 45, Code of Federal Regulations, as in effect on the date of the enactment of this subsection),
The bill says: Section 223 of the Internal Revenue Code of 1986 is amended by adding at the end the following new subsection:
Bill text · Current law (26 U.S.C. 223)
26 U.S.C. 223(b)added (D)by S. 3386 Sec. 101(b)
…(within the meaning of section 72(m)(7)). The term "testing period" means the period beginning with the last month of the taxable year referred to in subparagraph (A) and ending on the last day of the 12th month following such month.(D) the aggregate amount contributed to an Exchange plan HSA pursuant to section 102(a) of the Health Care Freedom for Patients Act of 2025 which is excludable from the taxpayer's gross income for the taxable year under section 102(f) of such Act (and such amount shall not be allowed as a deduction under subsection (a)).
The bill says: Paragraph (4) of section 223(b) of the Internal Revenue Code of 1986 is amended by striking "and" at the end of subparagraph (B), by striking the period at the end of subparagraph (C) and inserting ", and", and by inserting after subparagraph (C) the following new subparagraph:
Bill text · Current law (26 U.S.C. 223)
26 U.S.C. 6103(l)changedby S. 3386 Sec. 102(j)
…Patient Protection and Affordable Care Act or eligibility for participation in a State medicaid program under title XIX of the Social Security Act, a State's children's health insurance program under title XXI of the Social Security Act, or a basic health program under section 1331 of Patient Protection and Affordable Care Acta basic health program under section 1331 of the Patient Protection and Affordable Care Act, or a payment under section 102(a) of the Health Care Freedom for Patients Act of 2025. Such return information shall be limited to— (i) taxpayer identity information with respect to such taxpayer, (ii) the filing status of such taxpayer, (iii) the number of individuals for whom a deduction is allowed under section 151 with…
The bill says: by striking "or a basic health program under section 1331 of Patient Protection and Affordable Care Act" in subparagraph (A) and inserting "a basic health program under section 1331 of the Patient Protection and Affordable Care Act, or a payment under section 102(a) of the Health Care Freedom for Patients Act of 2025",
Bill text · Current law (26 U.S.C. 6103)
26 U.S.C. 6103(l)changedby S. 3386 Sec. 102(j)
…a return of tax imposed by chapter 1 for the taxable year, (v) such other information as is prescribed by the Secretary by regulation as might indicate whether the taxpayer is eligible for such credit or reduction (and the amount thereof) , program, or payment, and (vi) the taxable year with respect to which the preceding information relates or, if applicable, the fact that such information is not available. The Secretary of Health and Human Services may disclose to an Exchange established…
The bill says: by inserting ", program, or payment" after "(and the amount thereof)" in subparagraph (A)(v), and
Bill text · Current law (26 U.S.C. 6103)
26 U.S.C. 6103(l)changedby S. 3386 Sec. 102(j)
…the extent necessary in— (i) establishing eligibility for participation in the Exchange, and verifying the appropriate amount of, any credit or reduction described in subparagraph (A), (ii) determining eligibility for participation in the State programsState programs or payment described in subparagraph (A). (22) Disclosure of return information to Department of Health and Human Services for purposes of enhancing Medicare program integrity. The Secretary shall, upon written request from the Secretary of Health…
The bill says: by striking "State programs" in subparagraph (C)(ii) and inserting "State programs or payment".
Bill text · Current law (26 U.S.C. 6103)
42 U.S.C. 18071added (h)by S. 3386 Sec. 103
(h) Funding.—(1) In general.— There are appropriated, out of any monies in the Treasury not otherwise appropriated, such sums as may be necessary for purposes of making payments under this section for plan years beginning on or after January 1, 2027.(2) Use of funds.—(A) In general.— The amounts appropriated under paragraph (1) may not be used for purposes of making payments under this section for a qualified health plan that provides health benefit coverage that includes coverage of abortion.(B) Exception.— Subparagraph (A) shall not apply to payments for a qualified health plan that provides coverage of abortion only if necessary to save the life of the mother or if the pregnancy is a result of an act of rape or incest.
The bill says: Section 1402 of the Patient Protection and Affordable Care Act (42 U.S.C. 18071) is amended by adding at the end the following:
Bill text · Current law (42 U.S.C. 18071)
42 U.S.C. 18022(e)(1)renumberedby S. 3386 Sec. 104(a)
The bill says: by redesignating clauses (i) and (ii) of subparagraph (B) as subparagraphs (A) and (B), respectively, and adjusting the margins accordingly;
Bill text · Current law (42 U.S.C. 18022)
42 U.S.C. 18022(e)(1)changedby S. 3386 Sec. 104(a)
(1) In general. A health plan not providing a bronze, silver, gold, or platinum level of coverage shall be treated as meeting the requirements of subsection (d) with respect to any plan year if—plan year if the plan provides— (A) the only individuals who are eligible to enroll in the plan are individuals described in paragraph (2); and (B) the plan provides— (i) except as provided in clause (ii), the essential health benefits determined under subsection (b),…
The bill says: by striking "plan year if—" and all that follows through "the plan provides—" and inserting "plan year if the plan provides—"; and
Bill text · Current law (42 U.S.C. 18022)
42 U.S.C. 18022(e)(1)(A)changedby S. 3386 Sec. 104(a)
The bill says: in subparagraph (A), as redesignated by paragraph (1), by striking "clause (ii)" and inserting "subparagraph (B)";
Bill text · Current law (42 U.S.C. 18022)
42 U.S.C. 18022(e)removedby S. 3386 Sec. 104(a)
The bill says: by striking paragraph (2); and
Bill text · Current law (42 U.S.C. 18022)
42 U.S.C. 18022(e)renumberedby S. 3386 Sec. 104(a)
The bill says: by redesignating paragraph (3) as paragraph (2).
Bill text · Current law (42 U.S.C. 18022)
42 U.S.C. 18032(c)(1)a new sectionchangedby S. 3386 Sec. 104(b)
(1) Individual market. A health insurance issuer shall consider all enrollees in all health plans (other than grandfathered health plans) offered by such issuer in the individual market, including those enrollees who do not enroll in such plans through the Exchange and including enrollees in catastrophic plans described in section 1302(e), to be members of a single risk pool.
The bill says: Section 1312(c)(1) of the Patient Protection and Affordable Care Act (42 U.S.C. 18032(c)(1)) is amended by inserting "and including enrollees in catastrophic plans described in section 1302(e)" after "Exchange".
Bill text
42 U.S.C. 18032(d)(3)(C)a new sectionchangedby S. 3386 Sec. 104(c)
The bill says: Section 1312(d)(3)(C) of the Patient Protection and Affordable Care Act (42 U.S.C. 18032(d)(3)(C)) is amended by striking ", except that in the case of a catastrophic plan described in section 1302(e), a qualified individual may enroll in the plan only if the individual is eligible to enroll in the plan under section 1302(e)(2)".
Bill text
42 U.S.C. 1396d(y)(1)(E)changedby S. 3386 Sec. 201(1)
(E) 90 percent for calendar quarters in 2020 and each year thereafter (or, for calendar quarters beginning on or after October 1, 2027, in the case such State is a specified State with respect to such calendar quarter, 80 percent).
The bill says: in paragraph (1)(E), by inserting "(or, for calendar quarters beginning on or after October 1, 2027, in the case such State is a specified State with respect to such calendar quarter, 80 percent)" after "thereafter"; and
Bill text · Current law (42 U.S.C. 1396d)
42 U.S.C. 1396d(y)(2)added (C)by S. 3386 Sec. 201(1)
(C) Specified State.— The term "specified State" means, with respect to a quarter, a State that—(i) provides any form of financial assistance from a State general fund during such quarter, in whole or in part, whether or not made under a State plan (or waiver of such plan) under this title or under another program established by the State, to or on behalf of an alien who is not a qualified alien and is not a child or pregnant woman who is lawfully residing in the United States and eligible for medical assistance pursuant to section 1903(v)(4) or for child health assistance or pregnancy-related assistance pursuant to section 2107(e)(1)(Q), for the purchasing of health insurance coverage (as defined in section 2791(b)(1) of the Public Health Service Act) for an alien who is not a qualified alien and is not such a child or pregnant woman; or(ii) provides any form of comprehensive health benefits coverage, except such coverage required by Federal law, during such quarter, whether or not under a State plan (or waiver of such plan) under this title or under another program established by the State, and regardless of the source of funding for such coverage, to an alien who is not a qualified alien and is not such a child or pregnant woman.(D) Immigration terms.—(i) Alien.— The term "alien" has the meaning given such term in section 101(a) of the Immigration and Nationality Act.(ii) Qualified alien.— The term "qualified alien" has the meaning given such term in section 431 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, except that the references to "(in the opinion of the agency providing such benefits)" in subsection (c) of such section 431 shall be treated as references to "(in the opinion of the State in which such comprehensive health benefits coverage or such financial assistance is provided, as applicable)".
The bill says: in paragraph (2), by adding at the end the following new subparagraph:
Bill text · Current law (42 U.S.C. 1396d)
42 U.S.C. 1396d(z)(2)(A)changedby S. 3386 Sec. 201(2)
…of this title who are nonpregnant childless adults with respect to whom the State may require enrollment in benchmark coverage under section 1396u–7 of this title shall be equal to the percent specified in subparagraph (B)(i) for such yearfor such quarter. (A) in the case of the first fiscal year (or part of a fiscal year) for which this subsection applies to the State, the State's regular FMAP for the fiscal year is less than the Federal medical assistance percentage determined for the…
The bill says: in subparagraph (A), by striking "for such year" and inserting "for such quarter"; and
Bill text · Current law (42 U.S.C. 1396d)
42 U.S.C. 1396d(z)(2)(B)(i)changedby S. 3386 Sec. 201(2)
(B)(i) The percent specified in this subparagraph for a State for a yearfor a calendar quarter in a year is equal to the Federal medical assistance percentage (as defined in the first sentence of subsection (b)) for the State increased by a number of percentage points equal to the transition percentage (specified in clause (ii) for the year) of the number of percentage points by which— (I) such Federal medical assistance percentage for the State, is less than (II) the percent specified in subsection (y)(1) for the year. (i) to be comparable to the system of peer review of studies and investigations used by the National Institutes of Health; and
The bill says: in the matter preceding subclause (I), by striking "for a year" and inserting "for a calendar quarter in a year"; and
Bill text · Current law (42 U.S.C. 1396d)
42 U.S.C. 1396d(z)(2)(B)(i)(II)changedby S. 3386 Sec. 201(2)
(II) the percent specified in subsection (y)(1) for the yearfor the quarter for the State.
The bill says: in subclause (II), by striking "for the year" and inserting "for the quarter for the State".
Bill text · Current law (42 U.S.C. 1396d)
42 U.S.C. 1396b(i)(22)changedby S. 3386 Sec. 202(a)
(22) with respect to amounts expended for medical assistance for an individual who declares under section 1320b–7(d)(1)(A) of this title to be a citizen or national of the United States for purposes of establishing eligibility for benefits under this subchapter, unless the requirement of section 1396a(a)(46)(B) of this title is met; and
The bill says: by adding "and" at the end;
Bill text · Current law (42 U.S.C. 1396b)
42 U.S.C. 1396b(i)(22)changedby S. 3386 Sec. 202(a)
(22) with respect to amounts(A) amounts expended for medical assistance for an individual who declares under section 1320b–7(d)(1)(A) of this title to be a citizen or national of the United States for purposes of establishing eligibility for benefits under this subchapter, unless the requirement of section 1396a(a)(46)(B) of this title is met;
The bill says: by striking "to amounts" and inserting "to—
Bill text · Current law (42 U.S.C. 1396b)
42 U.S.C. 1396b(i)(22)added (B)by S. 3386 Sec. 202(a)
(B) in the case that the State elects under section 1902(a)(46)(C) to provide for making medical assistance available to an individual during—amounts expended for such medical assistance, unless the citizenship or nationality of such individual or the satisfactory immigration status of such individual (as applicable) is verified by the end of such period;(i) the period in which the individual is provided the reasonable opportunity to present satisfactory documentary evidence of citizenship or nationality under section 1902(ee)(2)(C) or subsection (x)(4);(ii) the 90-day period described in section 1902(ee)(1)(B)(ii)(II); or(iii) the period in which the individual is provided the reasonable opportunity to submit evidence indicating a satisfactory immigration status under section 1137(d)(4),
The bill says: by adding at the end the following new subparagraph:
Bill text · Current law (42 U.S.C. 1396b)
42 U.S.C. 1397gg(e)(1)(O)changedby S. 3386 Sec. 202(a)
The bill says: Section 2107(e)(1)(O) of the Social Security Act (42 U.S.C. 1397gg(e)(1)(O)) is amended by striking "and (17)" and inserting "(17), and (22)".
Bill text · Current law (42 U.S.C. 1397gg)
42 U.S.C. 1396b(x)changedby S. 3386 Sec. 202(b)
The bill says: by striking "under clauses (i) and (ii) of section 1137(d)(4)(A)" and inserting "under section 1137(d)(4)"; and
Bill text · Current law (42 U.S.C. 1396b)
42 U.S.C. 1396b(x)changedby S. 3386 Sec. 202(b)
The bill says: by inserting ", except that the State shall not be required to make medical assistance available to such individual during the period in which such individual is provided such reasonable opportunity if the State has not elected the option under section 1902(a)(46)(C)" before the period at the end.
Bill text · Current law (42 U.S.C. 1396b)
42 U.S.C. 1396a(ee)(1)(B)(ii)(II)changedby S. 3386 Sec. 202(b)
The bill says: in subclause (II), by striking "(and continues to provide the individual with medical assistance during such 90-day period)" and inserting "and, if the State has elected the option under subsection (a)(46)(C), continues to provide the individual with medical assistance during such 90-day period"; and
Bill text · Current law (42 U.S.C. 1396a)
42 U.S.C. 1396a(ee)(1)(B)(ii)(III)changedby S. 3386 Sec. 202(b)
The bill says: in subclause (III), by inserting ", or denies eligibility for medical assistance under this title for such individual, as applicable" after "under this title"; and
Bill text · Current law (42 U.S.C. 1396a)
42 U.S.C. 1396a(ee)(2)(C)changedby S. 3386 Sec. 202(b)
The bill says: by striking "under clauses (i) and (ii) of section 1137(d)(4)(A)" and inserting "under section 1137(d)(4)"; and
Bill text · Current law (42 U.S.C. 1396a)
42 U.S.C. 1396a(ee)(2)(C)changedby S. 3386 Sec. 202(b)
The bill says: by inserting ", except that the State shall not be required to make medical assistance available to such individual during the period in which such individual is provided such reasonable opportunity if the State has not elected the option under section 1902(a)(46)(C)" before the period at the end.
Bill text · Current law (42 U.S.C. 1396a)
42 U.S.C. 1320b-7(d)(4)(A)(ii)changedby S. 3386 Sec. 202(b)
(ii) may not delay, deny, reduce, or terminate the individual's eligibility for benefits under the program on the basis of the individual's immigration status until such a reasonable opportunity has been provided (except that such prohibition on delay, denial, reduction, or termination of eligibility for benefits under the Medicaid program under title XIX shall apply only if the State has elected the option under section 1902(a)(46)(C)); and
The bill says: in subparagraph (A)(ii), by inserting "(except that such prohibition on delay, denial, reduction, or termination of eligibility for benefits under the Medicaid program under title XIX shall apply only if the State has elected the option under section 1902(a)(46)(C))" after "has been provided"; and
Bill text · Current law (42 U.S.C. 1320b-7)
42 U.S.C. 1320b-7(d)(4)(B)(ii)changedby S. 3386 Sec. 202(b)
(ii) pending such verification, the State may not delay, deny, reduce, or terminate the individual's eligibility for benefits under the program on the basis of the individual's immigration status (except that such prohibition on delay, denial, reduction, or termination of eligibility for benefits under the Medicaid program under title XIX shall apply only if the State has elected the option under section 1902(a)(46)(C)), and
The bill says: in subparagraph (B)(ii), by inserting "(except that such prohibition on delay, denial, reduction, or termination of eligibility for benefits under the Medicaid program under title XIX shall apply only if the State has elected the option under section 1902(a)(46)(C))" after "status".
Bill text · Current law (42 U.S.C. 1320b-7)
42 U.S.C. 1396a(a)(46)(A)changedby S. 3386 Sec. 202(c)
(46)(A) provide that information is requested and exchanged for purposes of income and eligibility verification in accordance with a State system which meets the requirements of section 1320b–7 of this title; and
The bill says: in subparagraph (A), by striking "and" at the end;
Bill text · Current law (42 U.S.C. 1396a)
42 U.S.C. 1396a(a)(46)(B)(ii)changedby S. 3386 Sec. 202(c)
(ii) subsection (ee); and
The bill says: in subparagraph (B)(ii), by adding "and" at the end; and
Bill text · Current law (42 U.S.C. 1396a)
42 U.S.C. 1396a(a)(46)added (C)by S. 3386 Sec. 202(c)
(C) provide, at the option of the State, for making medical assistance available—(i) to an individual described in subparagraph (B) during the period in which such individual is provided the reasonable opportunity to present satisfactory documentary evidence of citizenship or nationality under subsection (ee)(2)(C) or section 1903(x)(4), or during the 90-day period described in subsection (ee)(1)(B)(ii)(II); or(ii) to an individual who is not a citizen or national of the United States during the period in which such individual is provided the reasonable opportunity to submit evidence indicating a satisfactory immigration status under section 1137(d)(4);
The bill says: by inserting after subparagraph (B)(ii) the following new subparagraph:
Bill text · Current law (42 U.S.C. 1396a)
42 U.S.C. 1397ee(c)(9)a new sectionadded (C)by S. 3386 Sec. 202(c)
(C) Option to continue providing child health assistance during reasonable opportunity period.— Section 1902(a)(46)(C) shall apply to States under this title in the same manner as it applies to a State under title XIX.
The bill says: Section 2105(c)(9) of the Social Security Act (42 U.S.C. 1397ee(c)(9)) is amended by adding at the end the following new subparagraph:
Bill text
42 U.S.C. 18022(b)(2)added (C)by S. 3386 Sec. 301(a)
(C) Gender transition procedures.— For plan years beginning on or after January 1, 2027, the essential health benefits defined pursuant to paragraph (1) may not include items and services furnished for a gender transition procedure.
The bill says: Section 1302(b)(2) of the Patient Protection and Affordable Care Act (42 U.S.C. 18022(b)(2)) is amended by adding at the end the following new subparagraph:
Bill text · Current law (42 U.S.C. 18022)
42 U.S.C. 18024a new sectionadded (f)by S. 3386 Sec. 301(b)
(f) Gender transition procedure.—(1) In general.— In this title, except as provided in paragraph (2), the term "gender transition procedure" 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:(A) 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 body features of an individual.(B) Any placement of chest implants to create feminine breasts or any placement of erection or testicular prosthesis.(C) Any placement of fat or artificial implants in the gluteal region.(D) Administering, prescribing, or dispensing 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, or other androgens to an individual at doses that are supraphysiologic than would normally be produced endogenously in a healthy individual of the same age and sex.(2) Exception.— Paragraph (1) shall not apply to the following:(A) Puberty suppression or blocking prescription drugs for the purpose of normalizing puberty for an individual experiencing precocious puberty.(B) Medically necessary procedures or treatments to correct for—(i) a medically verifiable disorder of sex development, including—(I) 46,XX chromosomes with virilization;(II) 46,XY chromosomes with undervirilization; and(III) both ovarian and testicular tissue;(ii) sex chromosome structure, sex steroid hormone production, or sex hormone action, if determined to be abnormal by a physician through genetic or biochemical testing;(iii) infection, disease, injury, or disorder caused or exacerbated by a previous procedure described in paragraph (1), 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 paragraph (1), which may include the removal of a pseudo phallus or breast augmentation.(3) Sex.— For purposes of this subsection, the term sex means either male or female, as biologically determined and defined by subparagraph (A) and subparagraph (B).(A) 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.(B) 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 1304 of the Patient Protection and Affordable Care Act (42 U.S.C. 18024) is amended by adding at the end the following new subsection:
Bill text
42 U.S.C. 1396b(i)(26)changedby S. 3386 Sec. 302(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;
Bill text · Current law (42 U.S.C. 1396b)
42 U.S.C. 1396b(i)(27)changedby S. 3386 Sec. 302(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";
Bill text · Current law (42 U.S.C. 1396b)
42 U.S.C. 1396b(i)added (28)by S. 3386 Sec. 302(a)
(28) with respect to any amount expended for specified gender transition procedures (as defined in section 1905(ll)) furnished to an individual enrolled in a State plan (or waiver of such plan).
The bill says: by inserting after paragraph (27) the following new paragraph:
Bill text · Current law (42 U.S.C. 1396b)
42 U.S.C. 1396b(i)changedby S. 3386 Sec. 302(a)
The bill says: in the flush left matter at the end, by striking "and (18)," and inserting "(18), and (28)".
Bill text · Current law (42 U.S.C. 1396b)
42 U.S.C. 1396dadded (ll)by S. 3386 Sec. 302(c)
(ll) Specified gender transition procedures.—(1) In general.— For purposes of section 1903(i)(28), except as provided in paragraph (2) , the term specified gender transition procedure 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:(A) 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 body features of an individual.(B) Any placement of chest implants to create feminine breasts or any placement of erection or testicular prosthesis.(C) Any placement of fat or artificial implants in the gluteal region.(D) Administering, prescribing, or dispensing 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, or other androgens to an individual at doses that are supraphysiologic than would normally be produced endogenously in a healthy individual of the same age and sex.(2) Exception.— Paragraph (1) shall not apply to the following when furnished to an individual by a health care provider if the individual is a minor with the consent of such individual’s parent or legal guardian:(A) Puberty suppression or blocking prescription drugs for the purpose of normalizing puberty for an individual experiencing precocious puberty.(B) Medically necessary procedures or treatments to correct for—(i) a medically verifiable disorder of sex development, including—(I) 46,XX chromosomes with virilization;(II) 46,XY chromosomes with undervirilization; and(III) both ovarian and testicular tissue;(ii) sex chromosome structure, sex steroid hormone production, or sex hormone action, if determined to be abnormal by a physician through genetic or biochemical testing;(iii) infection, disease, injury, or disorder caused or exacerbated by a previous procedure described in paragraph (1), or a physical disorder, physical injury, or physical illness that would, as certified by a physician, place the individual in 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 paragraph (1), which may include the removal of a pseudo phallus or breast augmentation.(3) Sex.— For purposes of paragraph (1), the term sex means either male or female, as biologically determined and defined in paragraphs (4) and (5), respectively.(4) Female.— For purposes of paragraph (3), 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.(5) Male.— For purposes of paragraph (3), 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:
Bill text · Current law (42 U.S.C. 1396d)