Do No Harm in Medicaid Act
- Bill Number
- H.R. 498
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Passed House
- Latest Action
- 2025-12-18: Received in the Senate and Read twice and referred to the Committee on Finance.
- Last Updated
- 2026-01-22T09:06:06Z
AI-Generated Summary
Purpose of the Legislation
The "Do No Harm in Medicaid Act" (H.R. 498) aims to prevent the use of federal Medicaid funds for medical procedures or treatments that enable gender transitions for individuals under 18 years old. It seeks to limit federal financial support for such interventions, emphasizing biological definitions of sex and allowing exceptions only for specific medical conditions unrelated to gender identity.
Key Provisions
- Prohibition on Federal Funding: Amends Section 1903(i) of the Social Security Act (which governs Medicaid payments) by adding a new paragraph (28). This bars federal matching funds for "specified gender transition procedures" provided to Medicaid enrollees under 18, including costs for program administration related to these services.
- Definition of Specified Gender Transition Procedures: Adds a new subsection (kk) to Section 1905 of the Social Security Act, defining these procedures as any medical interventions intended to alter an individual's body (through surgery, implants, or medications) to make it not align with their biological sex. Examples include:
- Surgeries such as castration, hysterectomy, mastectomy, phalloplasty, vaginoplasty, and various facial or cosmetic procedures to masculinize or feminize features.
- Placement of breast implants, erection/testicular prostheses, or gluteal implants.
- Medications like puberty blockers (e.g., GnRH analogues) or cross-sex hormones (e.g., high-dose testosterone or estrogen) when used to delay puberty or induce opposite-sex characteristics.
- Exceptions to the Prohibition: Funding is allowed for:
- Puberty-blocking drugs to treat precocious puberty (early onset of puberty), with parental consent.
- Medically necessary treatments for genetic disorders of sex development (e.g., conditions like 46,XX with virilization or 46,XY with undervirilization), abnormal sex chromosome/hormone issues confirmed by testing, infections/injuries from prior procedures, life-threatening physical conditions (not mental health-related), or reversal surgeries to restore alignment with biological sex.
- Definition of Sex: Explicitly defines "sex" as biologically determined: "female" refers to individuals with a reproductive system that produces/transports eggs for fertilization; "male" refers to those producing/transporting sperm. This accounts for natural developmental anomalies but excludes gender identity.
Significant Changes to Existing Law
- Prior to this act, federal Medicaid law did not explicitly prohibit funding for gender transition procedures for minors, allowing states to cover such services under broader Medicaid rules for medically necessary care.
- This introduces a targeted federal ban on funding for these specific procedures for those under 18, overriding state-level decisions on coverage while carving out narrow exceptions for non-gender-related medical needs.
- It expands the list of non-reimbursable Medicaid expenditures in Section 1903(i), previously focused on other ineligible services like certain experimental treatments.
Potential Impacts
- On Government Agencies: The Centers for Medicare & Medicaid Services (CMS) and state Medicaid programs must enforce the ban, potentially requiring new administrative processes to verify procedures and exceptions. States could lose federal matching funds (typically 50-75% of costs) for non-compliant services, increasing state budgets or leading to reduced coverage options.
- On Citizens: Low-income minors (and their families) enrolled in Medicaid who seek gender transition care will no longer have access to federal funding for these services, possibly delaying or preventing treatment. This affects an estimated subset of transgender youth in poverty, while exceptions preserve coverage for unrelated medical conditions like genetic disorders.
- On International Relations: No direct impacts, as the legislation is domestic and focused on U.S. health policy.
Main Stakeholders Affected
- Minors Under 18 on Medicaid: Primarily transgender or gender-diverse youth from low-income families, who may face barriers to gender-affirming care.
- Families and Guardians: Parents or legal guardians of affected minors, who must navigate exceptions and consent requirements.
- Healthcare Providers: Doctors, surgeons, and pharmacists delivering these services, who may need to adjust practices to comply and could face reimbursement denials.
- State and Federal Governments: Medicaid administrators at state and federal levels, responsible for implementation and funding oversight.
- Advocacy Groups: Organizations supporting or opposing gender-affirming care for minors, including medical associations and civil rights groups.
Notable Legal, Constitutional, or Political Implications
- Legal Implications: The act could invite lawsuits challenging the definitions of procedures and sex as overly restrictive or discriminatory, potentially under anti-discrimination laws like Section 1557 of the Affordable Care Act (which prohibits bias in health programs). Enforcement may require CMS guidance on verifying biological sex and exceptions, raising questions about medical privacy.
- Constitutional Implications: May face scrutiny under the 14th Amendment for equal protection (treating transgender minors differently) or substantive due process (interfering with parental rights or bodily autonomy). It does not directly address state bans but could influence ongoing debates on minors' access to care.
- Political Implications: As a partisan measure passed by the House, it highlights divisions on gender identity policies, potentially setting a precedent for federal limits on state Medicaid flexibility while aligning with conservative priorities on youth protections.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Cosponsors (6)
Rep. Greene, Marjorie Taylor [R-GA-14], Rep. Weber, Randy K. Sr. [R-TX-14], Rep. Steube, W. Gregory [R-FL-17], Rep. Davidson, Warren [R-OH-8], Rep. Grothman, Glenn [R-WI-6], Rep. Luna, Anna Paulina [R-FL-13]
Recent Actions
- 2025-12-18: Received in the Senate and Read twice and referred to the Committee on Finance.
- 2025-12-18: Motion to reconsider laid on the table Agreed to without objection.
- 2025-12-18: On passage Passed by the Yeas and Nays: 215 - 201 (Roll no. 362). (text: CR H6057) (Roll call 362)
- 2025-12-18: Passed/agreed to in House: On passage Passed by the Yeas and Nays: 215 - 201 (Roll no. 362). (Roll call 362)
- 2025-12-18: On motion to recommit Failed by the Yeas and Nays: 204 - 212 (Roll no. 361). (Roll call 361)
- 2025-12-18: Considered as unfinished business. (consideration: CR H6072-6073)
- 2025-12-18: POSTPONED PROCEEDINGS - At the conclusion of debate on H.R. 498, the Chair put the question on motion to recommit and by voice vote announced that the noes had prevailed. Mr. Soto demanded the yeas and nays and the Chair postponed further proceedings until a time to be announced.
- 2025-12-18: The previous question on the motion to recommit was ordered pursuant to clause 2(b) of rule XIX.
- 2025-12-18: Mr. Soto moved to recommit to the Committee on Energy and Commerce. (text: CR H6065)
- 2025-12-18: The previous question was ordered pursuant to the rule.
- 2025-12-18: DEBATE - The House proceeded with one hour of debate on H.R. 498.
- 2025-12-18: Rule provides for consideration of H.R. 6703, H.R. 498 and H.R. 3492. The resolution provides for consideration of H.R. 6703 and H.R. 498 under a closed rule and H.R. 3492 under a structured rule with one hour of general debate and one motion to recommit on each bill.
- 2025-12-18: Considered under the provisions of rule H. Res. 953. (consideration: CR H6057-6065)
- 2025-12-17: Rules Committee Resolution H. Res. 953 Reported to House. Rule provides for consideration of H.R. 6703, H.R. 498 and H.R. 3492. The resolution provides for consideration of H.R. 6703 and H.R. 498 under a closed rule and H.R. 3492 under a structured rule with one hour of general debate and one motion to recommit on each bill.
- 2025-01-16: Referred to the House Committee on Energy and Commerce.
Bill Versions
- Do No Harm in Medicaid Act — issued 2025-12-18 — PDF (10 pages)
- Do No Harm in Medicaid Act — issued 2025-01-16 — PDF (7 pages)
- Do No Harm in Medicaid Act — issued 2025-12-18 — PDF (8 pages)