Health Care Freedom for Patients Act of 2025

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 3386 Placed on Calendar Senate (PCS)]

<DOC>

                                                       Calendar No. 285
119th CONGRESS
  1st Session
                                S. 3386

To provide a health savings account contribution to certain enrollees,
          to reduce health care costs, and for other purposes.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

             December 8 (legislative day, December 4), 2025

Mr. Crapo (for himself and Mr. Cassidy) introduced the following bill;
                     which was read the first time

                            December 8, 2025

            Read the second time and placed on the calendar

_______________________________________________________________________

                                 A BILL

To provide a health savings account contribution to certain enrollees,
          to reduce health care costs, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Health Care
Freedom for Patients Act of 2025''.
    (b) Table of Contents.--The table of contents for this Act is as
follows:

Sec. 1. Short title; table of contents.
            TITLE I--INCREASING CHOICE AND REDUCING PREMIUMS

Sec. 101. Exchange plan HSAs.
Sec. 102. Exchange plan HSA contribution program.
Sec. 103. Funding cost-sharing reduction payments.
Sec. 104. Allowing all individuals purchasing health insurance in the
                            individual market the option to purchase a
                            lower premium plan.
               TITLE II--PUTTING AMERICAN PATIENTS FIRST

Sec. 201. Expansion FMAP for certain States providing payments for
                            health care furnished to certain
                            individuals.
Sec. 202. Prohibiting Federal financial participation under Medicaid
                            and CHIP for individuals without verified
                            citizenship, nationality, or satisfactory
                            immigration status.
                TITLE III--PREVENTING WASTEFUL SPENDING

Sec. 301. Prohibiting coverage of gender transition procedures as an
                            essential health benefit under plans
                            offered by Exchanges.
Sec. 302. Prohibiting Federal Medicaid and CHIP funding for certain
                            items and services.

            TITLE I--INCREASING CHOICE AND REDUCING PREMIUMS

SEC. 101. EXCHANGE PLAN HSAS.

    (a) In General.--Section 223 of the Internal Revenue Code of 1986
is amended by adding at the end the following new subsection:
    ``(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--
                    ``(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),
        shall not be treated as paid for medical care.''.
    (b) Treatment of Governmental Contributions.--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:
                    ``(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)).''.
    (c) Effective Date.--The amendments made by this section shall
apply to taxable years beginning after December 31, 2025.

SEC. 102. EXCHANGE PLAN HSA CONTRIBUTION PROGRAM.

    (a) In General.--As soon as administratively feasible, the
Secretary of Health and Human Services shall make payments to the
Exchange plan HSA of each individual who is an eligible enrollee, for
each month which is an eligible month with respect to such individual,
in the amount described in subsection (c).
    (b) Eligible Month.--For purposes of this section, the term
``eligible month'' with respect to an individual means a calendar
month--
            (1) occurring in calendar year 2026 or 2027, and
            (2) for which the individual is enrolled in a bronze level
        qualified health plan or a catastrophic plan through an
        Exchange established under subtitle D of title I of the Patient
        Protection and Affordable Care Act (42 U.S.C. 18021 et seq.).
    (c) Payment Amount.--The amount of each payment under subsection
(a) for any individual for an eligible month is \1/12\ of--
            (1) $1,000, in the case of an eligible enrollee who has
        attained age 18, and has not attained age 50, as of the first
        day of the calendar year which includes such month, and
            (2) $1,500, in the case of an eligible enrollee who has
        attained age 50, and has not attained age 65, as of the first
        day of such calendar year.
    (d) Eligible Enrollee.--For purposes of this section, with respect
to months occurring during a calendar year, the term ``eligible
enrollee'' means an eligible individual (as defined in section
223(c)(1) of the Internal Revenue Code of 1986)--
            (1) who has attained age 18, and has not attained age 65,
        as of the first day of such calendar year,
            (2) in the case of an alien, who is an eligible alien, as
        defined in section 36B(e)(2)(B) of such Code (as in effect for
        taxable years beginning after December 31, 2026, applied by
        substituting ``for which the payment under section 102(a) of
        the Health Care Freedom for Patients Act of 2025 is made'' for
        ``for which the credit under this section is being claimed''),
        and
            (3) whose household income, expressed as a percent of the
        poverty line for the family size involved, does not exceed 700
        percent.
    (e) Determination of Eligibility.--
            (1) In general.--Upon election pursuant to paragraph (2) by
        an individual enrolling in a plan described in subsection
        (b)(2), the Secretary of Health and Human Services shall make a
        determination of the individual's status as an eligible
        enrollee on the basis of the latest determination pursuant to
        section 1412 of the Patient Protection and Affordable Care Act
        (42 U.S.C. 18082) of the individual's eligibility for the
        advance payment of the premium tax credits under section 36B of
        the Internal Revenue Code of 1986 and cost-sharing reductions
        under section 1402 of such Act (42 U.S.C. 18071).
            (2) Election.--At such time and in such manner as the
        Secretary of Health and Human Services shall provide, an
        eligible enrollee shall notify the Secretary of such enrollee's
        election to receive the payments under subsection (a) and shall
        provide--
                    (A) the social security number of such eligible
                enrollee,
                    (B) in the case of an alien, an attestation that
                the individual is an eligible alien, and
                    (C) sufficient information to allow for the
                identification of, and deposit of the payments under
                subsection (a) into, the Exchange plan HSA of the
                eligible enrollee.
            (3) Reporting by exchange.--The Exchange through which an
        individual is enrolling in a plan described in subsection
        (b)(2) shall provide to the Secretary of Health and Human
        Services the information provided by the individual which is
        necessary for the determination under paragraph (1).
            (4) Timing of payments.--The payments under subsection (a)
        with respect to any eligible months occurring before the
        determination under paragraph (1) is completed shall be made as
        early as possible after the completion of such determination.
    (f) Tax Treatment of Contributions.--For purposes of the Internal
Revenue Code of 1986, payments under subsection (a) shall not be
included in gross income of an eligible enrollee.
    (g) Definitions.--For purposes of this section--
            (1) Exchange plan hsa.--The term ``Exchange plan HSA'' has
        the meaning given such term in section 223(i) of the Internal
        Revenue Code of 1986.
            (2) Household income; poverty line.--The terms ``household
        income'', ``poverty line'', and ``family size'' have the same
        respective meanings and shall be determined in the same manner
        as for purposes of section 36B of the Internal Revenue Code of
        1986.
            (3) Bronze level qualified health plan.--The term ``bronze
        level qualified health plan'' means a qualified health plan, as
        defined in section 1301(a) of the Patient Protection and
        Affordable Care Act (42 U.S.C. 18021(a)), in the bronze level,
        as defined in section 1302(d)(1)(A) of such Act (42 U.S.C.
        18022(d)(1)(A)).
            (4) Catastrophic plan.--The term ``catastrophic plan''
        means a plan described in section 1302(e) of such Act (42
        U.S.C. 18022(e)).
    (h) Regulatory Authority.--The Secretary of Health and Human
Services shall prescribe such regulations or other guidance as are
necessary to carry out the purposes of this section.
    (i) Funding.--In addition to amounts otherwise available, there is
appropriated to the Secretary of Health and Human Services, out of any
money in the Treasury not otherwise appropriated, $10,000,000,000 for
each of fiscal years 2026 and 2027, to remain available until September
30, 2028, to carry out the purposes of this section.
    (j) Information Sharing.--Paragraph (21) of section 6103(l) of the
Internal Revenue Code of 1986 is amended--
            (1) 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'',
            (2) by inserting ``, program, or payment'' after ``(and the
        amount thereof)'' in subparagraph (A)(v), and
            (3) by striking ``State programs'' in subparagraph (C)(ii)
        and inserting ``State programs or payment''.

SEC. 103. FUNDING COST-SHARING REDUCTION PAYMENTS.

    Section 1402 of the Patient Protection and Affordable Care Act (42
U.S.C. 18071) is amended by adding at the end the following:
    ``(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.''.

SEC. 104. ALLOWING ALL INDIVIDUALS PURCHASING HEALTH INSURANCE IN THE
              INDIVIDUAL MARKET THE OPTION TO PURCHASE A LOWER PREMIUM
              PLAN.

    (a) In General.--Section 1302(e) of the Patient Protection and
Affordable Care Act (42 U.S.C. 18022(e)) is amended--
            (1) in paragraph (1)--
                    (A) by redesignating clauses (i) and (ii) of
                subparagraph (B) as subparagraphs (A) and (B),
                respectively, and adjusting the margins accordingly;
                    (B) by striking ``plan year if--'' and all that
                follows through ``the plan provides--'' and inserting
                ``plan year if the plan provides--''; and
                    (C) in subparagraph (A), as redesignated by
                paragraph (1), by striking ``clause (ii)'' and
                inserting ``subparagraph (B)'';
            (2) by striking paragraph (2); and
            (3) by redesignating paragraph (3) as paragraph (2).
    (b) Risk Pools.--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''.
    (c) Conforming Amendment.--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)''.
    (d) Effective Date.--The amendments made by subsections (a), (b),
and (c) shall apply with respect to plan years beginning on or after
January 1, 2027.

               TITLE II--PUTTING AMERICAN PATIENTS FIRST

SEC. 201. EXPANSION FMAP FOR CERTAIN STATES PROVIDING PAYMENTS FOR
              HEALTH CARE FURNISHED TO CERTAIN INDIVIDUALS.

    Section 1905 of the Social Security Act (42 U.S.C. 1396d) is
amended--
            (1) in subsection (y)--
                    (A) 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
                    (B) in paragraph (2), by adding at the end the
                following new subparagraph:
                    ``(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)'.''; and
            (2) in subsection (z)(2)--
                    (A) in subparagraph (A), by striking ``for such
                year'' and inserting ``for such quarter''; and
                    (B) in subparagraph (B)(i)--
                            (i) in the matter preceding subclause (I),
                        by striking ``for a year'' and inserting ``for
                        a calendar quarter in a year''; and
                            (ii) in subclause (II), by striking ``for
                        the year'' and inserting ``for the quarter for
                        the State''.

SEC. 202. PROHIBITING FEDERAL FINANCIAL PARTICIPATION UNDER MEDICAID
              AND CHIP FOR INDIVIDUALS WITHOUT VERIFIED CITIZENSHIP,
              NATIONALITY, OR SATISFACTORY IMMIGRATION STATUS.

    (a) In General.--
            (1) Medicaid.--Section 1903(i)(22) of the Social Security
        Act (42 U.S.C. 1396b(i)(22)) is amended--
                    (A) by adding ``and'' at the end;
                    (B) by striking ``to amounts'' and inserting "to--
                ``
                    ``(A) amounts''; and
                    (C) by adding at the end the following new
                subparagraph:
                    ``(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--
                            ``(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),
                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;''.
            (2) CHIP.--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)''.
    (b) Eliminating State Requirement to Provide Medical Assistance
During Reasonable Opportunity Period.--
            (1) Documentary evidence of citizenship or nationality.--
        Section 1903(x)(4) of the Social Security Act (42 U.S.C.
        1396b(x)) is amended--
                    (A) by striking ``under clauses (i) and (ii) of
                section 1137(d)(4)(A)'' and inserting ``under section
                1137(d)(4)''; and
                    (B) 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.
            (2) Social security data match.--Section 1902(ee) of the
        Social Security Act (42 U.S.C. 1396a(ee)) is amended--
                    (A) in paragraph (1)(B)(ii)--
                            (i) 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
                            (ii) in subclause (III), by inserting ``,
                        or denies eligibility for medical assistance
                        under this title for such individual, as
                        applicable'' after ``under this title''; and
                    (B) in paragraph (2)(C)--
                            (i) by striking ``under clauses (i) and
                        (ii) of section 1137(d)(4)(A)'' and inserting
                        ``under section 1137(d)(4)''; and
                            (ii) 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.
            (3) Individuals with satisfactory immigration status.--
        Section 1137(d)(4) of the Social Security Act (42 U.S.C. 1320b-
        7(d)(4)) is amended--
                    (A) 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
                    (B) 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''.
    (c) Option to Continue Providing Medical Assistance During
Reasonable Opportunity Period.--
            (1) Medicaid.--Section 1902(a)(46) of the Social Security
        Act (42 U.S.C. 1396a(a)(46)) is amended--
                    (A) in subparagraph (A), by striking ``and'' at the
                end;
                    (B) in subparagraph (B)(ii), by adding ``and'' at
                the end; and
                    (C) by inserting after subparagraph (B)(ii) the
                following new subparagraph:
            ``(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);''.
            (2) CHIP.--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:
                    ``(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.''.
    (d) Effective Date.--The amendments made by this section shall
apply beginning on October 1, 2026.

                TITLE III--PREVENTING WASTEFUL SPENDING

SEC. 301. PROHIBITING COVERAGE OF GENDER TRANSITION PROCEDURES AS AN
              ESSENTIAL HEALTH BENEFIT UNDER PLANS OFFERED BY
              EXCHANGES.

    (a) In General.--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:
                    ``(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.''.
    (b) Gender Transition Procedure Defined.--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:
    ``(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.''.

SEC. 302. PROHIBITING FEDERAL MEDICAID AND CHIP FUNDING FOR CERTAIN
              ITEMS AND SERVICES.

    (a) Medicaid.--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'';
            (3) by inserting after paragraph (27) the following new
        paragraph:
            ``(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).''; and
            (4) in the flush left matter at the end, by striking ``and
        (18),'' and inserting ``(18), and (28)''.
    (b) CHIP.--Section 2107(e)(1)(O) of the Social Security Act (42
U.S.C. 1397gg(e)(1)(O)), as amended by this Act, is further amended by
striking ``and (22)'' and inserting ``(22), and (28)''.
    (c) Specified Gender Transition Procedures Defined.--Section 1905
of the Social Security Act (42 U.S.C. 1396d) is amended by adding at
the end the following new subsection:
    ``(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.''.
                                                       Calendar No. 285

119th CONGRESS

  1st Session

                                S. 3386

_______________________________________________________________________

                                 A BILL

To provide a health savings account contribution to certain enrollees,
          to reduce health care costs, and for other purposes.

_______________________________________________________________________

                            December 8, 2025

            Read the second time and placed on the calendar