Do No Harm in Medicaid Act

Bill Summary: Do No Harm in Medicaid Act (H.R. 498)

Overview

The Do No Harm in Medicaid Act (H.R. 498) is a legislative proposal designed to prohibit the use of federal Medicaid funds to pay for gender transition procedures and medications for individuals under the age of 18. The bill seeks to amend the Social Security Act to ensure that federal healthcare dollars are not used for medical interventions intended to align a minor's physical appearance or bodily functions with a gender identity different from their biological sex.

Key Provisions

1. Prohibition of Funding

The bill prohibits federal Medicaid funding (including state plans and waivers) for "specified gender transition procedures" administered to individuals under 18. This prohibition extends not only to the medical procedures themselves but also to the administrative costs of running state programs that provide these services to minors.

2. Defined "Specified Gender Transition Procedures"

The Act provides a comprehensive list of prohibited services, including:
* Surgical Procedures: A wide range of surgeries, including mastectomies, phalloplasty, vaginoplasty, and various other genital or facial plastic/cosmetic surgeries intended to feminize or masculinize an individual.
* Implants: The placement of chest implants, erection or testicular prostheses, and gluteal implants.
* Medications: The administration of puberty-blocking drugs (such as GnRH analogues) and the use of supraphysiologic doses of testosterone, estrogen, or progesterone.

3. Legal Definitions of Sex

To implement these restrictions, the bill establishes strict biological definitions of sex:
* Female: An individual who naturally possesses the reproductive system that produces, transports, and utilizes eggs for fertilization.
* Male: An individual who naturally possesses the reproductive system that produces, transports, and utilizes sperm for fertilization.

Exemptions

The bill includes specific exceptions where Medicaid funding would still be permitted, provided there is consent from a parent or legal guardian:
* Precocious Puberty: Puberty-blocking drugs used to normalize puberty for those experiencing it prematurely.
* Genetic Disorders: Treatments for medically verifiable genetic disorders of sex development.
* Medical Necessity: Procedures to treat infections, diseases, or injuries resulting from previous gender-transition procedures, or emergency procedures to prevent death or major bodily impairment (explicitly excluding procedures performed solely to alleviate mental distress).
* Reconstructive Surgery: Procedures to restore the body to its biological sex after previous transition procedures.

Affected Parties

• Minors (Under 18): Individuals enrolled in Medicaid who seek gender-affirming healthcare will no longer have access to federal funding for these services.
• State Governments: States will be unable to use federal Medicaid matching funds to provide or administer gender transition services for minors.
• Healthcare Providers: Providers who rely on Medicaid reimbursement for these specific pediatric services will see a loss of federal funding for such treatments.

Procedural Status

• Introduced: January 16, 2025.
• House Action: Passed the House of Representatives on December 18, 2025, with a vote of 215 - 201.
• Senate Action: Received in the Senate on December 18, 2025, and referred to the Committee on Finance.