[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
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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