Do No Harm in Medicaid Act

The bill would amend the Social Security Act to add gender transition procedures for minors to the list of services for which federal Medicaid reimbursement is prohibited. It defines "specified gender transition procedures" broadly to include a detailed list of surgeries (such as mastectomy, orchiectomy, phalloplasty, and vaginoplasty), implants, and medications (such as puberty-blocking GnRH analogues and supraphysiologic doses of sex hormones) when provided with the intent of changing a minor's body away from biological sex. The bill also defines "sex" for its own purposes as biologically determined.

Exceptions preserve federal Medicaid coverage — with parental or guardian consent — for procedures addressing precocious puberty, medically verifiable genetic disorders of sex development, conditions certified as placing the individual in imminent danger of death or major bodily harm, and procedures to restore the body after a prior gender transition procedure. Mental distress alone would not qualify as a basis for the imminent-danger exception.

Medicaid-enrolled individuals under 18 who seek or receive gender transition procedures, their parents and guardians, and the health care providers who furnish those services. State Medicaid programs that currently cover such procedures would lose federal matching funds for them, shifting any continued coverage cost entirely to state budgets.

States covering gender transition procedures for Medicaid-enrolled minors would have to choose between dropping coverage or absorbing the full cost without federal matching dollars. For low-income families whose children are enrolled in Medicaid, federal defunding could make these services financially inaccessible. Providers operating in state Medicaid programs would face changed billing and reimbursement conditions for this category of care.

The bill is largely self-executing through the Medicaid payment-exclusion mechanism: it adds a new paragraph to the existing list of services for which federal financial participation is disallowed under Section 1903(i) of the Social Security Act. States would receive no federal matching funds for covered expenditures, including administrative costs of programs furnishing these services to minors. No rulemaking is specified, but the Centers for Medicare and Medicaid Services would need to update Medicaid guidance and auditing practices to enforce the exclusion. Providers and states would need to track which procedures fall within the defined terms and which qualify for the stated exceptions.