AN ACT
To provide for reconciliation pursuant to title II of H. Con. Res. 14.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``One Big Beautiful Bill Act''.
. . .
SEC. 44125. PROHIBITING FEDERAL MEDICAID AND CHIP FUNDING FOR GENDER
TRANSITION PROCEDURES.
(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(kk))
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)(N) of the Social Security Act (42
U.S.C. 1397gg(e)(1)(N)) is amended by striking ``and (17)'' and
inserting ``(17), 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:
``(kk) 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 prostheses.
``(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 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 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 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.''.