[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 1551 Introduced in Senate (IS)]
<DOC>
119th CONGRESS
1st Session
S. 1551
To deny tax deductions and other Federal funding for the costs of
gender transition procedures.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
May 1, 2025
Mr. Marshall (for himself, Mr. Ricketts, Mr. Cassidy, and Mr. Lee)
introduced the following bill; which was read twice and referred to the
Committee on Finance
_______________________________________________________________________
A BILL
To deny tax deductions and other Federal funding for the costs of
gender transition procedures.
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 ``No Subsidies for Gender Transition
Procedures Act''.
SEC. 2. DENIAL OF MEDICAL EXPENSE TAX DEDUCTION.
(a) In General.--Subsection (d) of section 213 of the Internal
Revenue Code of 1986 is amended by adding at the end the following new
paragraph:
``(12) Expenses relating to gender transition.--
``(A) In general.--The term `medical care' does not
include any gender transition procedure.
``(B) Definitions.--For purposes of this
paragraph--
``(i) Gender transition procedure.--
``(I) In general.--The term `gender
transition procedure' means any
hormonal or surgical intervention for
the purpose of gender transition,
including--
``(aa) the provision of
gonadotropin-releasing hormone
agonists or other puberty-
suppression drugs or puberty-
blocking drugs to stop or delay
normally-timed puberty in an
individual who does not
identify as his or her sex,
``(bb) the provision of
testosterone, estrogen,
progesterone, or other androgen
blockers to an individual at
doses which are
supraphysiologic to what would
normally be produced
endogenously in a healthy
individual of the same age and
sex, with the intent to align
an individual's physical
appearance with an identity
that differs from his or her
sex,
``(cc) surgical procedures
that attempt to transform an
individual's physical
appearance to align with an
identity that differs from his
or her sex or that attempt to
alter or remove an individual's
sexual organs to minimize or
destroy their natural
biological functions,
``(dd) castration,
vasectomy, penectomy,
orchiectomy, vaginoplasty,
clitoroplasty, vulvoplasty,
mastectomy, hysterectomy,
oophorectomy, ovariectomy,
reconstruction of the fixed
part of the urethra with or
without metoidioplasty or
phalloplasty, metoidioplasty,
phalloplasty, vaginectomy,
scrotoplasty, implantation of
erection or testicular
prostheses, reduction
thyrochondroplasty,
chondrolaryngoplasty, tubal
ligation, sterilization,
augmentation mammoplasty,
placement of chest implants to
create feminine breasts,
placement of fat or artificial
implants in the gluteal region,
liposuction, lipofilling, voice
surgery, hair reconstruction,
pectoral implants, any plastic,
cosmetic, or aesthetic surgery
which feminizes or masculinizes
the facial or other
physiological features of an
individual, and any removal of
any otherwise healthy or non-
diseased body part or tissue.
``(II) Exclusions.--The term
`gender transition procedure' does not
include, when furnished to an
individual by a health care provider
with the consent of such individual
(or, if applicable, such individual's
parents or legal guardian)--
``(aa) services to
individuals born with a
medically verifiable disorder
of sex development, including
an individual with external sex
characteristics which are
irresolvably ambiguous, such as
an individual born with 46 XX
chromosomes with virilization,
an individual born with 46 XY
chromosomes with
undervirilization, or an
individual born having both
ovarian and testicular tissue,
``(bb) services relating to
any other physician-diagnosed
disorder of sexual development
with respect to which the
physician has determined
through genetic or biochemical
testing that the individual
does not have normal sex
chromosome structure, sex
steroid hormone production, or
sex steroid hormone action for
a healthy male or female of the
same age,
``(cc) the treatment of any
infection, injury, disease, or
disorder caused or exacerbated
by the performance of gender
transition procedures, without
regard to whether the gender
transition procedure was
performed in accordance with
State and Federal law or
whether the gender transition
procedure is treated as medical
care under this section,
``(dd) any procedure
undertaken because the
individual suffers from a
physical disorder, physical
injury, or physical illness
(but not mental, behavioral, or
emotional distress or a mental,
behavioral, or emotional
disorder) which would, as
certified by a physician, place
the individual in imminent
danger of death or impairment
of major bodily function unless
the procedure is performed to
alleviate said physical
disorder, physical injury, or
physical illness,
``(ee) procedures to
restore or reconstruct the body
of the individual in order to
correspond to the individual's
sex after one or more previous
gender transition procedures,
which may include the removal
of a pseudo phallus or breast
augmentation,
``(ff) puberty suppression
or puberty-blocking
prescription drugs for the
purpose of normalizing puberty
for a minor experiencing
precocious puberty, or
``(gg) male circumcision.
``(ii) Gender transition.--The term `gender
transition' means the process by which an
individual goes from identifying with or
presenting as his or her sex to identifying
with or presenting as a self-proclaimed
identity which does not correspond with or is
different from his or her sex, and may be
accompanied by social, legal, or physical
changes.
``(iii) Sex.--The term `sex', when
referring to an individual's sex, means either
male or female, as biologically determined.
``(iv) Female.--The term `female', when
used to refer to a natural person, means a
person belonging, at conception, to the sex
characterized by a reproductive system with the
biological function of producing eggs (ova).
``(v) Male.--The term `male', when used to
refer to a natural person, means a person
belonging, at conception, to the biological sex
characterized by a reproductive system with the
biological function of producing sperm.''.
(b) Effective Date.--The amendment made by this section shall apply
to taxable years beginning after the date of the enactment of this Act.
SEC. 3. PROHIBITING FEDERAL MEDICAID FUNDING FOR GENDER TRANSITION
PROCEDURES.
(a) In General.--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 amounts expended for any
specified gender transition procedure (as defined in section
1905(kk)) to an individual enrolled in a State plan under this
title (or a waiver of such plan), including any amounts
expended for the administration of a State program that
furnishes any such procedure.''; and
(4) in the flush left matter at the end, by striking ``and
(18),'' and inserting ``(18), and (28)''.
(b) Prohibiting Federal Medicaid Funding for Gender Transition
Procedures.--Section 1905 of the Social Security Act (42 U.S.C. 1396d)
is amended by adding at the end the following new subsection:
``(kk) Prohibiting Federal Medicaid Funding for Specified Gender
Transition Procedures.--
``(1) Specified gender transition procedures defined.--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 hormonal or surgical
intervention for the purpose of gender transition, including--
``(A) the provision of gonadotropin-releasing
hormone agonists or other puberty suppression drugs or
puberty-blocking drugs to stop or delay normally timed
puberty in an individual who does not identify as his
or her sex;
``(B) the provision of testosterone, estrogen,
progesterone, or other androgen blockers to an
individual at doses which are supraphysiologic to what
would normally be produced endogenously in a healthy
individual of the same age and sex, with the intent to
align an individual's physical appearance with an
identity that differs from his or her sex;
``(C) surgical procedures that attempt to transform
an individual's physical appearance to align with an
identity that differs from his or her sex or that
attempt to alter or remove an individual's sexual
organs to minimize or destroy their natural biological
functions; or
``(D) castration, vasectomy, penectomy,
orchiectomy, vaginoplasty, clitoroplasty, vulvoplasty,
mastectomy, hysterectomy, oophorectomy, ovariectomy,
reconstruction of the fixed part of the urethra with or
without metoidioplasty or phalloplasty, metoidioplasty,
phalloplasty, vaginectomy, scrotoplasty, implantation
of erection or testicular prostheses, reduction
thyrochondroplasty, chondrolaryngoplasty, tubal
ligation, sterilization, augmentation mammoplasty,
placement of chest implants to create feminine breasts,
placement of fat or artificial implants in the gluteal
region, liposuction, lipofilling, voice surgery, hair
reconstruction, pectoral implants, any plastic,
cosmetic, or aesthetic surgery which feminizes or
masculinizes the facial or other physiological features
of an individual, and any removal of any otherwise
healthy or non-diseased body part or tissue.
``(2) Exclusions.--The term `specified gender transition
procedure' shall not include, when furnished to an individual
by a health care provider with the consent of such individual
(or, if applicable, the parents or legal guardian of such
individual)--
``(A) services to individuals born with a medically
verifiable disorder of sex development, including an
individual with external sex characteristics which are
irresolvably ambiguous, such as an individual born with
46 XX chromosomes with virilization, an individual born
with 46 XY chromosomes with undervirilization, or an
individual born having both ovarian and testicular
tissue;
``(B) services relating to any other physician-
diagnosed disorder of sexual development with respect
to which the physician has determined through genetic
or biochemical testing that the individual does not
have normal sex chromosome structure, sex steroid
hormone production, or sex steroid hormone action for a
healthy male or female of the same age;
``(C) the treatment of any infection, injury,
disease, or disorder caused or exacerbated by the
performance of gender transition procedures, without
regard to whether the gender transition procedure was
performed in accordance with State and Federal law or
whether the gender transition procedure is treated as
medical care under this section;
``(D) any procedure undertaken because the
individual suffers from a physical disorder, physical
injury, or physical illness (but not mental,
behavioral, or emotional distress or a mental,
behavioral, or emotional disorder) which would, as
certified by a physician, place the individual in
imminent danger of death or impairment of major bodily
function unless the procedure is performed to alleviate
said physical disorder, physical injury, or physical
illness;
``(E) any procedure to restore or reconstruct the
body of the individual in order to correspond to the
individual's sex after 1 or more previous gender
transition procedures, which may include the removal of
a pseudo phallus or breast augmentation;
``(F) puberty suppression or puberty-blocking
prescription drugs for the purpose of normalizing
puberty for an individual experiencing precocious
puberty; or
``(G) male circumcision.
``(3) Additional definitions.--For purposes of this
subsection:
``(A) Gender transition.--The term `gender
transition' means the process by which an individual
goes from identifying with or presenting as his or her
sex to identifying with or presenting as a self-
proclaimed identity which does not correspond with or
is different from his or her sex, and may be
accompanied by social, legal, or physical changes.
``(B) Sex.--The term `sex', when referring to an
individual's sex, means either male or female, as
biologically determined, including as described in
subparagraphs (C) and (D).
``(C) Female.--The term `female', when used to
refer to a natural person, means an individual
belonging, at conception, to the sex characterized by a
reproductive system with the biological function of
producing eggs (ova).
``(D) Male.--The term `male', when used to refer to
a natural person, means an individual belonging, at
conception, to the biological sex characterized by a
reproductive system with the biological function of
producing sperm.''.
(c) Effective Date.--The amendments made by this section shall
apply to services furnished on or after the date of the enactment of
this Act.
SEC. 4. PROHIBITING FEDERAL CHILDREN'S HEALTH INSURANCE PROGRAM FUNDING
FOR GENDER TRANSITION PROCEDURES ON MINORS.
(a) In General.--Section 2105(c) of the Social Security Act (42
U.S.C. 1397ee(c)) is amended by adding at the end the following new
paragraph:
``(13) Limitation on payment for specified gender
transition procedures for minors.--Payment shall not be made to
a State under this section for any amount expended under the
State plan to pay for specified gender transition procedures
(as defined in section 1905(kk)) or to assist in the purchase,
in whole or in part, of health benefit coverage that includes
coverage of any such procedure.''.
(b) Conforming Amendment.--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) Effective Date.--The amendments made by this section shall
apply to services furnished on or after the date of the enactment of
this Act.
SEC. 5. PROHIBITING FEDERAL MEDICARE FUNDING FOR GENDER TRANSITION
PROCEDURES.
(a) In General.--Section 1862(a) of the Social Security Act (42
U.S.C. 1395y(a)) is amended--
(1) in paragraph (24), by striking ``or'' at the end;
(2) in paragraph (25), by striking the period at the end
and inserting ``; or''; and
(3) by inserting after paragraph (25) the following new
paragraph:
``(26) which are specified gender transition procedures (as
defined in section 1905(kk)).''.
(b) Effective Date.--The amendments made by subsection (a) shall
apply to items and services furnished on or after the date of the
enactment of this Act.
SEC. 6. EXCLUSION OF GENDER TRANSITION PROCEDURES FROM ESSENTIAL HEALTH
BENEFITS.
Section 1302(b)(2) of the Patient Protection and Affordable Care
Act (42 U.S.C. 18022(b)(2)) is amended--
(1) in the paragraph heading, by striking ``Limitation''
and inserting ``Limitations'';
(2) by redesignating subparagraph (B) as subparagraph (C);
(3) by inserting after subparagraph (A) the following:
``(B) Exclusions.--In defining the essential health
benefits under paragraph (1), or in revising essential
health benefits under paragraph (4)(H), the Secretary
shall not include the category of gender transition
procedures (as defined in section 213(d)(12)(B) of the
Internal Revenue Code of 1986) or any items or services
covered within such a category.''; and
(4) in subparagraph (C) (as so redesignated), by striking
``paragraph (2)'' and inserting ``subparagraph (A)''.
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