(a) Medicaid

Section 1903(i) of the Social Security Act (42 U.S.C. 1396b(i)) is amended—

(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.