Do No Harm in Medicaid Act
Key claim: The Do No Harm in Medicaid Act (HR498) prohibits federal Medicaid payment for gender transition procedures intended to change the body of individuals under 18 to no longer correspond to biological sex, while excluding parental-consent treatments for early puberty, genetic or chromosomal disorders, reversal of prior procedures, or prevention of imminent death or major bodily impairment.
Abstract
(HR498 · 119th Congress) Do No Harm in Medicaid Act This bill prohibits federal Medicaid payment for specified gender transition procedures for individuals under the age of 18. The bill defines these procedures to mean those that are intended to change the body of an individual to no longer correspond to the individual’s biological sex (male or female), including specified surgeries, implants, and medications (e.g., hormones). The bill excludes procedures that are provided to an individual under the age of 18 with the consent of a parent or legal guardian and that are intended to (1) rectify early puberty, genetic disorders, or chromosomal abnormalities; (2) reverse prior gender transition procedures; or (3) prevent imminent death or impairment of a major bodily function. Latest action (2025-12-18): Received in the Senate and Read twice and referred to the Committee on Finance.
Why this matters
For Medicaid-enrolled minors and their families, HR498 would remove federal payment for a defined set of gender transition procedures, likely shifting coverage decisions to state Medicaid funds, private insurance, or out-of-pocket payment and effectively curtailing access for lower-income youth. The bill’s carve-outs (precocious puberty, intersex/chromosomal conditions, reversal, life-threatening complications) indicate an attempt to isolate elective transition care from other pediatric endocrine and surgical uses of the same drugs and procedures, a distinction that will be contested clinically and legally. It fits a broader pattern of federal funding-conditionality tools being used to shape contested medical care pathways.