,i  #aai? ,,congress  #a/ ,session  ,h4 
,r4 #cbje  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,may #e1 #bjbe ,ms4   
,t5ney 7= h]self & ,mr4 ,cr5%aw7        
introduc$ ! foll[+ bill2 :i* 0 ref]r$ to
 ! ,committee on ,en]gy & ,comm]ce1 & 9 
addition to ! ,committee on ,ways &     
,means1 = a p]iod to be subsequ5tly     
det]m9$ by ! ,speak]1 9 ea* case =      
consid]ation ( su* provisions z fall )9 
! jurisdiction ( ! committee conc]n$  ,a
 ,,bill  ,to d5y tax d$uctions & o!r    
,f$]al fund+ = ! co/s ( g5d] transition 
proc$ures4  #a4 ,%ort title ,?is ,act   
may be cit$ z ! ,no ,subsidies = ,g5d]  
,transition ,proc$ures ,act4  #b4 ,d5ial
 ( m$ical exp5se tax d$uction  7a7 ,9   
g5]al ,subsection 7d7 ( section #bac ( !
 ,int]nal ,rev5ue ,code ( #aihf is am5d$
 by add+ at ! end ! foll[+ new p>agraph3
  7#ab7 ,exp5ses relat+ to g5d]         
transition  7,a7 ,9 g5]al ,! t]m m$ical 
c>e does n include any g5d] transition  
proc$ure4  7,b7 ,def9itions ,= purposes 
( ?is p>agraph--  7i7 ,g5d] transition  

proc$ure  7,i7 ,9 g5]al ,! t]m g5d]     
transition proc$ure means any hormonal  
or surgical int]v5tion = ! purpose (    
g5d] transition1 includ+-- 7aa7 !       
provision ( gonadotrop9-releas+ hormone 
agoni/s or o!r pub]ty-suppression drugs 
or pub]ty-block+ drugs to /op or delay  
normally-tim$ pub]ty 9 an individual :o 
does n id5tify z 8 or h] sex1  7bb7 !   
provision ( te/o/]one1 e/rog51          
proge/]one1 or o!r &rog5 block]s to an  
individual at doses :i* are             
supraphysiologic to :at w\ld normally be
 produc$ endog5\sly 9 a heal?y          
individual ( ! same age & sex1 ) ! int5t
 to align an individual's physical      
appe>ance ) an id5tity t diff]s f 8 or  
h] sex1  7cc7 surgical proc$ures t      
attempt to trans=m an individual's      
physical appe>ance to align ) an id5tity
 t diff]s f 8 or h] sex or t attempt to 
alt] or remove an individual's sexual   
organs to m9imize or de/roy _! natural  
biological functions1  7dd7 ca/ration1  
vasectomy1 p5ectomy1 or*iectomy1        

vag9opla/y1 clitoropla/y1 vulvopla/y1   
ma/ectomy1 hy/]ectomy1 oophorectomy1    
ov>iectomy1 recon/ruction ( ! fix$ "p ( 
! ure?ra ) or )\t metoidiopla/y or      
phallopla/y1 metoidiopla/y1 phallopla/y1
 vag9ectomy1 scrotopla/y1 implantation (
 erection or te/icul> pro/heses1        
r$uction ?yro*ondropla/y1               
*ondrol>yngopla/y1 tubal ligation1      
/]ilization1 augm5tation mammopla/y1    
placem5t ( *e/ implants to create fem99e
 brea/s1 placem5t ( fat or artificial   
implants 9 ! gluteal region1            
liposuction1 lip(ill+1 voice surg]y1    
hair recon/ruction1 pectoral implants1  
any pla/ic1 cosmetic1 or ae/hetic surg]y
 :i* fem9izes or mascul9izes ! facial or
 o!r physiological features ( an        
individual1 & any removal ( any o!rwise 
heal?y or non-diseas$ body "p or tissue4
  7,,ii7 ,exclusions ,! t]m g5d]        
transition proc$ure does n include1 :5  
furni%$ to an individual by a heal? c>e 
provid] ) ! cons5t ( su* individual 7or1
 if applicable1 su* individual's p>5ts  

or legal gu>dian7--  7aa7 s]vices to    
individuals born ) a m$ically v]ifiable 
disord] ( sex developm5t1 includ+ an    
individual ) ext]nal sex *>act]i/ics :i*
 are irresolvably ambigu\s1 su* z an    
individual born ) #df ,,xx *romosomes ) 
virilization1 an individual born ) #df  
,,xy *romosomes ) und]virilization1 or  
an individual born hav+ bo? ov>ian &    
te/icul> tissue1  7bb7 s]vices relat+ to
 any o!r physician-diagnos$ disord] (   
sexual developm5t ) respect to :i* !    
physician has det]m9$ ?r\gh g5etic or   
bio*emical te/+ t ! individual does n h 
normal sex *romosome /ructure1 sex /]oid
 hormone production1 or sex /]oid       
hormone action = a heal?y male or female
 ( ! same age1  7cc7 ! treatm5t ( any   
infection1 injury1 disease1 or disord]  
caus$ or exac]bat$ by ! p]=mance ( g5d] 
transition proc$ures1 )\t reg>d to :e!r 
! g5d] transition proc$ure 0 p]=m$ 9    
accordance ) ,/ate & ,f$]al law or :e!r 
! g5d] transition proc$ure is treat$ z  
m$ical c>e "u ?is section1  7dd7 any    

proc$ure und]tak5 because ! individual  
suff]s f a physical disord]1 physical   
injury1 or physical illness 7b n m5tal1 
behavioral1 or emotional di/ress or a   
m5tal1 behavioral1 or emotional disord]7
 :i* w\ld1 z c]tifi$ by a physician1    
place ! individual 9 imm95t dang] ( dea?
 or impairm5t ( major bodily function   
unless ! proc$ure is p]=m$ to alleviate 
said physical disord]1 physical injury1 
or physical illness1  7ee7 proc$ures to 
re/ore or recon/ruct ! body ( !         
individual 9 ord] to correspond to !    
individual's sex aft] "o or m previ\s   
g5d] transition proc$ures1 :i* may      
include ! removal ( a pseudo phallus or 
brea/ augm5tation1  7ff7 pub]ty         
suppression or pub]ty-block+            
prescription drugs = ! purpose (        
normaliz+ pub]ty = a m9or exp]i5c+      
precoci\s pub]ty1 or  7gg7 male         
circumcision4  7ii7 ,g5d] transition ,! 
t]m g5d] transition means ! process by  
:i* an individual goes f id5tify+ ) or  
pres5t+ z 8 or h] sex to id5tify+ ) or  

pres5t+ z a self-proclaim$ id5tity :i*  
does n correspond ) or is diff]5t f 8 or
 h] sex1 & may be accompani$ by social1 
legal1 or physical *anges4  7iii7 ,sex  
,! t]m sex1 :5 ref]r+ to an individual's
 sex1 means ei!r male or female1 z      
biologically det]m9$4  7iv7 ,female ,!  
t]m female1 :5 us$ to ref] to a natural 
p]son1 means a p]son belong+1 at        
conception1 to ! sex *>act]iz$ by a     
reproductive sy/em ) ! biological       
function ( produc+ eggs 7ova74  7v7     
,male ,! t]m male1 :5 us$ to ref] to a  
natural p]son1 means a p]son belong+1 at
 conception1 to ! biological sex        
*>act]iz$ by a reproductive sy/em ) !   
biological function ( produc+ sp]m4  4  
7b7 ,effective date ,! am5dm5t made by  
?is section %all apply to taxable ye>s  
beg9n+ aft] ! date ( ! enactm5t ( ?is   
,act4  #c4 ,prohibit+ ,f$]al m$icaid    
fund+ = g5d] transition proc$ures  7a7  
,9 g5]al ,section #aijc7;i7 ( ! ,social 
,security ,act 7#db ,u4,s4,c4           
#acif;b7i77 is am5d$-- 7#a7 9 p>agraph  

7#bf71 by /rik+ 2 or & ins]t+ a         
semicolon2  7#b7 9 p>agraph 7#bg71 by   
/rik+ ! p]iod at ! end & ins]t+ 2 or2   
7#c7 by ins]t+ aft] p>agraph 7#bg7 !    
foll[+ new p>agraph3  7#bh7 ) respect to
 any am\nts exp5d$ = any specifi$ g5d]  
transition proc$ure 7z def9$ 9 section  
#aije7kk77 to an individual enroll$ 9 a 
,/ate plan "u ?is title 7or a waiv] (   
su* plan71 includ+ any am\nts exp5d$ = !
 adm9i/ration ( a ,/ate program t       
furni%es any su* proc$ure4  2 &  7#d7 9 
! flu% left matt] at ! end1 by /rik+ &  
7#ah71 & ins]t+ 7#ah71 & 7#bh74  7b7    
,prohibit+ ,f$]al m$icaid fund+ = g5d]  
transition proc$ures ,section #aije ( ! 
,social ,security ,act 7#db ,u4,s4,c4   
#acif;d7 is am5d$ by add+ at ! end !    
foll[+ new subsection3  7kk7 ,prohibit+ 
,f$]al m$icaid fund+ = specifi$ g5d]    
transition proc$ures  7#a7 ,specifi$    
g5d] transition proc$ures def9$ ,=      
purposes ( section #aijc7;i77#bh71      
except z provid$ 9 p>agraph 7#b71 ! t]m 
specifi$ g5d] transition proc$ure means1

 ) respect to an individual1 any        
hormonal or surgical int]v5tion = !     
purpose ( g5d] transition1 includ+--    
7,a7 ! provision ( gonadotrop9-releas+  
hormone agoni/s or o!r pub]ty           
suppression drugs or pub]ty-block+ drugs
 to /op or delay normally tim$ pub]ty 9 
an individual :o does n id5tify z 8 or  
h] sex2  7,b7 ! provision ( te/o/]one1  
e/rog51 proge/]one1 or o!r &rog5 block]s
 to an individual at doses :i* are      
supraphysiologic to :at w\ld normally be
 produc$ endog5\sly 9 a heal?y          
individual ( ! same age & sex1 ) ! int5t
 to align an individual's physical      
appe>ance ) an id5tity t diff]s f 8 or  
h] sex2  7,c7 surgical proc$ures t      
attempt to trans=m an individual's      
physical appe>ance to align ) an id5tity
 t diff]s f 8 or h] sex or t attempt to 
alt] or remove an individual's sexual   
organs to m9imize or de/roy _! natural  
biological functions2 or  7,d7          
ca/ration1 vasectomy1 p5ectomy1         
or*iectomy1 vag9opla/y1 clitoropla/y1   

vulvopla/y1 ma/ectomy1 hy/]ectomy1      
oophorectomy1 ov>iectomy1 recon/ruction 
( ! fix$ "p ( ! ure?ra ) or )\t         
metoidiopla/y or phallopla/y1           
metoidiopla/y1 phallopla/y1 vag9ectomy1 
scrotopla/y1 implantation ( erection or 
te/icul> pro/heses1 r$uction            
?yro*ondropla/y1 *ondrol>yngopla/y1     
tubal ligation1 /]ilization1 augm5tation
 mammopla/y1 placem5t ( *e/ implants to 
create fem99e brea/s1 placem5t ( fat or 
artificial implants 9 ! gluteal region1 
liposuction1 lip(ill+1 voice surg]y1    
hair recon/ruction1 pectoral implants1  
any pla/ic1 cosmetic1 or ae/hetic surg]y
 :i* fem9izes or mascul9izes ! facial or
 o!r physiological features ( an        
individual1 & any removal ( any o!rwise 
heal?y or non-diseas$ body "p or tissue4
  7#b7 ,exclusions ,! t]m specifi$ g5d] 
transition proc$ure %all n include1 :5  
furni%$ to an individual by a heal? c>e 
provid] ) ! cons5t ( su* individual 7or1
 if applicable1 ! p>5ts or legal gu>dian
 ( su* individual7-- 7,a7 s]vices to    

individuals born ) a m$ically v]ifiable 
disord] ( sex developm5t1 includ+ an    
individual ) ext]nal sex *>act]i/ics :i*
 are irresolvably ambigu\s1 su* z an    
individual born ) #df ,,xx *romosomes ) 
virilization1 an individual born ) #df  
,,xy *romosomes ) und]virilization1 or  
an individual born hav+ bo? ov>ian &    
te/icul> tissue2  7,b7 s]vices relat+ to
 any o!r physician-diagnos$ disord] (   
sexual developm5t ) respect to :i* !    
physician has det]m9$ ?r\gh g5etic or   
bio*emical te/+ t ! individual does n h 
normal sex *romosome /ructure1 sex /]oid
 hormone production1 or sex /]oid       
hormone action = a heal?y male or female
 ( ! same age2  7,c7 ! treatm5t ( any   
infection1 injury1 disease1 or disord]  
caus$ or exac]bat$ by ! p]=mance ( g5d] 
transition proc$ures1 )\t reg>d to :e!r 
! g5d] transition proc$ure 0 p]=m$ 9    
accordance ) ,/ate & ,f$]al law or :e!r 
! g5d] transition proc$ure is treat$ z  
m$ical c>e "u ?is section2  7,d7 any    
proc$ure und]tak5 because ! individual  

suff]s f a physical disord]1 physical   
injury1 or physical illness 7b n m5tal1 
behavioral1 or emotional di/ress or a   
m5tal1 behavioral1 or emotional disord]7
 :i* w\ld1 z c]tifi$ by a physician1    
place ! individual 9 imm95t dang] ( dea?
 or impairm5t ( major bodily function   
unless ! proc$ure is p]=m$ to alleviate 
said physical disord]1 physical injury1 
or physical illness2  7,e7 any proc$ure 
to re/ore or recon/ruct ! body ( !      
individual 9 ord] to correspond to !    
individual's sex aft] #a or m previ\s   
g5d] transition proc$ures1 :i* may      
include ! removal ( a pseudo phallus or 
brea/ augm5tation2  7,f7 pub]ty         
suppression or pub]ty-block+            
prescription drugs = ! purpose (        
normaliz+ pub]ty = an individual        
exp]i5c+ precoci\s pub]ty2 or  7,g7 male
 circumcision4  7#c7 ,additional        
def9itions ,= purposes ( ?is subsection3
 7,a7 ,g5d] transition ,! t]m g5d]      
transition means ! process by :i* an    
individual goes f id5tify+ ) or pres5t+ 

z 8 or h] sex to id5tify+ ) or pres5t+ z
 a self-proclaim$ id5tity :i* does n    
correspond ) or is diff]5t f 8 or h]    
sex1 & may be accompani$ by social1     
legal1 or physical *anges4  7,b7 ,sex ,!
 t]m sex1 :5 ref]r+ to an individual's  
sex1 means ei!r male or female1 z       
biologically det]m9$1 includ+ z describ$
 9 subp>agraphs 7,c7 & 7,d74  7,c7      
,female ,! t]m female1 :5 us$ to ref] to
 a natural p]son1 means an individual   
belong+1 at conception1 to ! sex        
*>act]iz$ by a reproductive sy/em ) !   
biological function ( produc+ eggs      
7ova74  7,d7 ,male ,! t]m male1 :5 us$  
to ref] to a natural p]son1 means an    
individual belong+1 at conception1 to ! 
biological sex *>act]iz$ by a           
reproductive sy/em ) ! biological       
function ( produc+ sp]m4  4  7c7        
,effective date ,! am5dm5ts made by ?is 
section %all apply to s]vices furni%$ on
 or aft] ! date ( ! enactm5t ( ?is ,act4
  #d4 ,prohibit+ ,f$]al *ildr5's heal?  
insurance program fund+ = g5d]          

transition proc$ures on m9ors  7a7 ,9   
g5]al ,section #baje7;c7 ( ! ,social    
,security ,act 7#db ,u4,s4,c4           
#acig;ee7c77 is am5d$ by add+ at ! end !
 foll[+ new p>agraph3  7#ac7 ,limitation
 on paym5t = specifi$ g5d] transition   
proc$ures = m9ors ,paym5t %all n be made
 to a ,/ate "u ?is section = any am\nt  
exp5d$ "u ! ,/ate plan to pay = specifi$
 g5d] transition proc$ures 7z def9$ 9   
section #aije7kk77 or to assi/ 9 !      
pur*ase1 9 :ole or 9 "p1 ( heal? b5efit 
cov]age t includes cov]age ( any su*    
proc$ure4  4  7b7 ,con=m+ am5dm5t       
,section #bajg7;e77#a77,n7 ( ! ,social  
,security ,act 7#db ,u4,s4,c4           
#acig;gg7e77#a77,n77 is am5d$ by /rik+ &
 7#ag7 & ins]t+ 7#ag71 & 7#bh74  7c7    
,effective date ,! am5dm5ts made by ?is 
section %all apply to s]vices furni%$ on
 or aft] ! date ( ! enactm5t ( ?is ,act4
  #e4 ,prohibit+ ,f$]al m$ic>e fund+ =  
g5d] transition proc$ures  7a7 ,9 g5]al 
,section #ahfb7;a7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #aciey7a77 is      

am5d$-- 7#a7 9 p>agraph 7#bd71 by /rik+ 
or at ! end2  7#b7 9 p>agraph 7#be71 by 
/rik+ ! p]iod at ! end & ins]t+ 2 or2 & 
7#c7 by ins]t+ aft] p>agraph 7#be7 !    
foll[+ new p>agraph3  7#bf7 :i* are     
specifi$ g5d] transition proc$ures 7z   
def9$ 9 section #aije7kk774  4  7b7     
,effective date ,! am5dm5ts made by     
subsection 7a7 %all apply to items &    
s]vices furni%$ on or aft] ! date ( !   
enactm5t ( ?is ,act4  #f4 ,exclusion (  
g5d] transition proc$ures f ess5tial    
heal? b5efits ,section #acjb7;b77#b7 ( !
 ,pati5t ,protection & ,af=dable ,c>e   
,act 7#db ,u4,s4,c4 #ahjbb7;b77#b77 is  
am5d$-- 7#a7 9 ! p>agraph head+1 by     
/rik+ ,limitation & ins]t+ ,limitations2
  7#b7 by r$esignat+ subp>agraph 7,b7 z 
subp>agraph 7,c72  7#c7 by ins]t+ aft]  
subp>agraph 7,a7 ! foll[+3  7,b7        
,exclusions ,9 def9+ ! ess5tial heal?   
b5efits "u p>agraph 7#a71 or 9 revis+   
ess5tial heal? b5efits "u p>agraph      
7#d77;,h71 ! ,secret>y %all n include ! 
category ( g5d] transition proc$ures 7z 

def9$ 9 section #bac7;d77#ab77;,b7 ( !  
,int]nal ,rev5ue ,code ( #aihf7 or any  
items or s]vices cov]$ )9 su* a         
category4  2 &  7#d7 9 subp>agraph 7,c7 
7z s r$esignat$71 by /rik+ p>agraph 7#b7
 & ins]t+ subp>agraph 7,a74