,,ii  #aai? ,,congress  #a/ ,session    
,s4 #bjjh  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,june #aj1 #bjbe ,mr4  
,cornyn 7= himself & ,mr4 ,lank=d7      
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,f9ance  ,a ,,bill  ,to am5d title ,,xix
 ( ! ,social ,security ,act to prohibit 
,m$icaid & ,,*ip fund+ = g5d] transition
 proc$ures4  #a4  ,%ort title  ,?is ,act
 may be cit$ z ! ,/op ,fund+ ,g5ital    
,mutilation ,act4  #b4  ,prohibit+      
,f$]al ,m$icaid & ,,*ip fund+ = g5d]    
transition proc$ures  7a7  ,m$icaid     
,section #aijc7;i7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acif;b7i77 is     
am5d$--  7#a7 9 p>agraph 7#bf71 by /rik+
 2 or & ins]t+ a semicolon2  7#b7 9     
p>agraph 7#bg71 by /rik+ ! p]iod at !   
end & ins]t+ 2 or2  7#c7 by ins]t+ aft] 
p>agraph 7#bg7 ! foll[+ new p>agraph3   
7#bh7 ) respect to any am\nt exp5d$ =   
specifi$ g5d] transition proc$ures 7z   
def9$ 9 section #aije7kk77 furni%$ to an
 individual enroll$ 9 a ,/ate plan 7or  

waiv] ( su* plan74  2 &  7#d7 9 ! flu%  
left matt] at ! end1 by /rik+ & 7#ah71 &
 ins]t+ 7#ah71 & 7#bh74  7b7  ,,*ip     
,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    
,specifi$ g5d] transition proc$ures     
def9$  ,section #aije ( ! ,social       
,security ,act 7#db ,u4,s4,c4 #acif;d7  
is am5d$ by add+ at ! end ! foll[+ new  
subsection3  7kk7  ,specifi$ g5d]       
transition proc$ures  7#a7  ,9 g5]al  ,=
 purposes ( section #aijc7;i77#bh71     
except z provid$ 9 p>agraph 7#b71 ! t]m 
specifi$ g5d] transition proc$ure means1
 ) respect to an individual1 any ( !    
foll[+ :5 p]=m$ = ! purpose (           
int5tionally *ang+ ! body ( su*         
individual 7includ+ by disrupt+ ! body's
 developm5t1 inhibit+ its natural       
functions1 or modify+ its appe>ance7 to 
no long] correspond to ! individual's   
sex3  7,a7 ,p]=m+ any surg]y1 includ+-- 
7i7 ca/ration2  7ii7 /]ilization2  7iii7

 or*iectomy2  7iv7 scrotopla/y2  7v7    
vasectomy2  7vi7 tubal ligation2  7vii7 
hy/]ectomy2  7viii7 oophorectomy2  7ix7 
ov>iectomy2  7x7 metoidiopla/y2  7xi7   
clitoropla/y2  7xii7 recon/ruction ( !  
fix$ "p ( ! ure?ra ) or )\t a           
metoidiopla/y or a phallopla/y2  7xiii7 
p5ectomy2  7xiv7 phallopla/y2  7xv7     
vag9opla/y2  7xvi7 vag9ectomy2  7xvii7  
vulvopla/y2  7xviii7 r$uction           
?yro*ondropla/y2  7xix7                 
*ondrol>yngopla/y2  7xx7 ma/ectomy2 &   
7xxi7 any pla/ic1 cosmetic1 or ae/hetic 
surg]y t fem9izes or mascul9izes !      
facial or o!r body features ( an        
individual4  7,b7 ,any placem5t ( *e/   
implants to create fem99e brea/s or any 
placem5t ( erection or te/icul>         
pro/heses4  7,c7 ,any placem5t ( fat or 
artificial implants 9 ! gluteal region4 
7,d7 ,adm9i/]+1 prescrib+1 or disp5s+ to
 an individual m$ications1 includ+--    
7i7 gonadotrop9-releas+ hormone         
7,gn,r,h7 analogues or o!r pub]ty-block+
 drugs to /op or delay normal pub]ty2 & 

7ii7 te/o/]one1 e/rog51 or o!r &rog5s to
 an individual at doses t are           
supraphysiologic ?an w\ld normally be   
produc$ endog5\sly 9 a heal?y individual
 ( ! same age & sex4  7#b7  ,exception  
,p>agraph 7#a7 %all n apply to ! foll[+ 
:5 furni%$ to an individual by a heal?  
c>e provid] ) ! cons5t ( su*            
individual's p>5t or legal gu>dian3     
7,a7 ,pub]ty suppression or block+      
prescription drugs = ! purpose (        
normaliz+ pub]ty = an individual        
exp]i5c+ precoci\s pub]ty4  7,b7        
,m$ically necess>y proc$ures or         
treatm5ts to correct =--  7i7 a m$ically
 v]ifiable disord] ( sex developm5t1    
includ+--  7,i7 #df1,,xx *romosomes )   
virilization2  7,,ii7 #df1,,xy          
*romosomes ) und]virilization2 &        
7,,iii7 bo? ov>ian & te/icul> tissue2   
7ii7 sex *romosome /ructure1 sex /]oid  
hormone production1 or sex hormone      
action1 if det]m9$ to be abnormal by a  
physician ?r\gh g5etic or bio*emical    
te/+2  7iii7 infection1 disease1 injury1

 or disord] caus$ or exac]bat$ by a     
previ\s proc$ure describ$ 9 p>agraph    
7#a71 or a physical disord]1 physical   
injury1 or physical illness t w\ld1 z   
c]tifi$ by a physician1 place !         
individual 9 imm95t dang] ( dea? or     
impairm5t ( a major bodily function     
unless ! proc$ure is p]=m$1 n includ+   
proc$ures p]=m$ = ! alleviation ( m5tal 
di/ress2 or  7iv7 proc$ures to re/ore or
 recon/ruct ! body ( ! individual 9 ord]
 to correspond to ! individual's sex    
aft] "o or m previ\s proc$ures describ$ 
9 p>agraph 7#a71 :i* may include !      
removal ( a pseudo phallus or brea/     
augm5tation4  7#c7  ,sex  ,= purposes ( 
p>agraph 7#a71 ! t]m sex means ei!r male
 or female1 z biologically det]m9$ &    
def9$ 9 p>agraphs 7#d7 & 7#e71          
respectively4  7#d7  ,female  ,=        
purposes ( p>agraph 7#c71 ! t]m female  
means an individual :o naturally has1   
_h1 w h1 or w\ld h1 b = a developm5tal  
or g5etic anomaly or hi/orical accid5t1 
! reproductive sy/em t at "s po9t       

produces1 transports1 & utilizes eggs = 
f]tilization4  7#e7  ,male  ,= purposes 
( p>agraph 7#c71 ! t]m male means an    
individual :o naturally has1 _h1 w h1 or
 w\ld h1 b = a developm5tal or g5etic   
anomaly or hi/orical accid5t1 !         
reproductive sy/em t at "s po9t         
produces1 transports1 & utilizes sp]m = 
f]tilization4  4