Federal funding cut for gender transition care, shifting costs to individuals

What it does

This bill denies federal tax deductions and federal funding (Medicaid, CHIP, Medicare) for gender transition procedures, defined to include hormone therapy and surgeries. It carves out exceptions for intersex conditions, treatment of complications, and procedures for precocious puberty. The bill restricts who can access these procedures using public money or tax benefits, effectively shifting costs to individuals and private insurance.

Why we flagged it

The bill's operative mechanism is to exclude a category of medical procedures from federal tax deductions and public insurance programs. While framed as a subsidy denial, it functions as a restriction on access to care for a specific population.

What the text implies

• The definition of 'sex' as 'biologically determined' at conception may create legal ambiguity for intersex individuals and complicate medical determinations of sex development disorders, potentially narrowing the carve-out for intersex care.
• Exclusion from ACA essential health benefits may allow insurers to drop coverage entirely, not just deny federal subsidy — shifting burden from tax code to insurance market.
• The bill does not restrict private insurance or out-of-pocket payment, creating a two-tier system where wealthy individuals retain access while lower-income citizens lose it.
• Medicaid exclusion applies to state plans and waivers, potentially blocking states from using their own funds to cover procedures even if they choose to do so.

Section numbers refer to the bill text the analysis read — linked under Primary records below.

Who it affects

Individuals seeking gender transition procedures lose access to federal tax deductions and public insurance coverage (Medicaid, CHIP, Medicare), shifting costs entirely to out-of-pocket payment or private insurance. This restricts a category of medical care from public funding and tax support, making it less affordable for lower-income citizens and those reliant on public insurance.

Named in the bill

Internal Revenue Service, Centers for Medicare & Medicaid Services, Medicaid, Medicare, Children's Health Insurance Program (CHIP), Patient Protection and Affordable Care Act

Where it stands

4 cosponsors: 4 Republicans.

• May 1, 2025 — Introduced · Congress.gov: “Introduced in Senate”
• May 1, 2025 — Referred to Senate Committee on Finance · Congress.gov: “Read twice and referred to the Committee on Finance”

Dates and quoted wording are Congress.gov's action record; the timeline shows status changes, not every procedural step.

Money around this bill

1 lobbying clients named this bill on 2 disclosure filings across 2 quarters, Dec 2025 to Jun 2026. Those filings disclosed $439,908 in lobbying spend. A filing names 132 bills on average, so that figure is what each filing reported, not a share belonging to this bill.

More lobbying clients named this bill than 0% of bills with at least one filing.

Roger Marshall, the sponsor, reported $1,777,391 in PAC receipts in the 2026 cycle.

• Human Rights Campaign — $439,908 on 2 filings

Lobbying Disclosure Act filings through Jul 17, 2026. A filing shows who paid to lobby on a bill it names, not what changed.