AN ACT
 
 To provide for reconciliation pursuant to title II of H. Con. Res. 14.
    Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
    This Act may be cited as the ``One Big Beautiful Bill Act''.
. . .
SEC. 44125. PROHIBITING FEDERAL MEDICAID AND CHIP FUNDING FOR GENDER
              TRANSITION PROCEDURES.
    (a) Medicaid.--Section 1903(i) of the Social Security Act (42
U.S.C. 1396b(i)) is amended--
            (1) in paragraph (26), by striking ``; or'' and inserting a
        semicolon;
            (2) in paragraph (27), by striking the period at the end
        and inserting ``; or'';
            (3) by inserting after paragraph (27) the following new
        paragraph:
            ``(28) with respect to any amount expended for specified
        gender transition procedures (as defined in section 1905(kk))
        furnished to an individual enrolled in a State plan (or waiver
        of such plan).''; and
            (4) in the flush left matter at the end, by striking ``and
        (18),'' and inserting ``(18), and (28)''.
    (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.''.