H.R. 498 (119th): Do No Harm in Medicaid Act

The bill prohibits federal Medicaid payment for specified gender transition procedures for individuals under age 18. It defines those procedures as surgeries, implants, and medications (such as hormones) intended to change the body so it no longer corresponds to the individual's biological sex. It excludes procedures for minors that are provided with parent or guardian consent and are intended to rectify early puberty, genetic disorders, or chromosomal abnormalities; reverse prior gender transition procedures; or prevent imminent death or impairment of a major bodily function.

Theological note: Scripture grounds the dignity of the body as created by God and calls parents to protect and nurture children, so the bill bears on the protection of minors from irreversible bodily alteration that opposes their created sex. The measure's exceptions for medically necessary care and for reversing prior procedures reflect concern for the child's bodily good rather than a blanket denial of care.

• Tier: capped at tier 2.
• Lane: abuse_accountability. Category: justice_truth. Lane tag: general equity.
• Lane: defends_children. Category: children. Lane tag: command.
• Lane: federal_funding. Category: not stored. Lane tag: not stored.
• Lane: gender_transition. Category: not stored. Lane tag: not stored.
• Lane: medicaid. Category: not stored. Lane tag: not stored.
• Lane: minor_protection. Category: not stored. Lane tag: not stored.
• Tier 1 sign-off: tier2. Signed by Adam Malin on 2026-10-20.
• Cap: tier 2 at full tier-2 weight. Exposure and points are not halved. It cannot be a Tier 1 or disqualifying event.
• Matched vehicle: this bill stays a matched vehicle.
• Review note: Do No Harm in Medicaid Act. Adam Malin, 2026-10-21: keep the cap at tier 2 so it can never be a Tier 1 or disqualifying event, and count it at full tier-2 weight. Its exposure and its points are not halved, for any member. It stays a matched vehicle with H.R. 3492, so a later yea here still counts as support for that protection. The same rule applies to every member.
• Stored polarity: good. A yea supports the bill. A nay is the penalized direction when the tag is scored as a protection. A yea on a credit tag is a credit.
• Procedural polarity: matched with hr-3492-119.
• For each member, the latest polarity-known vote among cloture, the motion to proceed, and passage governs a matched group, or the bill alone when it is not in a group. A supporting latest vote, including a cloture yea, counts as support on every vehicle in the group. An opposing latest vote removes earlier support, including an earlier amendment yea. Members vote only in their own chamber. A procedural yea that would be Tier 1 is at most tier 2 when a later governing vote on a matched vehicle opposes; the vote is not erased.
• Tested-record vehicle: a recorded yea or nay on this bill counts toward a Qualified label. A member with no recorded yea or nay on a key life or child-protection vehicle keeps the score and is shown as Not yet tested on life and child-protection votes.
• Roll 361: On Motion to Recommit. Vote type: recommit.
• Roll 362: On Passage. Vote type: final_passage.
• Polarity rationale: Reviewed enrichment (llm_import) polarity: The bill directly restrains a named harm: federal funding of gender transition procedures for minors. Restraining the financing of such procedures for children defends the vulnerable and aligns with protecting minors from corruption, so the measure is good under the framework. Its narrow medical exceptions keep it from being a blanket prohibition on necessary care, which supports a clear high-level classification rather than an unclear or mixed one.
• Theological note: Scripture grounds the dignity of the body as created by God and calls parents to protect and nurture children, so the bill bears on the protection of minors from irreversible bodily alteration that opposes their created sex. The measure's exceptions for medically necessary care and for reversing prior procedures reflect concern for the child's bodily good rather than a blanket denial of care.

Tested record Debt and war Cloture and Tier 1 Procedural votes Scoring mechanics abuse accountability child sexual corruption