25 LC 46 1061S
The Senate Committee on Insurance and Labor offered the following
substitute to SB 39:
A BILL TO BE ENTITLED
AN ACT
To amend Chapter 18 of Title 45, Chapter 4 of Title 49, and Chapter 1 of Title 50 of the1
Official Code of Georgia Annotated, relating to the employees' insurance and benefits plans,2
public assistance, and general provisions relative to state government, respectively, so as to3
prohibit coverage of expenses for gender-affirming care under the state health benefit plan4
or with any state funds; to provide for definitions; to provide for limited exceptions; to5
prohibit state healthcare facilities and healthcare providers employed by the state from6
providing gender-affirming care; to provide for related matters; to provide for legislative7
findings; to provide for an effective date and applicability; to repeal conflicting laws; and for8
other purposes.9
BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:10
SECTION 1.11
The General Assembly finds that:12
(1) The State of Georgia has taken measures to protect individuals from a radical gender13
ideology that has, among other things, resulted in a massive unexplained rise in diagnoses14
of gender dysphoria;15
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(2) Senate Bill 140 enacted by the General Assembly in the 2023 regular session broadly16
banned physicians from performing sex reassignment surgeries, hormone replacement17
therapies, and other gender transition procedures on minors, and similar bills from other18
states have been upheld by a federal appeals court;19
(3) In October, 2023, under the guidance of the Georgia Attorney General, a lawsuit20
brought by or on behalf of a number of state employees and a child seeking access to21
transgender related healthcare coverage under the state health plan was settled;22
(4) Prior to the settlement, coverage under the state health benefit plan excluded23
operations to change one's sex and related services;24
(5) Under the settlement, the state health benefit plan was required to implement25
provisions defining transgender related health coverage and to make it available to all26
employees. In addition, the state reportedly paid a sum of $365,000.00 that was split27
among four individuals, including a child, and an organization called the Campaign for28
Southern Equality, which has been described in news reports as "a nonprofit organization29
dedicated to advancing LGBTQ+ civil rights in the South." According to the plaintiffs'30
attorneys, the settlement also covered a portion of the plaintiffs' legal expenses;31
(6) This settlement was entered into by the state health benefit plan and the Attorney32
General without prior notice to or approval by the General Assembly; and33
(7) It is the policy of the State of Georgia that these procedures shall neither be covered34
by the state health benefit plan nor otherwise paid for through the use of state funds.35
SECTION 2.36
Chapter 18 of Title 45 of the Official Code of Georgia Annotated, relating to employees'37
insurance and benefits plans, is amended by revising Code Section 45-18-4, relating to38
expenses not to be covered by the state employees' health insurance plan, as follows:39
"45-18-4.40
(a) As used in this Code section, the term:41
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(1) 'Abortion' shall have the same meaning as provided in Code Section 31-9A-2.42
(2) 'Gender' means the psychological, behavioral, social, and cultural aspects of being43
male or female.44
(3) 'Gender-affirming care' means healthcare, such as hormone therapy or sex45
reassignment surgery, to attempt to affirm an individual's perception of such individual's46
sex that is inconsistent with such individual's sex.47
(4) 'Hormone therapy' means treatment that adds, blocks, or removes hormones for the48
purpose of assisting an individual in attempting to alter such individual's sex or to alter49
the appearance of such individual's sex that is inconsistent with such individual's sex.50
(5) 'Sex' means the biological state of being male or female, in the context of51
reproductive potential or capacity, based on the individual's sex organs, chromosomes,52
naturally occurring sex hormones, gonads, and internal and external genitalia present at53
birth, including secondary sex characteristics, without regard to an individual's54
psychological, chosen, or subjective identification of gender.55
(6) 'Sex reassignment surgery' means any surgical procedure that seeks to surgically alter56
or remove healthy or nondiseased physical or anatomical characteristics or features that57
are typical for an individual's sex in order to instill or create physiological or anatomical58
characteristics that resemble a sex different from such individual's sex. Such term means59
genital or nongenital surgery performed for the purpose of assisting an individual with60
attempting to alter such individual's sex or to alter the appearance of or affirm such61
individual's perception of his or her gender or sex if such appearance or perception is62
inconsistent with such individual's sex. Such term includes but is not limited to63
castration, clitorectomy, clitoroplasty, facial gender-affirming surgery, hysterectomy,64
mammoplasty, mastectomy, metoidioplasty, oophorectomy, orchiectomy, ovariectomy,65
penectomy, phalloplasty, scrotoplasty, vaginectomy, vaginoplasty, vasectomy, voice66
feminization or masculinization surgery, and vulvoplasty, and any healthcare services67
before or after such surgery.68
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(b) The health insurance plan shall not include expenses incurred by or on account of an69
individual prior to the effective date of the plan; expenses for services received for injury70
or sickness due to war or any act of war, whether declared or undeclared, which war or act71
of war shall have occurred after the effective date of this plan; expenses for which the72
individual is not required to make payment; expenses to the extent of benefits provided73
under any employer group plan other than this plan in which the state participates in the74
cost thereof; expenses for abortion services except to the extent permitted under the state75
health benefit plan approved by the board as such plan existed on January 1, 2014;76
expenses for gender-affirming care except as provided in subsection (c) of this Code77
section; and such other expenses as may be excluded by regulations of the board. For78
purposes of this Code section, the term 'abortion' shall have the same meaning as provided79
in Code Section 31-9A-2.80
(c) The board shall adopt rules and regulations regarding the exclusion of expenses for81
gender-affirming care provided in subsection (b) of this Code section, which shall contain82
limited exceptions for:83
(1) Treatments for medical conditions other than gender dysphoria or for the purpose of84
sex reassignment where such treatments are deemed medically necessary;85
(2) Treatments for individuals born with a medically verifiable disorder of sex86
development, including individuals born with ambiguous genitalia or chromosomal87
abnormalities resulting in ambiguity regarding the individual's biological sex;88
(3) Treatments for individuals with partial androgen insensitivity syndrome; and89
(4) Any other treatments for similar conditions to the extent permitted under the state90
health benefit plan approved by the board as such plan existed on January 1, 2025."91
SECTION 3.92
Chapter 4 of Title 49 of the Official Code of Georgia Annotated, relating to public assistance,93
is amended by adding a new Code section to read as follows:94
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"49-4-159.5.95
The department shall prohibit the coverage of gender-affirming care as provided for in96
Code Section 45-18-4 for recipients of medical assistance."97
SECTION 4.98
Chapter 1 of Title 50 of the Official Code of Georgia Annotated, relating to general99
provisions relative to state government, is amended by adding a new Code section to read as100
follows:101
"50-1-14.102
(a) No state funds shall be expended for health benefits coverage that includes coverage103
for gender-affirming care as provided for in Code Section 45-18-4.104
(b) No healthcare facility owned or operated by the state and no physician or other105
healthcare provider employed by an agency or entity of this state shall provide106
gender-affirming care as provided for in Code Section 45-18-4.107
(c) Nothing in this Code section shall be construed as:108
(1) Prohibiting any individual, entity, or local government from purchasing separate109
coverage for gender-affirming care or health benefits coverage that includes110
gender-affirming care, provided that such coverage is paid for entirely using only funds111
not authorized or appropriated by the state; or112
(2) Restricting the ability of any nonstate health benefits coverage provider from offering113
coverage for gender-affirming care, or the ability of a local government to contract114
separately with such a provider for such coverage, provided that such coverage is paid115
for entirely using only funds not authorized or appropriated by the state."116
SECTION 5.117
This Act shall become effective on January 1, 2026, and shall apply to all state health benefit118
plans issued, delivered, issued for delivery, or renewed in this state on or after such date.119
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SECTION 6.120
All laws and parts of laws in conflict with this Act are repealed.121
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