| 8 | | - | prohibit coverage of expenses for any transition related intervention under the state health4 |
|---|
| 9 | | - | benefit plan or with any state funds; to provide for definitions; to prohibit state healthcare5 |
|---|
| 10 | | - | facilities and healthcare providers employed by the state from providing any transition6 |
|---|
| 11 | | - | related intervention; to prohibit correctional facilities owned or operated by the state and7 |
|---|
| 12 | | - | healthcare providers employed at such facilities from providing any transition related8 |
|---|
| 13 | | - | intervention; to provide for related matters; to provide for legislative findings; to provide for9 |
|---|
| 14 | | - | an effective date; to repeal conflicting laws; and for other purposes.10 |
|---|
| 15 | | - | BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:11 |
|---|
| 16 | | - | SECTION 1.12 |
|---|
| 17 | | - | The General Assembly finds that:13 |
|---|
| 18 | | - | (1) The State of Georgia has taken measures to protect individuals from a radical gender14 |
|---|
| 19 | | - | ideology that has, among other things, resulted in a massive unexplained rise in diagnoses15 |
|---|
| 20 | | - | of gender dysphoria;16 |
|---|
| 21 | | - | S. B. 39 (SUB) |
|---|
| 22 | | - | - 1 - 25 LC 46 1248S |
|---|
| 23 | | - | (2) Senate Bill 140 enacted by the General Assembly in the 2023 regular session broadly17 |
|---|
| 24 | | - | banned procedures or treatments performed for the purpose of enabling a minor to18 |
|---|
| 25 | | - | identify with or live as a purported identity inconsistent with such minor's sex or treating19 |
|---|
| 26 | | - | purported discomfort or distress from a discordance between a minor's sex and asserted20 |
|---|
| 27 | | - | identity, and similar bills from other states have been upheld by a federal appeals court;21 |
|---|
| 28 | | - | and22 |
|---|
| 29 | | - | (3) It is the policy of the State of Georgia that these procedures or treatments shall23 |
|---|
| 30 | | - | neither be covered by the state health benefit plan nor otherwise paid for through the use24 |
|---|
| 31 | | - | of any state funds.25 |
|---|
| 32 | | - | SECTION 2.26 |
|---|
| 33 | | - | Chapter 18 of Title 45 of the Official Code of Georgia Annotated, relating to employees'27 |
|---|
| 34 | | - | insurance and benefits plans, is amended by adding a new Code section to read as follows:28 |
|---|
| 35 | | - | "45-18-4.2.29 |
|---|
| 36 | | - | (a) As used in this Code section, the term:30 |
|---|
| 37 | | - | (1) 'Congenital defect' means a physical or chemical abnormality present from birth in31 |
|---|
| 38 | | - | a minor that is inconsistent with the normal development of a human being of such32 |
|---|
| 39 | | - | minor's sex, including abnormalities caused by a medically verifiable disorder of sex33 |
|---|
| 40 | | - | development. Such term does not include gender dysphoria, gender identity disorder,34 |
|---|
| 41 | | - | gender incongruence, or any mental condition, disorder, disability, or abnormality.35 |
|---|
| 42 | | - | (2) 'Medical procedure' means a surgical procedure or nonsurgical treatment consisting36 |
|---|
| 43 | | - | of:37 |
|---|
| 44 | | - | (A) Surgically removing, modifying, altering, artificially constructing, or entering into38 |
|---|
| 45 | | - | tissues, cavities, or organs of a human being; or39 |
|---|
| 46 | | - | (B) Prescribing, administering, or dispensing any supraphysiological hormone dosage40 |
|---|
| 47 | | - | to a human being.41 |
|---|
| 48 | | - | S. B. 39 (SUB) |
|---|
| 49 | | - | - 2 - 25 LC 46 1248S |
|---|
| 50 | | - | (3) 'Sex' means an individual's immutable characteristics of the reproductive system that42 |
|---|
| 51 | | - | define such individual as male or female, as determined by anatomy and genetics existing43 |
|---|
| 52 | | - | at the time of birth.44 |
|---|
| 53 | | - | (4) 'State health plan' means any healthcare benefits provided pursuant to Subpart 2 of45 |
|---|
| 54 | | - | Part 6 of Article 17 of Chapter 2 of Title 20, Subpart 3 of Part 6 of Article 17 of46 |
|---|
| 55 | | - | Chapter 2 of Title 20, Code Section 31-2-4, and Article 1 of Chapter 18 of this title.47 |
|---|
| 56 | | - | (5) 'Transition related intervention' means any medical procedure performed for the48 |
|---|
| 57 | | - | purpose of:49 |
|---|
| 58 | | - | (A) Enabling an individual to identify with or live as a purported identity inconsistent50 |
|---|
| 59 | | - | with such individual's sex; or51 |
|---|
| 60 | | - | (B) Treating an individual's purported discomfort or distress from a discordance52 |
|---|
| 61 | | - | between such individual's sex and asserted identity.53 |
|---|
| 62 | | - | (b) On or after January 1, 2026, the state health plan shall not include expenses for any54 |
|---|
| 63 | | - | transition related intervention except as provided in subsection (c) of this Code section.55 |
|---|
| 64 | | - | (c) The board shall adopt rules and regulations regarding the exclusion of expenses for any56 |
|---|
| 65 | | - | transition related intervention as provided for in subsection (b) of this Code section;57 |
|---|
| 66 | | - | provided, however, that it is not a violation of this Code section if a healthcare provider58 |
|---|
| 67 | | - | performs or administers a medical procedure for the purpose of treating:59 |
|---|
| 68 | | - | (1) A minor's congenital defect, precocious puberty, disease, or physical injury;60 |
|---|
| 69 | | - | provided, however, that the term 'disease' does not include gender dysphoria, gender61 |
|---|
| 70 | | - | identity disorder, gender incongruence, or any mental condition, disorder, disability, or62 |
|---|
| 71 | | - | abnormality; and63 |
|---|
| 72 | | - | (2) Any infection, injury, disease, or disorder that has been caused or exacerbated by the64 |
|---|
| 73 | | - | performance of a medical procedure, including a transition related intervention, whether65 |
|---|
| 74 | | - | or not such procedure was performed in accordance with federal or state law; provided,66 |
|---|
| 75 | | - | however, that the purpose of such medical procedure shall not be to continue any67 |
|---|
| 76 | | - | S. B. 39 (SUB) |
|---|
| 77 | | - | - 3 - 25 LC 46 1248S |
|---|
| 78 | | - | transition related intervention for gender dysphoria, gender identity disorder, gender68 |
|---|
| 79 | | - | incongruence, or any mental condition, disorder, disability, or abnormality."69 |
|---|
| 80 | | - | SECTION 3.70 |
|---|
| 81 | | - | Chapter 4 of Title 49 of the Official Code of Georgia Annotated, relating to public assistance,71 |
|---|
| 82 | | - | is amended by adding a new Code section to read as follows:72 |
|---|
| 83 | | - | "49-4-159.5.73 |
|---|
| 84 | | - | The department shall prohibit the coverage of any transition related intervention as74 |
|---|
| 85 | | - | provided for in Code Section 45-18-4.2 for recipients of medical assistance."75 |
|---|
| 86 | | - | SECTION 4.76 |
|---|
| 87 | | - | Chapter 1 of Title 50 of the Official Code of Georgia Annotated, relating to general77 |
|---|
| 88 | | - | provisions relative to state government, is amended by adding a new Code section to read as78 |
|---|
| 89 | | - | follows:79 |
|---|
| 90 | | - | "50-1-14.80 |
|---|
| 91 | | - | (a) No state funds shall be expended for health benefits coverage that includes coverage81 |
|---|
| 92 | | - | for any transition related intervention as provided for in Code Section 45-18-4.2.82 |
|---|
| 93 | | - | (b) No healthcare facility owned or operated by the state and no physician or other83 |
|---|
| 94 | | - | healthcare provider employed by an agency or entity of this state shall provide any84 |
|---|
| 95 | | - | transition related intervention as provided for in Code Section 45-18-4.2.85 |
|---|
| 96 | | - | (c) No correctional facility owned or operated by the state and no physician or other86 |
|---|
| 97 | | - | healthcare provider employed by such facility shall provide any transition related87 |
|---|
| 98 | | - | intervention as provided for in Code Section 45-18-4.2 to any individual incarcerated at88 |
|---|
| 99 | | - | such facility.89 |
|---|
| 100 | | - | (d) Nothing in this Code section shall be construed as:90 |
|---|
| 101 | | - | (1) Prohibiting any individual, entity, or local government from purchasing separate91 |
|---|
| 102 | | - | coverage for any transition related intervention or health benefits coverage that includes92 |
|---|
| 103 | | - | S. B. 39 (SUB) |
|---|
| 104 | | - | - 4 - 25 LC 46 1248S |
|---|
| 105 | | - | any transition related intervention, provided that such coverage is paid for entirely using93 |
|---|
| 106 | | - | only funds not authorized or appropriated by the state; or94 |
|---|
| 107 | | - | (2) Restricting the ability of any nonstate health benefits coverage provider from offering95 |
|---|
| 108 | | - | coverage for any transition related intervention or the ability of a local government to96 |
|---|
| 109 | | - | contract separately with such a provider for such coverage, provided that such coverage97 |
|---|
| 110 | | - | is paid for entirely using only funds not authorized or appropriated by the state."98 |
|---|
| 111 | | - | SECTION 5.99 |
|---|
| 112 | | - | This Act shall become effective upon its approval by the Governor or upon its becoming law100 |
|---|
| 113 | | - | without such approval.101 |
|---|
| 114 | | - | SECTION 6.102 |
|---|
| 115 | | - | All laws and parts of laws in conflict with this Act are repealed.103 |
|---|
| 116 | | - | S. B. 39 (SUB) |
|---|
| 117 | | - | - 5 - |
|---|
| 12 | + | prohibit coverage of expenses for gender-affirming care under the state health benefit plan4 |
|---|
| 13 | + | or with any state funds; to provide for definitions; to provide for limited exceptions; to5 |
|---|
| 14 | + | prohibit state healthcare facilities and healthcare providers employed by the state from6 |
|---|
| 15 | + | providing gender-affirming care; to provide for related matters; to provide for legislative7 |
|---|
| 16 | + | findings; to provide for an effective date and applicability; to repeal conflicting laws; and for8 |
|---|
| 17 | + | other purposes.9 |
|---|
| 18 | + | BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:10 |
|---|
| 19 | + | SECTION 1.11 |
|---|
| 20 | + | The General Assembly finds that:12 |
|---|
| 21 | + | (1) The State of Georgia has taken measures to protect individuals from a radical gender13 |
|---|
| 22 | + | ideology that has, among other things, resulted in a massive unexplained rise in diagnoses14 |
|---|
| 23 | + | of gender dysphoria;15 |
|---|
| 24 | + | S. B. 39 |
|---|
| 25 | + | - 1 - 25 LC 46 1061S (SCS) |
|---|
| 26 | + | (2) Senate Bill 140 enacted by the General Assembly in the 2023 regular session broadly |
|---|
| 27 | + | 16 |
|---|
| 28 | + | banned physicians from performing sex reassignment surgeries, hormone replacement17 |
|---|
| 29 | + | therapies, and other gender transition procedures on minors, and similar bills from other18 |
|---|
| 30 | + | states have been upheld by a federal appeals court;19 |
|---|
| 31 | + | (3) In October, 2023, under the guidance of the Georgia Attorney General, a lawsuit20 |
|---|
| 32 | + | brought by or on behalf of a number of state employees and a child seeking access to21 |
|---|
| 33 | + | transgender related healthcare coverage under the state health plan was settled;22 |
|---|
| 34 | + | (4) Prior to the settlement, coverage under the state health benefit plan excluded23 |
|---|
| 35 | + | operations to change one's sex and related services;24 |
|---|
| 36 | + | (5) Under the settlement, the state health benefit plan was required to implement25 |
|---|
| 37 | + | provisions defining transgender related health coverage and to make it available to all26 |
|---|
| 38 | + | employees. In addition, the state reportedly paid a sum of $365,000.00 that was split27 |
|---|
| 39 | + | among four individuals, including a child, and an organization called the Campaign for28 |
|---|
| 40 | + | Southern Equality, which has been described in news reports as "a nonprofit organization29 |
|---|
| 41 | + | dedicated to advancing LGBTQ+ civil rights in the South." According to the plaintiffs'30 |
|---|
| 42 | + | attorneys, the settlement also covered a portion of the plaintiffs' legal expenses;31 |
|---|
| 43 | + | (6) This settlement was entered into by the state health benefit plan and the Attorney32 |
|---|
| 44 | + | General without prior notice to or approval by the General Assembly; and33 |
|---|
| 45 | + | (7) It is the policy of the State of Georgia that these procedures shall neither be covered34 |
|---|
| 46 | + | by the state health benefit plan nor otherwise paid for through the use of state funds.35 |
|---|
| 47 | + | SECTION 2.36 |
|---|
| 48 | + | Chapter 18 of Title 45 of the Official Code of Georgia Annotated, relating to employees'37 |
|---|
| 49 | + | insurance and benefits plans, is amended by revising Code Section 45-18-4, relating to38 |
|---|
| 50 | + | expenses not to be covered by the state employees' health insurance plan, as follows:39 |
|---|
| 51 | + | "45-18-4.40 |
|---|
| 52 | + | (a) As used in this Code section, the term: |
|---|
| 53 | + | 41 |
|---|
| 54 | + | S. B. 39 |
|---|
| 55 | + | - 2 - 25 LC 46 1061S (SCS) |
|---|
| 56 | + | (1) 'Abortion' shall have the same meaning as provided in Code Section 31-9A-2.42 |
|---|
| 57 | + | (2) 'Gender' means the psychological, behavioral, social, and cultural aspects of being43 |
|---|
| 58 | + | male or female.44 |
|---|
| 59 | + | (3) 'Gender-affirming care' means healthcare, such as hormone therapy or sex45 |
|---|
| 60 | + | reassignment surgery, to attempt to affirm an individual's perception of such individual's46 |
|---|
| 61 | + | sex that is inconsistent with such individual's sex.47 |
|---|
| 62 | + | (4) 'Hormone therapy' means treatment that adds, blocks, or removes hormones for the48 |
|---|
| 63 | + | purpose of assisting an individual in attempting to alter such individual's sex or to alter49 |
|---|
| 64 | + | the appearance of such individual's sex that is inconsistent with such individual's sex.50 |
|---|
| 65 | + | (5) 'Sex' means the biological state of being male or female, in the context of51 |
|---|
| 66 | + | reproductive potential or capacity, based on the individual's sex organs, chromosomes,52 |
|---|
| 67 | + | naturally occurring sex hormones, gonads, and internal and external genitalia present at53 |
|---|
| 68 | + | birth, including secondary sex characteristics, without regard to an individual's54 |
|---|
| 69 | + | psychological, chosen, or subjective identification of gender.55 |
|---|
| 70 | + | (6) 'Sex reassignment surgery' means any surgical procedure that seeks to surgically alter56 |
|---|
| 71 | + | or remove healthy or nondiseased physical or anatomical characteristics or features that57 |
|---|
| 72 | + | are typical for an individual's sex in order to instill or create physiological or anatomical58 |
|---|
| 73 | + | characteristics that resemble a sex different from such individual's sex. Such term means59 |
|---|
| 74 | + | genital or nongenital surgery performed for the purpose of assisting an individual with60 |
|---|
| 75 | + | attempting to alter such individual's sex or to alter the appearance of or affirm such61 |
|---|
| 76 | + | individual's perception of his or her gender or sex if such appearance or perception is62 |
|---|
| 77 | + | inconsistent with such individual's sex. Such term includes but is not limited to63 |
|---|
| 78 | + | castration, clitorectomy, clitoroplasty, facial gender-affirming surgery, hysterectomy,64 |
|---|
| 79 | + | mammoplasty, mastectomy, metoidioplasty, oophorectomy, orchiectomy, ovariectomy,65 |
|---|
| 80 | + | penectomy, phalloplasty, scrotoplasty, vaginectomy, vaginoplasty, vasectomy, voice66 |
|---|
| 81 | + | feminization or masculinization surgery, and vulvoplasty, and any healthcare services67 |
|---|
| 82 | + | before or after such surgery.68 |
|---|
| 83 | + | S. B. 39 |
|---|
| 84 | + | - 3 - 25 LC 46 1061S (SCS) |
|---|
| 85 | + | (b) The health insurance plan shall not include expenses incurred by or on account of an69 |
|---|
| 86 | + | individual prior to the effective date of the plan; expenses for services received for injury70 |
|---|
| 87 | + | or sickness due to war or any act of war, whether declared or undeclared, which war or act71 |
|---|
| 88 | + | of war shall have occurred after the effective date of this plan; expenses for which the72 |
|---|
| 89 | + | individual is not required to make payment; expenses to the extent of benefits provided73 |
|---|
| 90 | + | under any employer group plan other than this plan in which the state participates in the74 |
|---|
| 91 | + | cost thereof; expenses for abortion services except to the extent permitted under the state75 |
|---|
| 92 | + | health benefit plan approved by the board as such plan existed on January 1, 2014;76 |
|---|
| 93 | + | expenses for gender-affirming care except as provided in subsection (c) of this Code77 |
|---|
| 94 | + | section; and such other expenses as may be excluded by regulations of the board. For78 |
|---|
| 95 | + | purposes of this Code section, the term 'abortion' shall have the same meaning as provided79 |
|---|
| 96 | + | in Code Section 31-9A-2.80 |
|---|
| 97 | + | (c) The board shall adopt rules and regulations regarding the exclusion of expenses for81 |
|---|
| 98 | + | gender-affirming care provided in subsection (b) of this Code section, which shall contain82 |
|---|
| 99 | + | limited exceptions for:83 |
|---|
| 100 | + | (1) Treatments for medical conditions other than gender dysphoria or for the purpose of84 |
|---|
| 101 | + | sex reassignment where such treatments are deemed medically necessary;85 |
|---|
| 102 | + | (2) Treatments for individuals born with a medically verifiable disorder of sex86 |
|---|
| 103 | + | development, including individuals born with ambiguous genitalia or chromosomal87 |
|---|
| 104 | + | abnormalities resulting in ambiguity regarding the individual's biological sex;88 |
|---|
| 105 | + | (3) Treatments for individuals with partial androgen insensitivity syndrome; and89 |
|---|
| 106 | + | (4) Any other treatments for similar conditions to the extent permitted under the state90 |
|---|
| 107 | + | health benefit plan approved by the board as such plan existed on January 1, 2025."91 |
|---|
| 108 | + | SECTION 3.92 |
|---|
| 109 | + | Chapter 4 of Title 49 of the Official Code of Georgia Annotated, relating to public assistance,93 |
|---|
| 110 | + | is amended by adding a new Code section to read as follows:94 |
|---|
| 111 | + | S. B. 39 |
|---|
| 112 | + | - 4 - 25 LC 46 1061S (SCS) |
|---|
| 113 | + | "49-4-159.5.95 |
|---|
| 114 | + | The department shall prohibit the coverage of gender-affirming care as provided for in96 |
|---|
| 115 | + | Code Section 45-18-4 for recipients of medical assistance."97 |
|---|
| 116 | + | SECTION 4.98 |
|---|
| 117 | + | Chapter 1 of Title 50 of the Official Code of Georgia Annotated, relating to general99 |
|---|
| 118 | + | provisions relative to state government, is amended by adding a new Code section to read as100 |
|---|
| 119 | + | follows:101 |
|---|
| 120 | + | "50-1-14.102 |
|---|
| 121 | + | (a) No state funds shall be expended for health benefits coverage that includes coverage103 |
|---|
| 122 | + | for gender-affirming care as provided for in Code Section 45-18-4.104 |
|---|
| 123 | + | (b) No healthcare facility owned or operated by the state and no physician or other105 |
|---|
| 124 | + | healthcare provider employed by an agency or entity of this state shall provide106 |
|---|
| 125 | + | gender-affirming care as provided for in Code Section 45-18-4.107 |
|---|
| 126 | + | (c) Nothing in this Code section shall be construed as:108 |
|---|
| 127 | + | (1) Prohibiting any individual, entity, or local government from purchasing separate109 |
|---|
| 128 | + | coverage for gender-affirming care or health benefits coverage that includes110 |
|---|
| 129 | + | gender-affirming care, provided that such coverage is paid for entirely using only funds111 |
|---|
| 130 | + | not authorized or appropriated by the state; or112 |
|---|
| 131 | + | (2) Restricting the ability of any nonstate health benefits coverage provider from offering113 |
|---|
| 132 | + | coverage for gender-affirming care, or the ability of a local government to contract114 |
|---|
| 133 | + | separately with such a provider for such coverage, provided that such coverage is paid115 |
|---|
| 134 | + | for entirely using only funds not authorized or appropriated by the state."116 |
|---|
| 135 | + | SECTION 5.117 |
|---|
| 136 | + | This Act shall become effective on January 1, 2026, and shall apply to all state health benefit118 |
|---|
| 137 | + | plans issued, delivered, issued for delivery, or renewed in this state on or after such date.119 |
|---|
| 138 | + | S. B. 39 |
|---|
| 139 | + | - 5 - 25 LC 46 1061S (SCS) |
|---|
| 140 | + | SECTION 6. |
|---|
| 141 | + | 120 |
|---|
| 142 | + | All laws and parts of laws in conflict with this Act are repealed.121 |
|---|
| 143 | + | S. B. 39 |
|---|
| 144 | + | - 6 - |
|---|