TennCare

Plain English Breakdown

The official source material does not provide specific details on what happens if a medical procedure starts before the effective date but continues beyond March 31, 2027.

TennCare Medical Procedure Coverage Act

This bill restricts TennCare from covering or paying for certain medical procedures that change a person's sex characteristics unless they are treating specific health issues.

What This Bill Does

• Prohibits TennCare from providing coverage or reimbursement for medical procedures if the purpose is to help someone identify with an identity different from their biological sex or treat discomfort due to a mismatch between their sex and identity.
• Defines 'medical procedure' as surgeries that alter body parts or prescribing puberty blockers, hormones like estrogen or testosterone.
• Allows exceptions for treating congenital defects, precocious puberty, diseases other than gender dysphoria, and physical injuries.
• Permits ongoing treatments started before the bill's effective date to continue until March 31, 2027, if a doctor certifies it is medically necessary.

Who It Names or Affects

• TennCare recipients who need medical procedures that alter their sex characteristics.
• Doctors and healthcare providers who perform or prescribe treatments covered by TennCare.
• Individuals with gender dysphoria seeking medical assistance through TennCare.

Terms To Know

Medical procedure

Surgical changes to the body or prescribing puberty blockers, hormones like estrogen or testosterone.

Congenital defect

A physical abnormality present at birth that is not related to gender dysphoria.

Limits and Unknowns

• The bill does not specify what happens if a medical procedure starts before the effective date but continues beyond March 31, 2027.
• It remains unclear how this will affect individuals who need ongoing treatment after the specified exemption period ends.

Official Summary Text

This bill prohibits the
division
of TennCare ("division") from
provid
ing
coverage or reimbursement for a medical procedure if the performance or administration of the procedure is for the purpose of
(i) e
nabling an individual to identify with, or live as, a purported identity inconsistent with the individual's sex or

(
ii
)
t
reating purported discomfort or distress from a discordance between the individual's sex and asserted identity.
These provisions apply to
medical procedures that are
p
erformed or admini
stered in this state
or p
erformed or administered on an individual located in this state, including via telehealth.
As used in these provisions, a "medical procedure" means
(
i
)
s
urgically removing, modifying, altering, or entering into tissues, cavities, or organs of a human being; or

(
ii
)
p
rescribing, administering, or dispensing any puberty blocker
, androgen,
or
estrogen
to a human being
.

EXEMPTIONS

This bill provides that it is
not a violation of
this bill
if the division provides medical assistance coverage or reimbursement for a medical procedure performed on or administered to an individual, if
any of the following circumstances occur:



The performance or administration of the medical procedure is to treat an individual's congenital defect, precocious puberty, disease, or physical injury
. As used in this exemption,
"disease" does not include gender dysphoria, gender identity disorder, gender incongruence, or any mental condition, disorder, disability, or abnormality.



The performance or administration of the medical procedure on the individual began prior to the effective date of this
bill
and concludes on or before March 31, 2027.
However, for this exemption to apply, the
individual's treating physician must certify in writing that, in the physician's good faith medical judgment, based upon the facts known to the physician at the time, ending the medical procedure would be harmful to the individual. The certification must include the findings supporting the certification and must be made a part of the individual's medical record.
Additionally, this exemption
does not allow the division to provide coverage or reimbursement for the performance or administration of a medical procedure that is different from the medical procedure performed prior to the effective date of this act when the sole purpose of the subsequent medical procedure is to
(i) e
nable the individual to identify with, or live as, a purported identity inconsistent with the individual's sex or

(ii)
t
reat purported discomfort or distress from a discordance between the individual's sex and asserted identity.

Current Bill Text

HOUSE BILL 2498
By Capley

SENATE BILL 2118
By Lowe
SB2118
011208
- 1 -
AN ACT to amend Tennessee Code Annotated, Title 71,
Chapter 5, relative to TennCare.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF TENNESSEE:
SECTION 1. Tennessee Code Annotated, Title 71, Chapter 5, Part 1, is amended by
adding the following as a new section:
(a) As used in this section:
(1) "Congenital defect" means a physical or chemical abnormality present
in an individual that is inconsistent with the normal development of a human
being of the individual's sex, including abnormalities caused by a medically
verifiable disorder of sex development, but does not include gender dysphoria,
gender identity disorder, gender incongruence, or any mental condition, disorder,
disability, or abnormality;
(2) "Division" means the division of TennCare;
(3) "Hormone" means androgen or estrogen;
(4) "Medical procedure" means:
(A) Surgically removing, modifying, altering, or entering into
tissues, cavities, or organs of a human being; or
(B) Prescribing, administering, or dispensing any puberty blocker
or hormone to a human being;
(5) "Minor" means an individual under eighteen (18) years of age;
(6) "Puberty blocker" means a drug or device that suppresses the
production of hormones in a minor's body to stop, delay, or suppress pubertal
development; and

- 2 - 011208

(7) "Sex" means an individual's immutable characteristics of the
reproductive system that define the individual as male or female, as determined
by anatomy and genetics existing at the time of birth.
(b)
(1) The division shall not provide coverage or reimbursement for a
medical procedure if the performance or administration of the procedure is for the
purpose of:
(A) Enabling an individual to identify with, or live as, a purported
identity inconsistent with the individual's sex; or
(B) Treating purported discomfort or distress from a discordance
between the individual's sex and asserted identity.
(2) Subdivision (b)(1) applies to medical procedures that are:
(A) Performed or administered in this state; or
(B) Performed or administered on an individual located in this
state, including via telehealth, as defined in § 63-1-155.
(c)
(1) It is not a violation of subsection (b) if the division provides medical
assistance coverage or reimbursement for a medical procedure performed on or
administered to an individual, if:
(A) The performance or administration of the medical procedure
is to treat an individual's congenital defect, precocious puberty, disease,
or physical injury; or
(B) The performance or administration of the medical procedure
on the individual began prior to the effective date of this act and
concludes on or before March 31, 2027.

- 3 - 011208

(2) For purposes of subdivision (c)(1)(A), "disease" does not include
gender dysphoria, gender identity disorder, gender incongruence, or any mental
condition, disorder, disability, or abnormality.
(3) For the exception in subdivision (c)(1)(B) to apply, the individual's
treating physician must certify in writing that, in the physician's good faith medical
judgment, based upon the facts known to the physician at the time, ending the
medical procedure would be harmful to the individual. The certification must
include the findings supporting the certification and must be made a part of the
individual's medical record.
(4) The exception in subdivision (c)(1)(B) does not allow the division to
provide coverage or reimbursement for the performance or administration of a
medical procedure that is different from the medical procedure performed prior to
the effective date of this act when the sole purpose of the subsequent medical
procedure is to:
(A) Enable the individual to identify with, or live as, a purported
identity inconsistent with the individual's sex; or
(B) Treat purported discomfort or distress from a discordance
between the individual's sex and asserted identity.
SECTION 2. This act takes effect July 1, 2026, the public welfare requiring it.