Illinois Medicaid covers gender-affirming care. The massive House bill aims to end that.

In addition to cutting hundreds of billions of dollars from Medicaid, a massive bill passed by the House on Thursday would also prohibit the health insurance program from covering gender-affirming care — a provision that’s at odds with Illinois’ current practice.

The provision is a result of a last-minute change to the bill before its passage out of the Republican-controlled House early Thursday morning.

“As the conservative conscience of the GOP conference, we will continue our fight to be the voice for countless Americans who feel that Washington’s policies do not represent them,” the House Freedom Caucus said in a statement that cited the change, posted on X on Thursday.

Illinois’ Medicaid program now covers gender-affirming care, which can include a range of services such as hormone therapy and surgeries. Illinois Medicaid covers surgeries for people ages 21 and older who are diagnosed with gender dysphoria, which is when people experience distress because their gender identity differs from their sex at birth or physical characteristics. It covers surgeries for people younger than 21 “in specific cases if medical necessity is demonstrated.”

The new provision, however, would prohibit Medicaid programs from covering those services for people of all ages on Medicaid — not just people younger than 18, as a previous version of the bill proposed.

Medicaid is a state- and federally funded health insurance program for people with low incomes. In Illinois, more than 3.4 million people — about one-fourth of the state’s population — are on Medicaid.

Gov. JB Pritzker’s office did not provide comment Thursday on the portion of the bill addressing gender-affirming care, but Pritzker said in a 2019 news release, when the state announced that Medicaid would start covering gender-affirming surgeries: “Expanding Medicaid to cover gender affirming surgeries is cost effective, helps avoid long term health consequences, and most importantly is the right thing to do.”

On Thursday, Pritzker wrote in a post on X of the larger budget bill: “House Republicans pushed through their scam to punish working families across the nation early this morning. Hospitals will close, kids will go hungry, and people will lose their health care. This fight isn’t over, Illinois — stand up and speak out as it goes to the Senate.”

Attorney General Kwame Raoul’s office said in a statement Thursday that it is evaluating the proposal and its potential implications. The office remains committed “to advocating for and fighting to protect the rights of transgender and nonbinary individuals throughout the country who deserve access to quality health care and to live authentically,” according to the statement.

It’s likely that if the bill becomes law the provision barring Medicaid from covering gender-affirming care will be challenged in court, said Lindsey Dawson, director of LGBTQ health policy for KFF, a nonprofit organization focused on health policy. A different federal law, the Affordable Care Act, prohibits discrimination based on sex in health care programs that receive federal dollars.

Illinois health care providers say that if the new provision of the bill goes into effect, it could be devastating for patients who receive gender-affirming care.

Last year, about 24% of transgender and gender-diverse patients at Howard Brown Health were on Medicaid, according to Howard Brown Health. Howard Brown Health has clinics in Chicago and specializes in care for patients who are LGBTQ+.

“This is necessary, life-saving health care that people are just going to suddenly no longer have access to,” said Tim Wang, director of policy and advocacy at Howard Brown Health.

At Planned Parenthood of Illinois, nearly 30% of patients receiving gender-affirming care are on Medicaid, said Tonya Tucker, interim president and CEO of Planned Parenthood of Illinois, in a statement.

“If the bill is enacted, thousands of (Planned Parenthood of Illinois) patients would not be able to access the gender-affirming care they need and deserve,” Tucker said. “Gender-affirming care saves lives, and this is a clear attempt to take away bodily autonomy and block people from receiving care.”

It’s a proposal that should worry all people, not just those who are transgender, said Brian C. Johnson, CEO of Equality Illinois, which advocates for equal rights for LGBTQ+ people. If the government can slash coverage of gender-affirming care for people on Medicaid, then it can do the same for other types of care, such as services for people living with HIV or for vaccines, Johnson said.

“If we collectively as a nation acquiesce to this, then they can absolutely do it to any other medically appropriate, legal care they dislike,” Johnson said. “Any type of medically appropriate care they find distasteful is something they can defund, attack and do so by targeting the poorest Americans. This is a threat we should all be deeply alarmed by.”

The prohibition on Medicaid coverage for gender-affirming care is one of a number of proposed changes to Medicaid in the sweeping bill, which aims to cut federal spending to help pay for new and existing tax cuts and enhanced border and national security. The bill would also add work requirements for able-bodied adults on Medicaid and cut funding for states that use their state dollars to offer health care coverage to undocumented immigrants, such as Illinois, among other things.

The Congressional Budget Office estimated, before changes were made to the bill, that if it passed, millions of people would lose health care coverage over the next 10 years.

House Speaker Mike Johnson said in a statement Thursday after the bill passed, “Today, the House has passed generational, nation-shaping legislation that reduces spending, permanently lowers taxes for families and job creators, secures the border, unleashes American energy dominance, restores peace through strength, and makes government work more efficiently and effectively for all Americans.”

The bill must still pass the Senate and gain President Donald Trump’s signature before it can become law.

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