SB 904: Gender transition procedures; prohibiting certain use of public funds and state facilities; providing criminal penalty. Emergency. - Oklahoma

Committee Substitute → SB904 (3-17-26) (GOLLIHARE) FS FA1.PDF · 8 edits

MODERATE

The bill was reclassified from a 'Committee Substitute' to a 'Floor Substitute' and updated to reflect the 2nd Session of the 60th Legislature (2026) instead of the 1st Session (2025). The most significant substantive change is the complete replacement of the original text regarding nursing facility incentive payments with new provisions that strictly prohibit the use of public funds for gender transition procedures, including puberty blockers and hormone therapy, regardless of the patient's age.

Scope change

The bill's scope shifted from a program designed to incentivize nursing facilities for improving resident quality of care to a prohibition bill that restricts state Medicaid funding for specific medical procedures related to gender transition.

TIMELINE

The legislative session changed from the 1st Session of 2025 to the 2nd Session of 2026, indicating a delay in the bill's progression.

SCOPE

The bill's title and summary were changed from a 'Committee Substitute' to a 'Floor Substitute', reflecting its status in the legislative process.

FISCAL

All provisions establishing a $5.00 per patient day incentive fund for nursing facilities based on quality metrics were removed.

DEFINITION

New definitions were added to explicitly list 'gender transition procedures' as surgical alterations, puberty-blocking drugs, and cross-sex hormones.

REQUIREMENT

New requirements prohibit the use of public funds, state property, or state employees for providing gender transition procedures to any individual.

Requirements for nursing facilities to retain staff (Registered Nurses, LPNs, and CNAs) for at least 12 months were removed.

ENFORCEMENT

A new penalty was added stating that any state officer or employee who intentionally violates the prohibition faces misdemeanor charges.

ELIGIBILITY

Eligibility for Medicaid reimbursement was changed from being based on nursing home quality star ratings to being explicitly excluded for gender transition procedures.

Enrolled (final version) → Proposed Policy Committee Substitute 1 · 5 edits

MODERATE

The bill was completely rewritten to narrow its scope from applying to all Oklahomans to only minors. The new version removes the prohibition on using public funds for adults and adds a 'continuity of care' clause ensuring minors who started treatment before the law takes effect can finish it. It also adds an emergency exception allowing state facilities to treat minors if they are there for a medical emergency.

Scope change

The bill's applicability was restricted from all individuals to minors only, and an exception was added for minors requiring state care due to a medical emergency.

SCOPE

Restrictions on public funds, Medicaid reimbursement, and state facility use now apply only to minors, removing protections previously in place for adults.

REQUIREMENT

A new provision ensures patients who began gender transition treatment before the effective date can continue receiving it.

An exception was added allowing state facilities to provide gender transition procedures to minors if the patient is there due to a medical emergency.

TIMELINE

The effective date was changed from immediate passage to a specific date of November 1, 2026.

FISCAL

The blanket ban on using public funds for gender transition procedures for adults was removed.

Engrossed → Enrolled (final version) · 3 edits · May 13, 2026

MINOR

The bill was finalized and prepared for signature, adding specific dates for passage and governor approval while retaining the core restrictions on gender transition procedures. The substantive policy content regarding funding, Medicaid reimbursement, and facility use remains identical to the previous version.

Scope change

No change to the scope or applicability of the bill; it remains a restriction on state funding and services related to gender transition procedures.

TECHNICAL

Added specific dates for Senate and House passage (March 25 and May 6, 2026) and included signature lines for the Governor and Secretary of State, marking the bill as officially enrolled and ready for execution.

Corrected the list of sponsors in the House section to include Harris, Stinson, and Maynard, replacing the previous incomplete list.

Removed the 'Engrossed' header and replaced it with 'Enrolled,' indicating the bill has passed both chambers and is in its final form.

Floor (House) → Floor (Senate) · 5 edits

MODERATE

The bill was completely rewritten to shift from a prohibition on gender transition procedures to a new program that funds nursing home quality improvements and staff retention. The original text banning specific medical treatments was removed and replaced with a 'Committee Substitute' that allocates state Medicaid funds to nursing facilities based on their performance ratings and ability to retain nursing staff.

Scope change

The bill's scope changed from restricting access to gender-affirming care to incentivizing high-quality care and workforce stability in nursing facilities.

DEFINITION

Removed definitions prohibiting 'gender transition procedures' and banning the use of public funds for such care.

Added new definitions for 'public funds' and 'gender transition procedures' were replaced with definitions related to nursing facility quality and Medicaid reimbursement.

FISCAL

Added a new incentive reimbursement rate plan that allocates specific dollar amounts per patient day to nursing facilities based on their star ratings.

REQUIREMENT

Added requirements for facilities to retain Registered Nurses, Licensed Practical Nurses, and Certified Nurse Aides for at least 12 months.

Added a requirement for facilities to submit annual staff retention plans and meet specific performance metrics to receive payments.

Proposed Policy Committee Substitute 1 → Committee Substitute · 5 edits

MODERATE

The bill was completely rewritten to replace a proposal restricting gender transition procedures for minors with a new plan to improve nursing home care. The new version directs state funds to incentivize nursing facilities based on resident quality ratings and creates a staff retention initiative for nurses and aides.

Scope change

The bill's scope shifted entirely from prohibiting gender-affirming care for minors to regulating nursing facility reimbursement and staff retention.

SCOPE

All provisions prohibiting the use of public funds for gender transition procedures for minors were deleted.

FISCAL

New funding was established to pay nursing facilities $5.00 per patient day based on their quality rating, with higher payments for facilities achieving better star ratings.

REQUIREMENT

New requirements mandate that nursing facilities retain a specific percentage of Registered Nurses and Certified Nurse Aides for at least 12 months to qualify for additional retention payments.

DEFINITION

New definitions were added to establish 'Long-Stay Quality Measures' and an 'advisory group' to recommend quality metrics.

TIMELINE

The effective date was changed from November 1, 2026, to be contingent on federal Medicaid approval for the new incentive program.

Introduced → Engrossed · 7 edits · Mar 26, 2026

MODERATE

The bill was completely replaced with a new text that shifts focus from improving nursing home care to restricting gender transition procedures. The original version, which allocated funds to nursing facilities based on quality ratings and staff retention, is entirely gone. The new version defines gender transition procedures and prohibits the use of state funds, facilities, or Medicaid coverage for them.

Scope change

The bill's scope changed from regulating nursing facility reimbursement to prohibiting state support for gender transition procedures.

SCOPE

Removed all provisions related to the nursing facility incentive reimbursement rate plan, including funding amounts, quality metrics, and staff retention initiatives.

DEFINITION

Added a new definition for 'gender transition procedures' to include surgeries altering biological characteristics and puberty-blocking drugs.

ELIGIBILITY

Added exclusions for individuals with intersex conditions (DSD) and those facing imminent life-threatening injuries.

FISCAL

Added a prohibition on using public funds to pay for or subsidize gender transition procedures.

REQUIREMENT

Added a requirement that state Medicaid programs cannot reimburse for gender transition procedures.

Added a requirement that state property and facilities cannot be used to provide gender transition procedures.

ENFORCEMENT

Added a misdemeanor penalty for state officers or employees who intentionally violate the new prohibitions.

Gender transition procedures; prohibiting certain use of public funds and state facilities; providing criminal penalty. Emergency.

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