House Bill 1118 – Criminalizing Gender Affirming Care

Authored by Rep. Lorissa Sweet, HB-1118 Defines gender affirming care as a form of conversion therapy and defines criminal penalties for parents and medical providers who affirm the self-identify of their transgender children.

Related House bills: House Bill 1220, House Bill 1231, House Bill 1589.
Related Senate bill: Senate Bill 480, which is moving in the Senate.

Introduced House Bill (H)
Authored by Rep. Lorissa Sweet.
Co-Authored by Rep. Zach Payne.

Prohibited services relating to care of minors. Prohibits specified health care professionals from: (1) performing, or causing to be performed, certain medical procedures on a minor; or (2) subjecting a minor to certain activities that purposely attempt to change, reinforce, or affirm a minor’s perception of the minor’s own sexual attraction or sexual behavior, or attempt to change, reinforce, or affirm a minor’s gender identity when the identity is inconsistent with the minor’s biological sex.

H 01/12/2023 Representative Payne Z added as coauthor
H 01/10/2023 First reading: referred to Committee on Public Health
H 01/10/2023 Authored by Representative Sweet

Explanation of State Expenditures:

The bill would result in an increase in workload for the Department of Child Services (DCS) to investigate reports of health care professionals providing prohibited services under the bill to minors and refer cases to law enforcement. The Professional Licensing Agency (PLA) and applicable licensing boards may also experience additional workload to take disciplinary action against practitioners who are alleged to have violated the requirements of the bill. If health care professionals are convicted on felony charges under the bill, the Department of Correction (DOC) would incur additional costs for incarceration. Ultimately, total additional expenditures resulting from the bill will depend on legislative, administrative, and judicial decisions.

Additional Information:
A health care professional who violates provisions of the bill that prohibit certain medical procedures would commit a Level 5 felony. A Level 5 felony is punishable by a prison term ranging from 1 to 6 years, with an advisory sentence of 3 years. The sentence depends on mitigating and aggravating circumstances. The average expenditure to house an adult offender was $27,185 annually, or $74.43 daily, in FY 2022. (This does not include the cost of new construction.) If offenders can be housed in existing facilities with no additional staff, the marginal cost for medical care, food, and clothing is approximately $4,456 annually, or $12.21 daily, per prisoner. These marginal cost estimates are based on contractual agreements with food and medical vendors and projections based on prior years for clothing and hygiene. The estimated average cost of housing a juvenile in a state juvenile facility was $130,547, or $357.42 daily, in FY 2022. The marginal cost for juvenile facilities was $5,125 annually or $14.04 daily

The entire Level 5 sentence may be suspended and the person placed on either probation or community corrections. If no time is suspended, the offender can receive good time credit of 25% and educational credit time. After adjusting for credit time, the offender can be released from prison and placed on parole.

Explanation of State Revenues:
If civil actions are brought against health care professionals, the state General Fund and Common School Fund could collect additional revenue from court fees and criminal fines. Additionally, the PLA and applicable licensing boards could impose fines against violating practitioners, which would be deposited in the state General Fund. However, Licensing boards could also take action against a practitioner’s license, resulting in reduced state General Fund revenue from license fees. The bill’s overall impact on revenue will ultimately depend on administrative and judicial decisions.

Additional Information:

Penalty Provision:
If additional court cases occur and fines are collected, revenue to both the Common School Fund and the state General Fund would increase. The maximum fine for a Level 5 felony is $10,000. Criminal fines are deposited in the Common School Fund. The maximum fine for a Class A misdemeanor is $5,000.

If the case is filed in a circuit or superior court, 70% of the $120 criminal costs fee that is assessed and collected when a guilty verdict is entered would be deposited in the state General Fund. In addition, some or all of the following revenue is deposited into the state General Fund: automated record keeping fee ($20), judicial salaries fee ($20), public defense administration fee ($5), court administration fee ($5), judicial insurance adjustment fee ($1), and the DNA sample processing fee ($3).

Disciplinary Action:
The PLA may impose fines of up to $1,000 against practitioners who violate laws governing their profession. Revenue from fines is deposited in the state General Fund. Biennial license fees for the practitioners named in the bill range from $50 to $200 and are deposited in the state General Fund.

Explanation of Local Expenditures:
If more defendants are detained in county jails prior to their court hearings or receive jail sentences, local expenditures for jail operations may increase. However, any additional expenditures would likely be minimal. [A Class A misdemeanor is punishable by up to one year in jail.] County-owned hospitals could experience additional legal costs if they become involved in litigation against health care professionals practicing at their facilities.

The average cost per day is approximately $64.53 based on the per diem payments reported by U.S. Marshals to house federal prisoners in 11 county jails across Indiana during CY 2021.

Explanation of Local Revenues:
If additional court actions occur and a guilty verdict is entered, local governments would receive revenue from the following sources. The county general fund would receive 27% of the $120 criminal costs fee that is assessed in a court of record. Cities and towns maintaining a law enforcement agency that prosecutes at least 50% of its ordinance violations in a court of record may receive 3% of the criminal costs fee. Persons found guilty of a felony or misdemeanor are also required to pay the document storage fee ($5), which is deposited into the clerk record perpetuation fund, and the jury fee ($2) and the law enforcement continuing education fee ($4), which are both deposited in the county user fee fund.

State Agencies Affected:
Department of Child Services; Professional Licensing Agency; Department of Correction.

Local Agencies Affected:
Trial courts; local law enforcement agencies.

Information Sources:
Margaux Auxier, Department of Correction; IC 35-50-2-7; IC 35-50-3-2; Legislative Services Agency, Indiana Handbook of Taxes, Revenues, and Appropriations, FY 2022; U.S. Department of Justice Marshals Service.

Fiscal Analyst:
Jasmine Noel, 317-234-1360.

Link to introduced version of the bill: HB1118.01.INTR

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