A last-minute addition to the Republican’s “big, beautiful bill” that passed early Thursday morning would prohibit Medicaid from covering transgender medical care for children and adults.

The previous version of the recently passed House bill has specific language to ban Medicaid and the Children’s Health Insurance Program from providing such treatments as puberty blockers, hormone treatments, and body-altering procedures to minors. Republicans then expanded the ban through a manager’s amendment to include transgender patients of all ages.

The bill squeaked by early Thursday morning by a 215-214 vote with two Republicans and all Democrats voting against it. House Freedom Caucus Chair Andy Harris, R-Md., voted “present.”

Caleb Smith, director of LGBTQI+ policy at the Center for American Progress said in a statement the Republican’s actions show their previous language was never about protecting children. “The bans on coverage for trans medical care were made so much worse, really, in the eleventh hour of this bill,” Smith said to The Hill adding, “And what a display of how it’s really not just about youth. It’s never just been about youth; It’s always been about curtailing access to medical care and bodily autonomy. All they had to do was strike ‘under 18′ from the bill, and now it’s everybody.”

“There’s a wildly strong case for this to be discrimination — it is discrimination,” Smith continued. “It really clearly violates equal protection because what we’re saying, essentially, is that if you are a cisgender man and you want access to testosterone, you can have it, but if you are a transgender man and you want access to testosterone, ‘Sorry, we’re not going to cover that.’”

According to a report by the Williams Institute at the UCLA School of Law, an LGBTQ+ research center, an estimated 12% of transgender adults, or 180,000, use Medicaid. While it is unclear how many transgender children use the social safety net, roughly 40% of minors are on Medicaid.

The expansion was pushed by Rep. Dan Crenshaw, R-Texas, who has long advocated for banning the surgery for minors. “The Crenshaw Amendment will become law — and it’s long overdue,” he said to The Daily Wire. “Gender transition procedures are the lobotomy of our generation. So-called ‘gender-affirming care’ isn’t healthcare — it’s fringe science with no proven benefit and massive risks.”