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EXCLUSIVE: Obama extends protections to gay couples under Medicaid

Protects against liens, period of ineligibility and estate recovery

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Secretary of Health & Human Services Kathleen Sebelius (Blade file photo by Michael Key)

The Obama administration is set on Friday to issue policy guidance to states expanding their ability to offer same-sex couples the same protections afforded to straight couples when they receive long-term care under Medicaid, the Washington Blade has learned exclusively.

Under the new guidance, dated June 10, states have the option to allow healthy partners in a same-sex relationship to keep their homes while their partners are receiving support for long-term care under Medicaid, such as care in a nursing home.

Medicaid kicks in for a beneficiary to receive care after an individual depletes virtually all of their money. To pay for the beneficiary’s expenses under Medicaid, a state could impose a lein, or take possession, of a beneficiary’s home to pay for Medicaid expenses.

However, federal law prohibits imposing this lein if beneficiaries are married to someone of the opposite-sex who’s still living in their home. The new guidance, signed by Deputy Administrator of the Centers for Medicare & Medicaid Services Cindy Mann, clarifies that states can offer this protection to the healthy partner of a Medicaid recipient in a same-sex relationship.

“A State can have a policy or rule not to pursue liens when the same-sex spouse or domestic partner of the Medicaid beneficiary continues to lawfully reside in the home,” the guidance states.

The Obama administration previously hadn’t articulated whether gay couples could receive these protections under the Defense of Marriage Act, which prohibits federal recognition of same-sex marriage. The guidance doesn’t mandate that same-sex couples receive this protection, but allows states to “incorporate their criteria for determining when to impose a lien in the Medicaid State plan.”

The Department of Health & Human Services had been examining ways to offer more protections to same-sex couples under Medicaid as part of the work it has undertaken for LGBT people, but until now hadn’t issued the policy guidance to states.

Secretary of Health & Human Services Kathleen Sebelius said in a statement the new guidance represents a path for low-income same-sex couples to receive care under Medicaid.

“Low-income same-sex couples are too often denied equal treatment and the protections offered to other families in their greatest times of need,” she said. “That is now changing. Today’s guidance represents another important step toward ensuring the rights and dignity of every American are respected by their government.”

Michael Cole-Schwartz, a Human Rights Campaign spokesperson, praised the Obama administration for issuing the guidance, but maintained same-sex couples won’t have equal protection under the law until DOMA is repealed.

“No one should have to choose between keeping their home and getting the medical care they need and deserve,” Cole-Schwartz said. “This is an important step to give some couples the security and dignity they deserve when they need it most. However all same-sex couples will remain vulnerable until we end discrimination in marriage and repeal the Defense of Marriage Act.”

In addition to allowing states not to impose liens on the homes of same-sex couples, the guidance also allows individuals in same-sex relationships to sell their home below market value to their partner and still receive Medicaid support.

An individual seeking Medicaid coverage may want to make this transfer to deplete his or her assets more quickly to be eligible for care. Under other circumstances, the state could impose a period of ineligibility on the beneficiary because of this sale, but the guidance says states can ignore this transfer if they believe such ineligibility would institute “undue hardship.”

“Because of the flexibility afforded to States in determining undue hardship, we believe that States may adopt criteria, or even presumptions, that recognize that imposing transfer of assets penalties on the basis of the transfer of ownership interests in a shared home to a same-sex spouse or domestic partner would constitute undue hardship,” the guidance states.

Furthermore, the guidance says states can opt not to seize the home of Medicaid beneficiaries upon their death if their same-sex partner is still living in the home.

States may seize the property of Medicaid beneficiaries upon their death — if a lien has been imposed on the home or the recipient is age 55 or over and has received nursing services — but not if the recipient’s child or spouse is living in the home. The guidance clarifies that states may also decide not to do so if a same-sex partner is living in the home.

“States have flexibility to design reasonable criteria for determining what constitutes an undue hardship and who may be afforded protection from estate recovery in such instances,” the guidance states. “At the State’s discretion, this may include establishing reasonable protections applicable to the same-sex spouse or domestic partner of a deceased Medicaid recipient.”

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Congress

HRC president campaigns for Chris Pappas in NH

Gay congressman running to succeed retiring U.S. Sen. Jeanne Shaheen

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Human Rights Campaign President Kelley Robinson speaks at the group's 2025 National Dinner in D.C. She campaigned for U.S. Rep. Chris Pappas (D-N.H.) in New Hampshire on Aug. 30, 2026. (Washington Blade photo by Michael Key)

Human Rights Campaign President Kelley Robinson on Sunday campaigned for U.S. Rep. Chris Pappas (D-N.H.) in New Hampshire.

Robinson traveled to Manchester, the state’s largest city, nine days before the Sept. 8 primary that will determine who will vie for retiring U.S. Sen. Jeanne Shaheen (D-N.H.)’s seat.

Former U.S. Sen. John E. Sununu, who represented New Hampshire in the U.S. Senate from 2003-2009, will face off against former U.S. Sen. Scott Brown, who represented Massachusetts in the U.S. Senate from 2010-2013, in the Republican primary.

Karishma Manzur is among the Democrats challenging Pappas.

A poll the University of New Hampshire Survey Center released on Aug. 26 shows Sununu is ahead of Brown. The same survey shows Pappas ahead of Manzur and his other Democratic challengers.

The UNH Survey Center poll shows Sununu ahead of Pappas by a 45-43 percent margin if they were to face off in the general election. The margin of error is +/-2.1 percent.

Pappas would become the first openly gay man elected to the U.S. Senate if he were to win in November.

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National

Milo Yiannopoulos deported to UK

ICE arrested far-right provocateur in New Orleans on Thursday

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Milo Yiannopoulos (Photo via Homeland Security @DHSgov/X account)

Editor’s note: The Department of Homeland Security on Saturday said Milo Yiannopoulos has been deported to the U.K.

U.S. Immigration and Customs Enforcement on Thursday arrested far-right provocateur Milo Yiannopoulos.

A DHS spokesperson in a statement sent to the Washington Blade said ICE arrested Yiannopoulos, who they described as “an illegal alien from the United Kingdom,” at Louis Armstrong New Orleans International Airport.

The DHS spokesperson said Yiannopoulos “legally entered the country” in New York on May 14, 2019.

“He chose to overstay his welcome in violation of our nation’s laws,” said the spokesperson.

The DHS spokesperson said an immigration judge on July 22 “issued a final order of removal” for Yiannopoulos “after failing to show up for his immigration hearing.” The Times-Picayune newspaper in New Orleans on Friday reported Yiannopoulos is being held at an ICE detention center in Alexandria, La., which is about 200 miles northwest of the Crescent City.

“He will remain in ICE custody pending removal,” said the DHS spokesperson.

Yiannopoulos has, among other things, repeatedly targeted transgender people and Muslims.

The American Conservative Union, which organizes the annual Conversative Political Action Conference, in 2017 disinvited Yiannopoulos from speaking at that year’s CPAC after a video in which he appeared to condone sex between adults and underage boys emerged. Yiannopoulos subsequently resigned from Breitbart News, a far-right news website, where he had been a senior editor.

Yiannopoulos later that year married his boyfriend in Hawaii. The far-right provocateur in 2021 claimed he was an “ex-gay.”

The Australian government in 2019 banned Yiannopoulos from entering the country “on character grounds.” Yiannopoulos was also banned from Facebook, Twitter (now X), and other social media platforms.

Milo Yiannopoulos speaks at a “Gays for Trump” event during the 2016 Republican National Convention in Cleveland. (Washington Blade file photo by Michael Key)

The Times-Picayune reported Yiannopoulos “most recently worked for” Ye, formerly known as Kanye West.

The controversial rapper is scheduled to perform in New Orleans on Friday.

Laura Loomer, a far-right conspiracy theorist who is close to President Donald Trump, has called for Yiannopoulos’s deportation. Loomer on Friday wrote on X that she “reported him to ICE and the FBI” after he “called for me to be assassinated.”

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California

San Francisco, long a queer safe haven, remains competitive for homebuyers

AI boom has boosted market as housing shortages continue

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San Francisco’s LGBTQ Castro neighborhood is seeing an uptick in home purchases, local real estate agents said. (Photo by Rick Gerharter)

LGBTQ people have a variety of housing options when they’re lucky enough to be able to afford property. In San Francisco – long considered a safe haven for the queer community – individual needs have to be weighed both against the city’s chronic housing shortage and a competitive but often lucrative job market.

After a lull of several years, the city’s real estate market has heated up in recent months, driven by the city’s economic recovery post-COVID lockdowns and the artificial intelligence boom.

For Rick Page, 68, and Anthony Farace, 57, both gay men, the job market was a top reason to move back to the city after they’d left the Bay Area five years ago.

Page said the couple had left behind a “huge home in a town called Oakhurst, on the way to Yosemite.” When moving back to San Francisco they wanted to balance suburban and downtown vibes, Farace said, leading them to settle in Diamond Heights, a tiny neighborhood built atop three hills above Noe Valley, that has suburban sensibilities but isn’t too far from downtown.

“In the summer it’s a little foggy but it’s nicer up here the rest of the time, and where it felt like you aren’t downtown where it’s just concrete and buildings,” Farace said. 

Added Page, “It sounds goofy, but if there’s a tsunami, it won’t get all the way up here.”

Page said that in the spring the couple initially bought a relatively small studio in Diamond Heights. But they found that it didn’t meet their needs and purchased a second studio unit nearby that did. They closed on the larger condo unit in October.

“It just didn’t have any kind of patio or outdoor thing for the dog,” Page said of their first studio, “so we saw something upgraded with a kitchen redone, nice hardwood floors, a fireplace, a sunny patio, so it was much nicer. We bought that one, now we have to figure out what to do with the first one.”

The first unit was $450,000 and the second $520,000, they stated.

The couple also mentioned a lack of some of the downtown, South of Market, and Mission District street disorder that garnered negative headlines in the past several years. The couple also noted that Diamond Heights is more affordable than traditionally high-priced Russian Hill, which is closer to downtown. 

Nevertheless, “The employment, the social life is better” in San Francisco, Page added. 

Federal data shows many LGBTQ people want to own a home.

Fannie Mae, the government sponsored enterprise that buys home loans, does have some LGBT data, according to research from 2023 that was published in 2024. The data is the result of sexual orientation and gender identity identifiers in the National Housing Survey. It did not ask about queer representation.

According to the report, 8.6% of respondents identified as lesbian, gay, bisexual, and transgender – similar to the U.S. Census Bureau’s Household Pulse Survey. The survey included responses from a weighted total of 12,363 people 18 years and older, with a weighted total of 1,059 identifying as LGBT.

The research found the LGBT homeownership rate to be 46%, which is much lower than the overall U.S. homeownership rate of 65%.

The latest available data from The Urban Institute reveals that the homeownership rate for individuals identifying as LGBTQ+ stands at 51%, in contrast to 71% for those who identify as both straight and cisgender. According to the U.S. Census Bureau, at least 1.3 million same-sex couples reside in the U.S., meaning a significant number of LGBTQ people in this country do not own their own homes.

In San Francisco, the Diamond Heights neighborhood is just a half-hour walk from the Castro, and even shorter on the bus. 

Charlie Mader is a gay man who has been a Realtor in San Francisco for “just under 25 years,” with a particular emphasis on Diamond Heights, the Castro, and Noe Valley. He said that while many LGBTQ people want to live relatively close to a queer neighborhood, such as the Castro, “It’s not like it used to be.”

Even in spite of a recent backlash to LGBTQ equality in the mid-2020s, leading to a number of federal policies largely targeting transgender and gender-nonconforming people, Mader said that since marriage equality, “You hear ‘There’s no need for us to live together in a gay ghetto,’ and we’re interspersed throughout the community and the country.”

Marriage equality became legal in California in June 2013, two years before the U.S. Supreme Court made same-sex unions legal nationwide in 2015.

Mader said marriage equality helped incentivize more LGBTQ home-buying due to an old Clinton administration tax law that gave married couples favorable tax incentives versus single homebuyers. 

But even within the City-by-the-Bay, the distinction between neighborhoods is not as stark.

“I hear the Mission is just as gay as the Castro is, and the food is better,” Mader said. “I can’t argue with that.”

Angel Carney, a lesbian Realtor, has also been in the Castro area for decades. She said the threshold of home ownership there has risen dramatically. 

“When I first started,” which was in 2002, she said, “I had teachers, I had nurses, I had a doctor … It was diverse in terms of who was buying. Everybody had a way to get into the market.”

Now, “with tech, they blew out everybody,” she added, saying first-time homebuyers are sometimes competing with tech employees making six-figure salaries from their early 20s due to their economic opportunities.

Carney said that even so, “It’s mostly a two-income household who’s buying in the Castro,” largely people in their 30s.

“LGBTQ is more of a rarity,” she added. “I’ve seen more non-LGBTQ, I would say, couples buying in the Castro.”

One reason is because while it is such an iconic epicenter of the LGBTQ community, it is “definitely a transit hub, and it’s geographically central, so if you work on the Peninsula, you go over Diamond Street and you’re on [Highway] 280. You can get to BART, to the airport, it definitely is transit centric for work, for traveling, if you’re a tech worker.”

Understanding that unhoused people are often part of San Francisco neighborhoods such as the Castro is also a factor, Mader said. 

“Because gays are so tolerant, it draws a magnet for people who you know are distressed and so you see more antisocial behavior, begging on the street, people just getting high because they know they can get away with it,” he said. That can impact people’s desire to buy a forever home in one neighborhood or another.

Indeed, the Castro has experienced fewer open-air drug scenes than other parts of the city, such as Sixth Street or the Civic Center Plaza, which are both near the downtown core. Such activity has, however, remained a persistent complaint of Castro merchants. In early December, Sophie Marie, a legislative aide to gay Board of Supervisors President Rafael Mandelman, who represents the neighborhood as District 8 supervisor, noted that “a lot” of unhoused people have recently moved into the Castro as they leave South of Market and Civic Center amid an increase in law enforcement activity and attention from city government there.

The Castro is among those neighborhoods seeing building height limits increased as a result of Mayor Daniel Lurie’s family zoning plan that, after much rancor, passed the Board of Supervisors for the final time on December 9. The plan is intended to increase the city’s housing stock to meet state housing goals.

San Francisco’s median home sale price rose nearly 6% to $1.85 million, its highest amount since 2022, earlier this year, as the San Francisco Standard reported.  

Mader said that nonetheless, “There are empty condos everywhere for sale,” and that market is down 20% from its peak.

“Right now I’m selling for $625,000 – I’ve sold for $100,000 more than that,” Mader noted.

Carney agreed that condos are very available right now.

“If you’re thinking about entering the market, think about condos,” she advised. “When interest rates go down, prices will go up, so get in now on a condo. People say they’re waiting for the market to drop – well, the market dropped on condos. Those are a great buy right now.”

The Fannie Mae data showed that homeownership aspirations are high among LGBT consumers, with 83% saying they “would like to buy at some point” or “continue to own,” the report stated. This share is comparable to non-LGBT consumers, the report stated. LGBT consumers also believe there are more obstacles to owning a home than their non-LGBT peers.

Those obstacles include that over 70% of LGBT respondents said it was difficult to get a home mortgage today, compared to only 55% of non-LGBT respondents, according to the research. LGBT consumers were more concerned about closing costs, credit score or history, current debt, and insufficient income for monthly payments.

The Federal Reserve on December 10 lowered interest rates for the third time this year. The recent reduction was by a quarter of a percentage point, as the New York Times reported. The new range is between 3.25% to 3.75%. But CNBC noted that mortgage rates may remain higher because they are less impacted by the Fed. The average rate for a 30-year, fixed-rate mortgage is currently about 6.35%, the network reported December 10.

Nationally, the real estate market is dealing with the same uncertainty as the rest of the economy, now almost one year into President Donald Trump’s second term.

“Everyone is afraid of another Trump recession,” Mader said. “People are not buying houses especially in places like Florida, where they’re having all kinds of issues with insurance.”
Florida is the nation’s most expensive state for home insurance due to natural disasters like hurricanes. 

California is also experiencing insurance issues, particularly in areas prone to wildfires, as the San Francisco Chronicle reported. Most of the Bay Area is not as affected as other parts of the state, though insurance premiums are rising for home insurance.

Not everyone wants to live in a big city. 

Mark Kliem, who’s part of the LGBTQ Real Estate Alliance, focuses on the North Bay, encompassing Solano, Napa, and Sonoma counties. 

“Consumers can contact the alliance no matter where they live and connect with the nearest LGBTQ agent close to their area whether they are buyers or sellers,” Kliem, who is gay, said.
Kliem lives in the Solano County city of Vallejo, where the real estate market took a dive during the Great Recession.

“A lot of investors swooped in and bought up as many of those places as they could, so there was a lot of investing in property through that, and a lot of flippers,” he said, referring to people who buy a property, fix it up, and then sell it for a profit.

Now, the area is one of the country’s hottest real estate markets, he said, because it’s near San Francisco, has warmer weather and is more affordable long-term.

“It’s a good place location wise – we’re on a bay, we have a ferry service to downtown San Francisco. We don’t have BART, so it’s a little problematic to get to the nearest BART, but our weather gets even warmer, less fog, than Oakland. Throughout the year, it’s a five-degree difference from San Francisco.”

Ultimately, the Golden State and the Bay Area in particular are poised to remain competitive for buyers of all sexual orientations and gender identity – despite the fact that that leads to so many barriers to entry. Gay Realtor Anthony Waite, 30, explained why.

“A lot of people who moved to Austin, Texas [during the COVID pandemic lockdowns] said there’s not a lot to do,” Waite said. “In San Francisco, you could find something to do every single corner every hour, day and night. Texas doesn’t offer that.”

(Editor’s note: This article was originally published by the Bay Area Reporter and is part of a national initiative exploring how geography, policy, and local conditions influence access to opportunity. Find more stories at economicopportunitylab.com .)

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