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HHS clarifies gay couples have nursing home visitation rights

Guidance was among Sebelius’ goals for improving LGBT health

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Secretary of Health & Human Services Kathleen Sebelius speaks before the AIDS 2012 International Conference

Secretary of Health & Human Services Kathleen Sebelius had sought to expand the hospital visitation rights memo to include nursing homes. (Blade file photo by Michael Key)

Gay people living in nursing homes will have the same guaranteed access to their partners and spouses as gay patients in hospitals receiving Medicare and Medicaid, according to new guidance obtained Friday by the Washington Blade.

In guidance dated June 28 to state survey agency directors, the Centers for Medicare & Medicaid clarifies that President Obama’s 2010 memorandum guaranteeing that patients can have a same-sex partner visit them in the hospital also means residents in long-term care facilities, or nursing homes, must “be given full and equal visitation privileges.”

“Residents must be notified of their rights to have visitors on a 24-hour basis, who could include, but are not limited to, spouses (including same-sex spouses), domestic partners (including same-sex domestic partners), other family members, or friends,” the guidance states.

The guidance, signed by CMS Director of Survey & Certification Thomas Hamilton, says the guidance takes effect immediately and should be communicated within 30 days toĀ all survey and certification staff, their managers and state or regional office training coordinators.

Clarifying that the hospital visitation rights memo for gay couples also applies to nursing homes was among the goals that Secretary of Health & Human Services Kathleen Sebelius identified in her 2012 report on objectives to improve LGBT health.

Brian Cook, a CMS spokesperson, said the new guidance will help ensure that gay residents living in nursing homes will have access to their partners or spouses while in long-term care.

ā€œToday, as the Department of Health & Human Services celebrates Pride Month, we have clarified regulations for federally regulated nursing facilities, to protect visitation rights for residents in same-sex relationships,” Cook said. “This new guidance furthers the administration’s commitment to equality for same-sex couples and will help to guarantee that spouses or domestic partners of nursing home residents have every opportunity to be with their loved ones.ā€

In April 2010, President Obama issued a memorandum mandating that hospitals receiving Medicare and Medicaid funds ā€” or most facilities ā€” permit patients to allow their same-sex partners and spouses to visit them. The guidance issued on Friday clarifies that memorandum also applies to nursing homes, which also receives funds from Medicare and Medicaid.

An estimated 1.5 million people are currently living in nursing homes. Given that the William Institute estimates 3.5 percent of the adult population identifies as gay, lesbian or bisexual, those numbers would indicate 52,500 LGB people live in nursing homes and would be covered under the new guidance.

Michael Cole-Schwartz, spokesperson for the Human Rights Campaign, praised HHS for clarifying these protections for gay people living in nursing homes.

ā€œAs weā€™ve urged HHS, weā€™re grateful they have made clear that the visitation rights of individuals in long-term care facilities, such as nursing homes, include the ability to receive visits from same-sex spouses and partners,” Cole-Schwartz said. “Too many older members of the LGBT community are forced back into the closet when they enter nursing facilities. Todayā€™s guidance will help ensure that they and their families are respected.ā€

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Congress

House passes spending bill as Greene threatens to oust Johnson

51 of 52 anti-LGBTQ riders were defeated

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Rep. Marjorie Taylor Greene (R-Ga.) speaks at a press conference on Sept. 20. (Washington Blade photo by Michael Key)

The U.S. House of Representatives averted a government shutdown on Friday with a vote of 286-134 to pass the $1.2 trillion spending bill, over the objections of hard-right members like U.S. Rep. Marjorie Taylor Greene (R-Ga.).

The congresswoman subsequently filed a motion to remove House Speaker Mike Johnson (R-La.), who is himself an ultraconservative legislator. The move marked the second time in six months that the party has called for a vote to oust their own leader.

ā€œToday I filed a motion to vacate after Speaker Johnson has betrayed our conference and broken our rules,ā€ said Greene, who refused to say whether she would call up the resolution to call for a snap vote, which likely means the matter will be delayed until after the two-week recess.

Greene and Johnson are at odds over the content of the minibus appropriations package, with the congresswoman calling it a “Chuck Schumer, Democrat-controlled bill” that does not contain conservative policy demands on matters like immigration and LGBTQ issues.

The speaker, meanwhile, proclaimed, ā€œHouse Republicans achieved conservative policy wins, rejected extreme Democrat proposals, and imposed substantial cuts while significantly strengthening national defense.ā€

With respect to anti-LGBTQ riders submitted by Republican members, more than 50 were ultimately stripped from the bill, which the Human Rights Campaign celebrated as “a victory,” crediting lawmakers for their “bipartisan, bicameral negotiations.”

Of the 52 anti-LGBTQ riders, only one survived in the $1.2 trillion package passed on Friday: A ban on flying Pride flags at U.S. embassies.

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Congress

Massive defeat for anti-trans, anti-LGBTQ riders in spending bill

Proposal has only one rider that would target community

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U.S. Capitol
U.S. Capitol (Washington Blade photo by Michael Key)

On Thursday, Congress unveiled the much-anticipated spending bill to avert a government shutdown. The bill, which includes funding for major government departments such as Health and Human Services and Education, featured fierce negotiations over conservative ā€œpolicy riders.ā€ 

These policy riders included bans on coverage for gender-affirming care, DEI bans, sports bans and more. Despite some indications that Democrats might compromise due to the sheer number of conservative policy riders, it appears those fears did not come to fruition. Democrats held firm in negotiations, and the most impactful anti-trans and anti-LGBTQ riders were nowhere to be found.

One policy rider proposed for the Food and Drug Administration would have defunded any hospital that ā€œdistributes, sells or otherwise uses drugs that disrupt the onset of puberty or sexual development for those under 18,ā€ a measure targeting not only transgender youth but also those experiencing precocious puberty. 

Another rider sought to bar any government funding toward ā€œsurgical procedures or hormone therapy for the purposes of gender-affirming careā€ in the Department of Health and Human Services. This move would have significantly impacted private and subsidized insurance in the Healthcare Marketplace. It also aimed to bar the enforcement of President Joe Bidenā€™s executive order titled ā€œPreventing and Combating Discrimination on the Basis of Gender Identity,ā€ which broadened anti-discrimination protections for trans individuals.

Additional riders included bans on funding for any organization thatĀ ā€œpromotes transgenderism,ā€Ā Title IX protections for trans youth, bans on legal challenges against states over anti-LGBTQ+ laws, book bans, DEI bans and more.

In total, over 40 riders were proposed and negotiated in the spending bills. None of these were found in the final bill.

Ultimately, the final spending bill released contained only a single anti-LGBTQ rider: A ban on Pride flags being raised or displayed above foreign embassies. The policy, while certainly qualifying as anti-LGBTQ and a regression to Trump-era policies, notably does not bar personal displays of Pride flags by embassy workers.

In the past, some embassies have gotten around such bans by not ā€œflying a flag over the embassyā€ but rather, painting portions of the embassy in rainbow colors or draping flags on the side of buildings.

News of the defeat of the most impactful anti-trans and anti-LGBTQ riders comes after a significant push from Equality Caucus Democrats and the Biden administration against the riders. ā€œAs you negotiate government funding for Fiscal Year 2024 (FY24), we write to strongly urge you to reject any attempts to include anti-LGBTQ+ provisions in any final FY24 funding agreement,ā€ said a letter signed by 163 representatives on behalf of the Congressional Equality Caucus to the Biden administration.

However, Republicans also pushed hard for their inclusion. In a shutdown threat issued Feb. 21 from the House Freedom Caucus, Republicans indicated that bans on gender affirming care and trans participation in sports were necessary to prevent a potential shutdown.

Previously, U.S. Dan Crenshaw (R-Texas) stated that such bans are the “hill we will die on.” In a report published by Axios, one Republican lawmaker stated, ā€œPeople are predicting a shutdown even if it’s just for a few days.ā€ Others concurred, citing gender affirming care riders as one of the potential reasons for such a shutdown.

Many anti-LGBTQ leaders in the Republican Party reacted negatively to the bill. U.S. Rep. Matt Gaetz (R-Fla.)Ā expressed angerĀ at funding for the New Jersey Garden State Equality in Education Fund, calling it ā€œforce feeding the LGBT agenda in schoolsā€ and stating that it enables ā€œgender mutilation surgeries in minors,ā€ ā€œbiological menā€ in womenā€™s bathrooms and trans participation in sports.

U.S. Rep. Marjorie Taylor Greene (R-Ga.) decried the lack of a DEI ban. U.S. Rep. Andrew Clyde (R-Ga.) stated that Republicans ā€œsurrenderedā€ to Democrats on hormone therapy. The House Freedom Caucus published a lengthy list of healthcare and equality centers that the budget would fund, urging the GOP to vote ā€œnoā€ and to shut down the government.

In a press release published by House Appropriations Democrats, they stated that the bill rejected over a hundred poison-pill riders, many of which targeted LGBTQ people. For example, the Labor-HHS-Education portion of the bill blocked provisions around gender affirming care, sports bans and nondiscrimination.

See the House Appropriations Democrats statement:

Press release, House Appropriations Democrats on Labor-HHS-Education

The bill must pass by Friday evening to avert a government shutdown, though the impacts of such a shutdown would likely not be felt until Monday. If passed, the bill would keep the government funded through September, at which point all of the riders could resurface during the peak of the 2024 presidential election.

However, for the next several months, LGBTQ riders will not pose a significant threat in a year where trans and queer individuals have faced attacks at historic levels.

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Erin Reed is a transgender woman (she/her pronouns) and researcher who tracks anti-LGBTQ+ legislation around the world and helps people become better advocates for their queer family, friends, colleagues, and community. Reed also is a social media consultant and public speaker.

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The preceding article was first published at Erin In The Morning and is republished with permission.

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Congress

Padilla, FCC introduce measure to improve 988 Suicide and Crisis Lifeline

HHS launched effort in 2022

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U.S. Sen. Alex Padilla (D-Calif.) (Screen capture: YouTube)

U.S. Sens. Alex Padilla (D-Calif.) and Thom Tillis (R-N.C.), joined by U.S. Rep. Tony CƔrdenas (D-Calif.), Federal Communications Commission Chairwoman Jessica Rosenworcel and U.S. Secretary of Health and Human Services Xavier Becerra, introduced a measure on Thursday to improve the 988 Suicide and Crisis Lifeline.

Calls are currently routed to mental health professionals and local public safety officials based on the caller’s area code ā€” even though, as the lawmakers and officials noted during their announcement ā€” in many cases, the area code, especially for cell phone numbers, does not match the location from which they are calling.

Under the new proposal, Padilla said, “We’re going to be in a position to be able to provide care as quickly and as safely as possible.”

“In the same way that 911 calls in the case of an emergency are routed to local providers, local first responders, so ambulances can come out and help quickly when you call 911, 988 should be tied to a caller’s location, not their area code,” he said.

Calling Padilla, Tillis, and CĆ”rdenas “great champions of mental health,” Rosenworcel noted, “that’s not our stock and trade” at the FCC.

“We are people who deal with technology and communications,” she said, “but we came to realize that we could work with Congress to make sure that everyone in this country who’s going through a crisis has someone to call and someone who can listen ā€” and that’s why in 2022, we set up 988, the easy-to-remember three digit number for anyone who is in crisis.”

A press release from Padilla’s office explains the details for how the update to the 988 Suicide and Crisis Lifeline will work:

“The Notice of Proposed Rulemaking (NPRM) announced today seeks to address the discrepancies and inefficiencies of the current system by proposing the adoption of a rule that would require a georouting solution to be implemented for all wireless calls to the 9-8-8 Lifeline while balancing the privacy needs of individuals in crisis. 

Georouting refers to technical solutions that enable calls to be directed based on the location of the caller without transmitting the callerā€™s precise location information.Ā These solutions would permit wireless calls to the 9-8-8 Lifeline to be directed to nearby crisis centers based on factors such as the cell tower that originated the call rather than the area code of the wireless device used to place the call.”

The 988 Suicide and Crisis Lifeline offers LGBTQ-affirming counseling, which is accessible by pressing three.

A 2023 survey by the Trevor Project, which included more than 28,000 LGBTQ participants aged 13-24, found that 41 percent had seriously considered suicide within the past year and 56 percent wanted ā€” but were unable to get ā€” mental health care within the last year.

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