National
EXCLUSIVE: Obama extends protections to gay couples under Medicaid
Protects against liens, period of ineligibility and estate recovery
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.”
South Carolina
Man faces first S.C. ‘hate intimidation’ charge
Timothy Truett allegedly shot at gay club in Myrtle Beach on April 1
A South Carolina man remains in custody on a more than $300,000 bond after he allegedly opened fire at a Myrtle Beach nightclub on April 1, according to WMBF.
Reports say 37-year-old Timothy James Truett Jr., of Clover, S.C., was detained by the Myrtle Beach Police Department after the April 1 incident outside Pulse Ultra Club. He was later arrested and charged with possession of a weapon during a violent crime, discharging a firearm into a dwelling, discharging a firearm within city limits, malicious injury to real property valued over $5,000, and assault or intimidation due to political opinions or the exercise of civil rights.
At 10:57 a.m. on April 1, officers responded to a call about a possible shooting at Pulse Ultra Club, located in the 2700 block of South Kings Highway.
In an affidavit released later, the club’s owner, Ken Phillips, said he was doing paperwork that morning when he heard “five or six” gunshots. He went outside and found a window and the windshield of his SUV shattered by bullets. An SUV with blue plastic covering one window was left at the scene.
Police later reviewed footage that showed a silver vehicle stopping in the middle of the road. The video appeared to capture muzzle flashes coming from the passenger-side window.
According to the affidavit, an officer later pulled over a vehicle driven by Truett and found spent shell casings in the back seat, along with a gun.
Documents do not detail why Truett was ultimately charged under the state law covering assault or intimidation tied to political opinions or the exercise of civil rights.
As of April 1, records show Truett is being held in Horry County on a combined bond of more than $312,000.
WMBF spoke with Phillips after the incident and asked whether there was any prior conflict that might have led to the shooting.
“I don’t know if it’s personal, I don’t know if it’s related to being gay, I don’t know if it’s related to the bar issues,” Phillips told WMBF. “Anybody with a mindset of pulling out a weapon in broad daylight is not right.”
“My primary concern has and always will be the safety of my community and my customers,” he added. “It’s given me great concern … as to how far people will go.”
WMBF also spoke with Adam Hayes, vice chair of Myrtle Beach’s Human Rights Coalition, who was involved in pushing for the ordinance. He said that while the incident itself is troubling, it shows the policy is being put to use.
The ordinance is intended to deter “crimes that are motivated by bias or hate towards any person or persons, in whole or in part, because of the actual or perceived” identity, in the absence of a statewide hate crime law.
“It’s nice to see that something we put into policy is not just a piece of paper, that it’s actually being used,” said Hayes.
He said the shooting underscores the need for a statewide hate crime law in South Carolina and added that the incident has left the local LGBTQ community shaken.
South Carolina and Wyoming are the only two states in the U.S. without a comprehensive statewide hate crime law.
Truett remains in jail as of publication.
The White House
Trump budget would codify expanded global gag rule
Funding for LGBTQ health programs around the world would also be cut
The Trump-Vance administration’s fiscal year 2027 budget would codify the expanded global gag rule and eliminate funding for LGBTQ-specific programs in global health initiatives.
“The budget would ensure no funding supports abortion, unfettered access to birth control, and also eliminates funding for circumcision and lesbian, gay, bisexual, transgender, and queer services to better focus funds on life-saving assistance,” reads the proposed budget the White House released on April 3. “The United States should not pay for the world’s birth control and therapy.”
The proposed budget includes four examples of “eliminated activities.”
- In the last administration, PEPFAR funded health workers who performed over 21 abortions in Mozambique
- Promoting reproductive health education and access to birth control and other harmful programs couched under ‘family planning’ in Ghana
- A supply chain “control tower” to provide a “holistic commercial of the shelf solution” on the Office of Population and Reproductive Health (PRH)
- Promoting health equity and providing condoms and contraception in Kenya.
President Ronald Reagan in 1985 implemented the global gag rule, also known as the “Mexico City” policy, which bans U.S. foreign aid for groups that support abortion and/or offer abortion-related services.
Trump reinstated the rule during his first administration. The Biden-Harris administration shortly after it took office in January 2021 rescinded it.
The Trump-Vance White House earlier this year expanded the global gag rule to ban U.S. foreign aid for groups that promote “gender ideology.” The expansion took effect on Feb. 26.
US funding cuts have devastated global LGBTQ rights movement
The Trump-Vance administration after it took office in January 2025 moved to dismantle the U.S. Agency for International Development, which funded LGBTQ and intersex rights groups around the world. USAID officially shut down on July 1, 2025.
Secretary of State Marco Rubio in March 2025 announced the State Department would administer the 17 percent of USAID contracts that had not been cancelled. Rubio issued a waiver that allowed PEPFAR and other “life-saving humanitarian assistance” programs to continue to operate during the U.S. foreign aid freeze the White House announced shortly after it took office.
The global LGBTQ and intersex rights movement has lost more than an estimated $50 million in funding because of these cuts. The Washington Blade has previously reported PEPFAR-funded programs in Kenya and other African countries have been forced to suspend services and even shut down.
The Trump-Vance administration has signed healthcare-specific agreements with Kenya, Uganda, and other African countries through its American First Global Health Strategy. Advocacy groups with whom the Blade has spoken have expressed concern these partnerships will result in further exclusion and government-sanctioned discrimination based on sexual orientation or gender identity.
The proposed fiscal year 2027 budget includes $5.1 billion for “global health to end the previous administration’s abuse of these programs and to execute (the State Department’s) newly released America First Global Health Strategy.” This figure represents a $4.3 billion cut from the previous year.
“The president’s new vision of bilateral health assistance eliminates bloated Beltway Bandit contracts, does more with fewer dollars, and transitions recipient countries to self-reliance,” reads the proposed budget. “The budget would also eliminate disease-specific accounts and provide the department crucial agility to address the actual needs of each recipient country — across HIV/AIDS and other infectious diseases such as malaria, tuberculosis, and polio — to strengthen global health security and protect Americans from disease.”
“The budget would focus on new compacts that unify funding, achieving economies of scale in both implementation and oversight,” it adds. “Under the prior administration, only about 40 percent of PEPFAR funds supported actual service delivery, including medications, testing, commodities, and health workers, with the remaining 60 percent wasted on duplicative administrative costs, unwieldy supply chains, and layers of endless bureaucracy. The new AFGHS (America First Global Health Strategy) compacts would improve efficiency, cut red tape, and dismantle the bloated ecosystem of foreign assistance profiteers.”
The Council for Global Equality on April 3 reiterated its criticism of the expanded global gag rule, and urged Congress to reject the proposed budget.
“We won’t mince words: people are dying because of this policy,” said the Council for Global Equality in a statement. “Making this policy permanent will only ensure that U.S. foreign assistance discriminates against those who need services the most, all while forcing people around the world to adhere to the Trump administration’s extremist, ideological agenda that denies the very existence of transgender, nonbinary, and intersex persons.”
“We will not be silent as Trump threatens to upend decades of bipartisan foreign assistance programs to appease his extremist base,” added the group. “We call on Congress to immediately reject this budget and block implementation of the expanded global gag rules.”
Vice President JD Vance and his wife, second lady Usha Vance, will visit Hungary next week.
An announcement the White House released on Thursday said the Vances will be in Budapest, the Hungarian capital, from April 7-8.
JD Vance “will hold bilateral meetings with” Hungarian Prime Minister Viktor Orbán. The announcement further indicates the vice president “will also deliver remarks on the rich partnership between the United States and Hungary.”
The Vances will travel to Hungary less than a week before the country’s parliamentary elections take place on April 12.
Orbán, who has been in office since 2010, and his Fidesz-KDNP coalition government have faced widespread criticism over its anti-LGBTQ crackdown.
The Associated Press notes polls indicate Orbán is trailing Péter Magyar and his center-right Tisza party.
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