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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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The White House

Biden, Harris, deliver remarks for White House Office of Gun Violence Prevention

Pulse survivor Brandon Wolf among those who spoke

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President Joe Biden and Vice President Kamala Harris listen as U.S. Rep. Maxwell Alejandro Frost (D-Fla.) addresses an audience in the Rose Garden including federal, state and local officials, survivors and family members, and gun violence prevention advocates on Sept. 22, 2023. (Photo courtesy of Brandon Wolf)

President Joe Biden, Vice President Kamala Harris, and U.S. Rep. Maxwell Frost (D-Fla.) addressed an audience from the Rose Garden of the White House on Friday to honor the establishment of a first-ever White House Office of Gun Violence Prevention.

In a press release Thursday announcing the move, the administration said its aim is to implement and expand the provisions of last year’s Bipartisan Safer Communities Act along with those contained in the president’s executive orders targeting issues of gun violence.

Additionally, Biden explained in his remarks, the office will coordinate more support for survivors, families and communities, including mental health services and financial aid; identify new avenues for executive action; and “expand our coalition of partners in states and cities across America” given the need for legislative solutions on the local and state level.

Harris, who will oversee the office, pledged to “use the full power of the federal government to strengthen the coalition of survivors and advocates and students and teachers and elected leaders to save lives and fight for the right of all people to be safe from fear and to be able to live a life where they understand that they are supported in that desire and that right.”

The vice president noted her close experiences with the devastating consequences of gun violence in her work as a federal prosecutor, San Francisco district attorney, California attorney general and in her current role.

Biden’s comments also included highlights of his administration’s accomplishments combatting gun violence and a call to action for Congress to do more. “It’s time again to ban assault weapons and high capacity magazines,” he told lawmakers.

The president also credited the the work of advocates including those who were gathered at the White House on Friday: “all of you here today, all across the country, survivors, families, advocates — especially young people who demand our nation do better to protect all; who protested, organized, voted, and ran for office, and, yes, marched for their lives.”

Taking the stage before introducing Biden, Frost noted that “Right before I was elected to Congress, I served as the national organizing director for March for Our Lives, a movement that inspired young people across the nation to demand safe communities.”

“The president understands that this issue especially for young people, especially for marginalized communities, is a matter of survival,” the congressman said. And the formation of this office, “comes from Pulse to Parkland,” he said, adding, “we fight because we love.”

Human Rights Campaign National Press Secretary Brandon Wolf, a survivor of the 2016 Pulse nightclub shooting, which was America’s second deadliest mass shooting and the deadliest against the LGBTQ community, shared a comment with the Washington Blade after Friday’s ceremony:

“Seven years ago, when my best friends and 47 others were murdered at our safe place — Pulse Nightclub — we promised to honor them with action. This is what that looks like. This deep investment in the fight to end gun violence matters, and I cannot wait to see Vice President Harris lead these efforts. We can blaze the path toward a future free of gun violence. And today marked an important step in that direction.”

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U.S. Federal Courts

Federal judge: drag is ‘vulgar and lewd,’ ‘sexualized conduct’

Ruling ‘bristles with hostility toward LGBTQ people’

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J. Marvin Jones Federal Building, U.S. Courthouse in Amarillo, Texas (Photo: Library of Congress)

Judge Matthew Kacsmaryk of the U.S. District Court for the Northern District of Texas issued a ruling Thursday denying relief to a group of university students who sought to host a drag show over the objections of their school’s president.

A Trump appointed jurist with deep ties to anti-LGBTQ and anti-abortion conservative legal activists, Kacsmaryk argued that drag performances probably do not constitute speech protected by the First Amendment.

As Slate Senior Writer Mark Joseph Stern wrote on X, this conclusion “conflicts with decisions from Texas, Florida, Tennessee and Montana which held that drag is constitutionally protected expression.”

“It also bristles with undisguised hostility toward LGBTQ people,” he added.

Kacsmaryk’s 26-page decision describes drag performances as lewd and licentious, obscene and sexually prurient, despite arguments the plaintiffs had presented about the social, political, and artistic merit of this art form.

As the Human Rights Campaign recently wrote, “drag artists and the spaces that host their performances have long served as a communal environment for queer expression.”

The group added, “It is a form of art and entertainment, but, historically, the performances haven’t only served to entertain, but also to truly advance the empowerment and visibility of LGBTQ+ people.”

Nevertheless, anti-LGBTQ conservative activists and organizations have perpetuated conspiracy theories about members of the community targeting children for sexual abuse including by bringing them to drag performances.

Among these is a group with ties to the Proud Boys that was cited by Kacsmaryk in his ruling: Gays Against Groomers, an anti-LGBTQ and anti-transgender extremist group, according to the Anti-Defamation League and Southern Poverty Law Center.

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The White House

Harris to oversee White House Office of Gun Violence Prevention

Goal is to implement and expand upon legislation, executive actions

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U.S. Vice President Kamala Harris, September 2023. (Official White House photograph by Lawrence Jackson)

The White House announced Thursday evening that President Joe Biden on Friday will establish the first-ever White House Office of Gun Violence Prevention, to be overseen by Vice President Kamala Harris.

The office will focus on implementing and expanding upon executive and legislative actions, including the Bipartisan Safer Communities Act, “to reduce gun violence, which has ravaged communities across the country.”

Serving under Harris will be Stefanie Feldman, “a longtime policy advisor to President Biden on gun violence prevention,” and “leading gun violence prevention advocates Greg Jackson and Rob Wilcox.”

“Every time I’ve met with families impacted by gun violence as they mourn their loved ones, and I’ve met with so many throughout the country, they all have the same message for their elected officials: ‘do something,'” Biden said in a statement.

The president noted his signing of last year’s bipartisan gun violence prevention law, a flagship legislative accomplishment for the administration, along with his issuance of more executive actions than any president in history to address this problem.

Calling these “just the first steps,” Biden said the establishment of the White House Office on Gun Violence Prevention will “build upon these measures and keep Americans safe.”

He also urged Congress to do more by passing legislation requiring universal background checks, and baning assault weapons and high capacity magazines.

In a statement, Harris said, “This epidemic of gun violence requires urgent leadership to end the fear and trauma that Americans experience every day.”

“The new Office of Gun Violence Prevention will play a critical role in implementing President Biden’s and my efforts to reduce violence to the fullest extent under the law,” she said, “while also engaging and encouraging Congressional leaders, state and local leaders, and advocates to come together to build upon the meaningful progress that we have made to save lives.”

“Our promise to the American people is this: we will not stop working to end the epidemic of gun violence in every community, because we do not have a moment, nor a life to spare,” the vice president said.

Then Vice President Biden hugs Brandon J. Wolf as he talks with family members of the victims and survivors in the June 12th mass shooting at the Pulse nightclub in Orlando, at the Amway Center in Orlando, Florida, June 16, 2016.
Wolf, a Pulse survivor, was recently appointed National Press Secretary of the Human Rights Campaign.
(Official White House Photo by David Lienemann)
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