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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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Megan Rapinoe among 17 Presidential Medal of Freedom recipients

White House ceremony to take place July 7

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Megan Rapinoe (Screen capture via U.S. Soccer YouTube)

The White House on Friday released President Joe Biden’s selection of recipients for bestowing the nation’s highest civilian honor, the Presidential Medal of Freedom. The awards will be presented at the White House on July 7.

Included among the seventeen honorees are Megan Rapinoe, the out Olympic gold medalist and two-time Women’s World Cup champion. She also captains OL Reign in the National Women’s Soccer League. She is a prominent advocate for gender pay equality, racial justice and LGBTQ rights.

Also selected by the president for a posthumous recognition was Richard Trumka, the powerful labor leader and longtime Democratic ally of the LGBTQ community who passed away last August. Trumka had led the AFL-CIO since 2009 and who throughout his career, was an outspoken advocate for LGBTQ Americans, social and economic justice.

The Presidential Medal of Freedom is the Nation’s highest civilian honor, presented to individuals who have made exemplary contributions to the prosperity, values, or security of the U.S., world peace, or other significant societal, public or private endeavors.

Presidential Medal of Freedom (The White House)

The following individuals will be awarded the Presidential Medal of Freedom:

Simone Biles
Simone Biles is the most decorated American gymnast in history, with a combined total of 32 Olympic and World Championship medals. Biles is also a prominent advocate for athletes’ mental health and safety, children in the foster care system and victims of sexual assault.

Sister Simone Campbell
Sister Simone Campbell is a member of the Sisters of Social Service and former Executive Director of NETWORK, a Catholic social justice organization. She is also a prominent advocate for economic justice, immigration reform and healthcare policy.

Julieta García
Dr. Julieta García is the former president of The University of Texas at Brownsville, where she was named one of Time magazine’s best college presidents. Dr. García was the first Hispanic woman to serve as a college president and dedicated her career to serving students from the Southwest Border region.

Gabrielle Giffords
Former Congresswoman Gabby Giffords was the youngest woman ever elected to the Arizona state Senate, serving first in the Arizona legislature and later in Congress. A survivor of gun violence, she co-founded Giffords, a nonprofit organization dedicated to gun violence prevention.

Fred Gray
Fred Gray was one of the first black members of the Alabama State legislature since Reconstruction. As an attorney, he represented Rosa Parks, the NAACP and Martin Luther King, who called him “the chief counsel for the protest movement.”

Steve Jobs (posthumous)
Steve Jobs (d. 2011) was the co-founder, chief executive and chair of Apple, Inc., CEO of Pixar and held a leading role at the Walt Disney Company. His vision, imagination and creativity led to inventions that have, and continue to, change the way the world communicates, as well as transforming the computer, music, film and wireless industries.

Father Alexander Karloutsos
Father Alexander Karloutsos is the former Vicar General of the Greek Orthodox Archdiocese of America. After over 50 years as a priest, providing counsel to several U.S. presidents, he was named by His All Holiness Ecumenical Patriarch Bartholomew as a protopresbyter of the Ecumenical Patriarchate.

Khizr Khan
Khizr Khan is a Gold Star father and founder of the Constitution Literacy and National Unity Center. He is a prominent advocate for the rule of law and religious freedom and served on the United States Commission on International Religious Freedom under President Biden.

Sandra Lindsay
Sandra Lindsay is a New York critical care nurse who served on the front lines of the COVID-19 pandemic response. She was the first American to receive a COVID-19 vaccine outside of clinical trials and is a prominent advocate for vaccines and mental health for health care workers.

John McCain (posthumous)
John McCain (d. 2018) was a public servant who was awarded a Purple Heart with one gold star for his service in the U.S. Navy in Vietnam. He also served the people of Arizona for decades in the U.S. House of Representatives and U.S. Senate and was the Republican nominee for president in 2008.

Diane Nash
Diane Nash is a founding member of the Student Nonviolent Coordinating Committee who organized some of the most important civil rights campaigns of the 20th century. Nash worked closely with Martin Luther King, who described her as the “driving spirit in the nonviolent assault on segregation at lunch counters.”

Megan Rapinoe
Megan Rapinoe is an Olympic gold medalist and two-time Women’s World Cup champion. She also captains OL Reign in the National Women’s Soccer League. She is a prominent advocate for gender pay equality, racial justice and LGBTQI+ rights.

Alan Simpson
Alan Simpson served as a U.S. senator from Wyoming for 18 years. During his public service, he has been a prominent advocate on issues including campaign finance reform, responsible governance and marriage equality.

Richard Trumka (posthumous)
Richard Trumka (d. 2021) was president of the 12.5-million-member AFL-CIO for more than a decade, president of the United Mine Workers, and secretary-treasurer of the AFL-CIO. Throughout his career, he was an outspoken advocate for social and economic justice.

Wilma Vaught
Brigadier General Wilma Vaught is one of the most decorated women in the history of the U.S. military, repeatedly breaking gender barriers as she rose through the ranks. When she retired in 1985, she was one of only seven women generals in the Armed Forces.

Denzel Washington
Denzel Washington is an actor, director, and producer who has won two Academy Awards, a Tony Award, two Golden Globes, and the 2016 Cecil B. DeMille Lifetime Achievement Award. He has also served as National Spokesman for the Boys & Girls Clubs of America for over 25 years.

Raúl Yzaguirre
Raúl Yzaguirre is a civil rights advocate who served as CEO and president of National Council of La Raza for thirty years. He also served as U.S. Ambassador to the Dominican Republic under President Barack Obama.

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The White House

U.S. orders 2.5 million more monkeypox vaccine doses

CDC has reported roughly 350 cases

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(Photo courtesy of Los Angeles County)

The U.S. Department of Health and Human Services announced Friday that it has ordered an additional 2.5 million doses of Bavarian Nordic’s JYNNEOS, an FDA-licensed vaccine indicated for prevention of smallpox and monkeypox, for use in responding to current or future monkeypox outbreaks and as part of U.S. smallpox preparedness.

Deliveries from this latest order of the Bavarian Nordic‘s Jynneos vaccine will begin arriving at the Strategic National Stockpile (SNS) later this year and will continue through early 2023 HHS said in a statement.

“We are working around-the-clock with public health officials in states and large metro areas to provide them with vaccines and treatments to respond to the current monkeypox outbreak,” said HHS Secretary Xavier Becerra. “This order of additional JYNNEOS vaccine will help us push out more vaccine quickly, knowing that we have more doses on the way in the coming months — and is only possible because of our longstanding investment in smallpox and monkeypox preparedness.”

The order announced today is in addition to the 500,000 doses of government-owned vaccine the company is producing in 2022 for use in the current response to monkeypox in the U.S and brings the total vaccine doses to be delivered in 2022 and 2023 to more than 4 million.

The company will produce these doses in liquid frozen form using vaccine already manufactured in bulk under an existing 10-year contract with the Biomedical Advanced Research and Development Authority, within the HHS Office of the Assistant Secretary for Preparedness and Response; that contract was part of ongoing national preparedness efforts against smallpox.

“The medical countermeasures available to help respond to the current outbreak are the result of years of investment and planning made possible through the ongoing work between HHS and private industry,” said Gary Disbrow, director of the Biomedical Advanced Research and Development Authority. “We are pleased that we have been able to work with our partners at Bavarian Nordic to accelerate delivery of vaccines that can help keep people safe and stem the spread of the virus.”

BARDA supported the development of JYNNEOS, which is approved by the FDA to prevent smallpox and monkeypox. The U.S. government owns enough smallpox vaccine — JYNNEOS and ACAM2000 — to vaccinate millions of Americans, if needed.

As of June 24, ASPR’s SNS held approximately 65,000 doses of JYNNEOS in immediate inventory with delivery of an additional 300,000 doses in the coming days. On June 28, HHS announced that it would immediately make available 56,000 doses and soon after would make available 240,000 additional doses. The SNS also has more than 100 million doses of ACAM2000 which was developed with SNS support and is approved by FDA for use in preventing smallpox. The Centers for Disease Control and Prevention currently has an expanded access Investigational New Drug protocol which allows use of ACAM2000 for monkeypox.

In addition, the SNS has over 1.7 million treatment courses of the smallpox antiviral drug TPOXX, which was developed with BARDA support and can be used to treat individuals with monkeypox under an appropriate regulatory mechanism. CDC currently has an expanded access Investigational New Drug protocol which allows its use for monkeypox.

As of June 29, the CDC has received reports of approximately 350 cases of monkeypox in the U.S., primarily among men who have sex with men.

To learn more about monkeypox, visit cdc.gov/monkeypox.

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Florida ‘Don’t Say Gay’ law goes into effect, impact already felt

LGBTQ youth, already at higher risk of depression, anxiety, & suicide than their peers, report their mental health being negatively impacted

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Jack Petocz (with bullhorn) leads Flagler Palm Coast High School protest against Florida's DSG bill (Photo by Alysa Vidal)

Florida’s HB 1557, known as the Don’t Say LGBTQ law, took effect today. The law, which bans classroom instruction on sexual orientation and gender identity in grades K-3 and restricts that instruction in grades 4-12, will immediately begin impacting efforts to make Florida classrooms more inclusive.

But its impacts have already been felt for months. Educators and school staff have shared the chilling effects they are experiencing across the state. Books with LGBTQ characters are being pulled from shelves. Rainbow “safe space” stickers are being peeled from classroom windows. LGBTQ educators are being asked to avoid speaking about their families. As the law officially goes into effect, these impacts will escalate. 

“Since the inception of this hateful policy, lawmakers have assured the public that it would not lead to censorship or erasure of LGBTQ people,” said Joe Saunders, Equality Florida Senior Political Director. “But our community has always known the truth. The Don’t Say LGBTQ law has always been fueled by anti-LGBTQ animus and designed to further stigmatize the LGBTQ community, ban books about us, erase us from classrooms, and force us back into the closet. It is a bigoted and dangerous law that is making Florida less safe for students and families, and we will work tirelessly to see it repealed.”

Throughout the legislative process, lawmakers scoffed at the suggestion that HB 1557 would have negative impacts on the LGBTQ community, even as they refused to clarify its dangerously vague language and prevent the eventual law from doing harm.

A bipartisan contingent of lawmakers offered up dozens of amendments to the bill, attempting to narrow its overly-broad scope and clarify the most vague components. These amendments came after assertions from their colleagues that the bill’s intent was narrow. However, those reasonable amendments were rejected by bill sponsors Representative Joe Harding, Senator Dennis Baxley, and their allies, leaving its language broad and discriminatory.

As a result, the chilling effects were swift and sweeping. Across the state, censorship of LGBTQ lives began in earnest and has continued until today. In Palm Beach County, School Superintendent Mike Burke began by circumventing the district’s material review process to remove multiple books featuring LGBTQ characters, citing concern about the implications of the Don’t Say LGBTQ law. He followed the move in recent weeks by issuing guidance to educators across the district for them to remove books currently being challenged and place them “in a classroom closet” and scour their shelves for other titles that may include LGBTQ characters or mention topics like racism or oppression.

Districts statewide have taken drastic steps in response to the Don’t Say Gay law. Graduation speeches have been scrubbed of references to LGBTQ advocacy. Yearbook pages have had images of Don’t Say LGBTQ walkouts blacked out. Conservative religious activists have successfully initiated challenges to dozens of books in multiple school districts. Rainbow-colored COEXIST banners and Pride flags have been stripped from school walls.

In total, LGBTQ+ equality rights advocacy group Equality Florida has received over 50 complaints of censorship aimed at the LGBTQ community since the bill was signed into law in March.

Most recently, Orange County Public Schools garnered national attention after reports emerged that during seminars designed to discuss the potential implementation of the Don’t Say LGBTQ law, school administrators were advised to begin removing rainbow “safe space” stickers from classroom windows, ask LGBTQ educators to remove family photos from their desks, and avoid talking about their loved ones at work for fear of running afoul of the new law. While exactly what advocates for equality had warned of, the revelation shocked educators across the district, who took to the next board meeting to express their deep concerns and demand written clarification.

All of these chilling effects come as LGBTQ youth, those already at higher risk of depression, anxiety, and suicidal ideation than their peers, report their mental health being negatively impacted by anti-LGBTQ policies and the debates that surround them. And they come amidst a surge in online harassment against LGBTQ people nationwide and threats of violence against LGBTQ spaces and Pride celebrations fueled by the dehumanizing anti-LGBTQ+ rhetoric launched by the DeSantis Administration in defense of the Don’t Say LGBTQ bill.

In March, the governor’s spokeswoman Christina Pushaw took to Twitter to traffic in age-old, anti-LGBTQ tropes to rescue the mired legislation, tropes that have since been parroted by Fox News hosts, right-wing influencers, and have exploded into the digital harassment and threats of violence running rampant across the country.

Equality Florida hosted a virtual press conference with lawmakers and those directly impacted on Friday morning. Those who have been impacted by the Don’t Say LGBTQ law can share their stories at freetosaygay.org.

White House Press Secretary Karine Jean-Pierre released a statement as Florida’s “Don’t Say Gay” Law took effect Friday:

Today, some of Florida’s most vulnerable students and families are more fearful and less free. As the state’s shameful “Don’t Say Gay” law takes effect, state officials who claim to champion liberty are limiting the freedom of their fellow Americans simply to be themselves. Already, there have been reports that “Safe Space” stickers are being taken down from classrooms. Teachers are being instructed not to wear rainbow clothing. LGBTQI+ teachers are being told to take down family photos of their husbands and wives—cherished family photos like the ones on my own desk.
 
This is not an issue of “parents’ rights.” This is discrimination, plain and simple. It’s part of a disturbing and dangerous nationwide trend of right-wing politicians cynically targeting LGBTQI+ students, educators, and individuals to score political points. It encourages bullying and threatens students’ mental health, physical safety, and well-being. It censors dedicated teachers and educators who want to do the right thing and support their students. And it must stop.
 
President Biden has been very clear that every student deserves to feel safe and welcome in the classroom. The Department of Education will be monitoring this law, and any student or parent who believes they are experiencing discrimination is encouraged to file a complaint with the Department’s Office for Civil Rights. Our Administration will continue to fight for dignity and opportunity for every student and family—in Florida and around the country.

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