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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,Ā 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.Ā 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 ServicesĀ 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 beenĀ 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.

ā€œLow-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.ā€

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.Ā 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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Kansas

Kansas governor vetoes ban on health care for transgender youth

Republican lawmakers have vowed to override veto

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Democratic Gov. Laura Kelly vetoed two abortion bills and a measure criminalizing transgender health care for minors. House and Senate Republican leaders responded with promises to seek veto overrides when the full Legislature returned to Topeka on April 26. (Photo by Sherman Smith/Kansas Reflector)

BY TIM CARPENTERĀ | Gov. Laura Kelly flexed a veto pen to reject bills Friday prohibiting gender identity health care for transgender youth, introducing a vague crime of coercing someone to have an abortion and implementing a broader survey of women seeking abortion that was certain to trigger veto override attempts in the Republican-led House and Senate.

The decisions by the Democratic governor to use her authority to reject these health and abortion rights bills didn’t come as a surprise given her previous opposition to lawmakers intervening in personal decisions that she believed ought to remain the domain of families and physicians.

Kelly saidĀ Senate Bill 233, which would ban gender-affirming care for trans minors in Kansas, was an unwarranted attack on a small number of Kansans under 18. She said the bill was based on a politically distorted belief the Legislature knew better than parents how to raise their children.

She said it was neither a conservative nor Kansas value to block medical professionals from performing surgery or prescribing puberty blockers for their patients. She said stripping doctors of their licenses for serving health interests of patients was wrong. Under the bill, offending physicians could be face lawsuits and their professional liability insurance couldn’t be relied on to defend themselves in court.

ā€œTo be clear, this legislation tramples parental rights,ā€ Kelly said. ā€œThe last place that I would want to be as a politician is between a parent and a child who needed medical care of any kind. And, yet, that is exactly what this legislation does.ā€

Senate President Ty Masterson (R-Andover) and House Speaker Dan Hawkins (R-Wichita) responded to the governor by denouncing the vetoes and pledging to seek overrides when legislators returned to the Capitol on April 26. The trans bill was passed 27-13 in the Senate and 82-39 in the House, suggesting both chambers were in striking distance of a two-thirds majority necessary to thwart the governor.

ā€œThe governor has made it clear yet again that the radical left controls her veto pen,ā€ Masterson said. ā€œThis devotion to extremism will not stand, and we look forward to overriding her vetoes when we return in two weeks.ā€

Cathryn Oakley, senior director of the Human Rights Campaign, said the ban on crucial, medically necessary health care for trans youth was discriminatory, designed to spread dangerous misinformation and timed to rile up anti-LGBTQ activists.

ā€œEvery credible medical organization — representing over 1.3 million doctors in the United States — calls for age-appropriate, gender-affirming care for transgender and nonbinary people,ā€ Oakley said. ā€œThis is why majorities of Americans oppose criminalizing or banning gender-affirming care.ā€

Abortion coercion

Kelly also vetoed House Bill 2436 that would create the felony crime of engaging in physical, financial or documentary coercion to compel a girl or woman to end a pregnancy despite an expressed desire to carry the fetus to term. It was approved 27-11 in the Senate and 82-37 in the House, again potentially on the cusp of achieving a veto override.

The legislation would establish sentences of one year in jail and $5,000 fine for those guilty of abortion coercion. The fine could be elevated to $10,000 if the adult applying the pressure was the fetuses’ father and the pregnant female was under 18. If the coercion was accompanied by crimes of stalking, domestic battery, kidnapping or about 20 other offenses the prison sentence could be elevated to 25 years behind bars.

Kelly said no one should be forced to undergo a medical procedure against their will. She said threatening violence against another individual was already a crime in Kansas.

ā€œAdditionally, I am concerned with the vague language in this bill and its potential to intrude upon private, often difficult, conversations between a person and their family, friends and health care providers,ā€ the governor said. ā€œThis overly broad language risks criminalizing Kansans who are being confided in by their loved ones or simply sharing their expertise as a health care provider.ā€

Hawkins, the House Republican leader, said coercion was wrong regardless of the circumstances and Kelly’s veto of the bill was a step too far to the left.

ā€œIt’s a sad day for Kansas when the governor’s uncompromising support for abortion won’t even allow her to advocate for trafficking and abuse victims who are coerced into the procedure,ā€ Hawkins said.

Emily Wales, president and CEO of Planned Parenthood Great Plains Votes, said HB 2436 sought to equate abortion with crime, perpetuate false narratives and erode a fundamental constitutional right to bodily autonomy. The bill did nothing to protect Kansas from reproductive coercion, including forced pregnancy or tampering with birth control.

ā€œPlanned Parenthood Great Plains Votes trusts patients and stands firmly against any legislation that seeks to undermine reproductive rights or limit access to essential health care services,ā€ Wales said.

Danielle Underwood, spokeswoman for Kansas for Life, said ā€œCoercion Kellyā€ demonstrated with this veto a lack of compassion for women pushed into an abortion.

The abortion survey

The House and Senate approved a bill requiring more than a dozen questions be added to surveys of women attempting to terminate a pregnancy in Kansas. Colorful debate in the House included consideration of public health benefits of requiring interviews of men about reasons they sought a vasectomy birth control procedure or why individuals turned to health professionals for treatment of erectile dysfunction.

House Bill 2749 adopted 81-39 in the House and 27-13 in the Senate would require the Kansas Department of Health and Environment to produce twice-a-year reports on responses to the expanded abortion survey. The state of Kansas cannot require women to answer questions on the survey.

Kelly said in her veto message the bill was ā€œinvasive and unnecessaryā€ and legislators should have taken into account rejection in August 2022 of a proposed amendment to the Kansas Constitution that would have set the stage for legislation further limiting or ending access to abortion.

ā€œThere is no valid medical reason to force a woman to disclose to the Legislature if they have been a victim of abuse, rape or incest prior to obtaining an abortion,ā€ Kelly said. ā€œThere is also no valid reason to force a woman to disclose to the Legislature why she is seeking an abortion. I refuse to sign legislation that goes against the will of the majority of Kansans who spoke loudly on Aug. 2, 2022. Kansans don’t want politicians involved in their private medical decisions.ā€

Wales, of Planned Parenthood Great Plains Votes, said the bill would have compelled health care providers to ā€œinterrogate patients seeking abortion careā€ and to engage in violations of patient privacy while inflicting undue emotional distress.

Hawkins, the Republican House speaker, said the record numbers of Kansas abortions — the increase has been driven by bans or restrictions imposed in other states — was sufficient to warrant scrutiny of KDHE reporting on abortion. He also said the governor had no business suppressing reporting on abortion and criticized her for tapping into ā€œirrational fears of offending the for-profit pro-abortion lobby.ā€

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Tim Carpenter

Tim Carpenter has reported on Kansas for 35 years. He covered the Capitol for 16 years at the Topeka Capital-Journal and previously worked for the Lawrence Journal-World and United Press International.

The preceding story was previously published by the Kansas Reflector and is republished with permission.

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The Kansas Reflector is a nonprofit news operation providing in-depth reporting, diverse opinions and daily coverage of state government and politics. This public service is free to readers and other news outlets. We are part of States Newsroom: the nation’s largest state-focused nonprofit news organization, with reporting from every capital.

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Colorado

Five transgender, nonbinary ICE detainees allege mistreatment at Colo. detention center

Advocacy groups filed complaint with federal officials on April 9

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(Photo courtesy of GEO Group)

Five transgender and nonbinary people who are in U.S. Immigration and Customs Enforcement custody at a privately-run detention center in Colorado say they continue to suffer mistreatment.

The Rocky Mountain Immigrant Advocacy Network, the National Immigration Project and the American Immigration Council on April 9 filed a complaint with the Department of Homeland Security’s Offices for Civil Rights and Civil Liberties, Immigration Detention Ombudsman and Inspector General and ICE’s Office of Professional Responsibility on behalf of the detainees at the Aurora Contract Detention Facility near Denver.

Charlotte, one of the five complainants, says she spends up to 23 hours a day in her room. 

She says in the complaint that a psychiatrist has prescribed her medications for anxiety and depression, but “is in the dark about her actual diagnoses because they were not explained to her.” Myriah and Elsa allege they do not have regular access to hormones and other related health care.

Omar, who identifies as trans and nonbinary, in the complaint alleges they would “start hormone replacement therapy if they could be assured that they would not be placed in solitary confinement.” Other detainees in the complaint allege staff have also threatened to place them in isolation.

“They have been told repeatedly that, if they started therapy, they would be placed in ‘protective custody’ (solitary confinement) because the Aurora facility has no nonbinary or men’s transgender housing unit,” reads the complaint. “This is so, despite other trans men having been detained in Aurora in the past, so Omar is very likely receiving misinformation that is preventing them from accessing the treatment they require.”

Omar further alleges staffers told them upon their arrival that “they had to have a ‘boy part’ (meaning a penis) to be assigned to” the housing unit in which other trans people live. Other complainants say staff have also subjected them to degrading comments and other mistreatment because of their gender identity. 

“Victoria, Charlotte and Myriah are all apprehensive about a specific female guard who is assigned to the housing unit for transgender women at Aurora,” reads the complaint. “Victoria has experienced this guard peering at her through the glass on the door of her form. Charlotte, Myriah and the other women in her dorm experienced the same guard making fun of them after they complained that she had confiscated all of their personal hygiene products, like their toothbrushes and toothpaste, and replaced them with menstrual pads and tampons, which she knows they do not need.”

“She said something to them like, ‘If you were real women, you would need these things,'” reads the complaint. “The same guard told them that they had to ask her for their personal hygiene products when they wanted to use them, stripping them of their most basic agency.”

Victoria, who has been in ICE custody for more than two years, also says she does not have regular access to hormones. Victoria further claims poor food, lack of access to exercise and stress and anxiety because of her prolonged detention has caused has made her health deteriorate.

The GEO Group, a Florida-based company, operates the Aurora Contract Detention Facility.

Advocates for years have complained about the conditions for trans and nonbinary people in ICE custody and have demanded the agency release all of them.

Roxsana HernƔndez, a trans Honduran woman with HIV, on May 25, 2018, died in ICE custody in New Mexico. Her family in 2020 sued the federal government and the five private companies who were responsible for her care.

Johana “Joa” Medina Leon, a trans Salvadoran woman, on June 1, 2019, passed away at a Texas hospital four days after her release from ICE custody. Kelly GonzĆ”lez Aguilar, a trans Honduran woman, had been in ICE custody for more than two years until her release from the Aurora Contract Detention Center on July 14, 2020.

ICE spokesperson Steve Kotecki on Friday told the Blade there were 10 “self-identified transgender detainees” at the Aurora Contract Detention Center on April 11. The facility’s “transgendered units” can accommodate up to 87 trans detainees. 

A 2015 memorandum then-ICE Executive Associate Director of Enforcement and Removal Operations Thomas Homan signed requires personnel to allow trans detainees to identify themselves based on their gender identity on data forms. The directive, among other things, also contains guidelines for a ā€œrespectful, safe and secure environmentā€ for trans detainees and requires detention facilities to provide them with access to hormone therapy and other trans-specific health care.

“U.S. Immigration and Customs Enforcement (ICE) is committed to ensuring that all those in its custody reside in safe, secure and humane environments,” said Kotecki. “ICE regularly reviews each case involving self-identified transgender noncitizens and determines on a case-by-case basis whether detention is warranted.”

The complaint, however, states this memo does not go far enough to protect trans and nonbinary detainees.

“ICE’s 2015 guidance has some significant flaws,” it reads. “It fails to provide meaningful remedies for policy violations. It does not acknowledge the challenges that nonbinary people face when imprisoned by ICE and the lack of such guidance explains why the needs of nonbinary people are largely misunderstood and unmet.”

“Further, the language used to describe people who are TNB is not inclusive and does not reflect terminology adopted by the community it is meant to describe,” adds the complaint. “Although this list is not exhaustive, it addresses some of the primary concerns voiced by the complaints.”

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The White House

Francisco Ruiz appointed director of White House Office of National AIDS Policy

Former CDC official is first Latino to run office

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Francisco Ruiz, director of the Office of National AIDS Policy. (Photo public domain)

Francisco Ruiz’s appointment as the director of the White House Office of National AIDS Policy has elicited widespread acknowledgment across various sectors.

Ruiz, a distinguished figure in public health with a history of collaboration and strategic partnerships, assumes the role as the first-ever Latino to serve as ONAP’s director, underscoring a commitment to diversity and inclusivity in addressing public health challenges.

In response to his appointment, Domestic Policy Advisor Neera Tanden underscored the Biden-Harris administration’s steadfast commitment to ending the HIV epidemic and enhancing the quality of life for people living with HIV. Ruiz himself acknowledged this sentiment, emphasizing that accelerating efforts to combat the HIV epidemic and improve the well-being of those affected remain a paramount public health priority for the White House.

Previously serving at the U.S. Centers for Disease Control and Prevention, Ruiz played a pivotal role in advancing national HIV prevention campaigns, particularly contributing to the goals of the Ending the HIV Epidemic in the U.S. Initiative. His experience in fostering strategic partnerships and ensuring sensitive prevention messaging has been noted as instrumental in reaching diverse communities across the country and in U.S. territories.

Ruiz in his new role will be tasked with accelerating efforts to end the HIV epidemic and improve the quality of life for people living with HIV. 

Guillermo Chacón, president of the Latino Commission on AIDS and founder of the Hispanic Health Network, expressed confidence in Ruiz’s ability to advance the national strategy to end the HIV epidemic.

“Mr. Ruiz is a respected public health leader and a fitting choice to ensure that the Biden-Harris administration meets the goal of ending the HIV epidemic in the United States and U.S. Territories,” said Chacón.

ā€œFrancisco Ruiz’s appointment signifies a renewed focus on addressing health disparities and promoting health equity, particularly for historically marginalized and underserved communities,ā€ he added. ā€œAs a person living with HIV and the son of Mexican immigrants, Ruiz brings personal insight and professional expertise to his new role, ensuring that strategies to combat HIV/AIDS are scientifically grounded and connected with the experiences of those most affected.ā€

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