Politics
Medicare lays out post-DOMA coverage policy for gay couples
Private insurers contracting through CMS must offer nursing home care
The Centers for Medicare & Medicaid has issued new post-DOMA guidance (Image public domain).
Gay married couples are now eligible for nursing home care through Medicare-funded private insurance in the aftermath of the Supreme Court’s decision against the Defense of Marriage Act, according to guidance from the Centers for Medicare & Medicaid obtained Thursday by the Washington Blade.
In the guidance dated Aug. 29, Danielle Moon, director of the Medicare Drug & Health Plan Contract Administration Group, explains the new post-DOMA policy to Medicare Advantage organizations, or private companies that contract with Medicare to provide coverage.
Moon says the ruling against Section 3 of DOMA requires these companies to cover services offered in a skilled nursing facility, or a nursing home, for a gay married couple to the same extent they would provide them to an opposite-sex couple.
“MA organizations therefore are required, effective immediately, to cover services in a SNF in which a validly married same sex spouse resides to the extent that they would be required to cover the services if an opposite sex spouse resided in the SNF,” Moon says.
Under current law, individuals enrolled in a Medicare Advantage plan are entitled to care in certain nursing homes where their spouse resides. But under DOMA, seniors with Medicare Advantage previously may have had to choose between receiving coverage in a nursing home away from their same-sex spouse or disenrolling from their plan to be with their loved one. The latter option would mean paying more out of pocket for care.
The guidance spells out in the wake the court decision against DOMA, Medicare-advantage programs must applyĀ the definition of spouse to married gay couples to provide nursing home coverage.
“In light of the Supreme Courtās decision in Windsor, CMS believes it would be impermissible to interpret the term ‘spouse,’ as used in section 1852(l)(4)(A)(iii), to exclude individuals who are in a legally valid same-sex marriage sanctioned by a state, territorial or foreign government,” Moon writes.
In a news statement accompanying the guidance, Secretary of Health & Human Services Kathleen Services says the new policy is the “first of many steps” that would her department would take to comply with the Supreme Court ruling against DOMA.
āHHS is working swiftly to implement the Supreme Courtās decision and maximize federal recognition of same-sex spouses in HHS programs,ā Sebelius said. āTodayās announcement is the first of many steps that we will be taking over the coming months to clarify the effects of the Supreme Courtās decision and to ensure that gay and lesbian married couples are treated equally under the law.ā
Centers for Medicare & Medicaid Services Administrator Marilyn Tavenner said the new policy will institute greater equality in coverage under private Medicare plans.
āToday, Medicare is ensuring that all beneficiaries will have equal access to coverage in a nursing home where their spouse lives, regardless of their sexual orientation,ā Tavenner said. āPrior to this, a beneficiary in a same-sex marriage enrolled in a Medicare Advantage plan did not have equal access to such coverage and, as a result, could have faced time away from his or her spouse or higher costs because of the way that marriage was defined for this purpose.ā
Moon’s guidance notes that gay married couples are eligible for the benefits even if they apply for them in a non-marriage equality state that doesn’t recognize their union.
“The foregoing analysis applies to individuals of the same sex who are domiciled in a state or territory that recognizes their relationship as a marriage,” the guidance states. “It also applies to individuals of the same sex who were legally married in a state or other jurisdiction without regard to whether they are domiciled in a state or territory that recognizes their relationship as a marriage.”
Congress
Anti-LGBTQ provisions removed from NDAA
New version omits restriction on gender affirming care, book and drag bans
Anti-LGBTQ provisions submitted by House Republicans to the National Defense Authorization Act (NDAA) have been removed from the defense spending bill, triggering outrage from conservative lawmakers and praise from LGBTQ groups.
The conference version of the bill was released on Thursday.
This week saw the revocation of two measures targeting gender affirming care along with the book ban and drag ban. Language stipulating the list of approved flags that can be flown at military bases was amended such that more flags can be added on a discretionary basis.
“MAGA members of Congress tried to hijack the National Defense Authorization Act to advance their anti-LGBTQ+ agenda, attempting to riddle it with discriminatory riders,” Human Rights Campaign National Press Secretary Brandon Wolf said in a statement to the Washington Blade.
His statement continued, “They failed and equality won. Anti-LGBTQ+ provisions, including efforts to restrict access to gender affirming care, were rejected. The anti-LGBTQ+ agenda continues to be deeply unpopular across the country and a failing political strategy.”
Wolf thanked U.S. Sen. Jack Reed (D-R.I.) and U.S. Rep. Adam Smith (D-Wash.) for “defending equality and defeating attacks on the community.”
Pledging to vote “no” on the bill, Republican U.S. Rep. Marjorie Taylor Greene (Ga.) said in a post on X, “I was appointed to the NDAA conference committee but NEVER got to work on the final version of the NDAA bc they made the deal behind closed doors and here are the horrible results.”
I was appointed to the NDAA conference committee but NEVER got to work on the final version of the NDAA bc they made the deal behind closed doors and here are the horrible results š
— Rep. Marjorie Taylor Greenešŗšø (@RepMTG) December 8, 2023
Iām voting NO!!! pic.twitter.com/jnmTHCgzNG
Congress
New bill would protect LGBTQ-owned businesses from lending discrimination
Legislation introduced by Sens. Padilla, Gillibrand and Rep. Torres
A bicameral bill introduced on Wednesday by U.S. Sens. Alex Padilla (D-Calif.) and Kirsten Gillibrand (D-N.Y.), along with U.S. Rep. Ritchie Torres (D-N.Y.) would require financial institutions to collect data on access to credit and capital by LGBTQ-owned businesses.
The legislation would thereby allow regulators to better identify and potentially remedy instances of anti-LGBTQ discrimination in these areas.
CNBC reported in June that a study by the Movement Advancement Project found LGBTQ-owned businesses encountered more rejections than non-LGBTQ-owned businesses that applied for funding, amid a tightening of lending standards across the board.
Specifically, the bill would “clarify that Section 1071 of the Dodd-Frank Wall Street Reform and Consumer Protection Act (Dodd-Frank) requires financial institutions to collect the self-identified sexual orientation and gender identity of the principal owners of small businesses, in addition to their sex, race, and ethnicity,” according to a press release by Padilla’s office.
The California senator said, āWith anti-LGBTQ+ legislation and hate crimes on the rise, LGBTQ+ business owners continue to face persistent and unjust barriers to financial success,āĀ adding that āLGBTQ+-owned small businesses are a cornerstone of local economies, and they deserve equitable resources to help them grow and thrive.”
Padilla’s press release notes the legislation “would also add a definition for businesses owned by lesbian, gay, bisexual, transgender, queer, and intersex individuals to the ECOA statute.”
Additionally, “The legislation also includes a Sense of Congress confirming that sexual orientation and gender identity are already covered under the ECOA (including the current data collection requirements)” while clarifying “that the sex, sexual orientation, and gender identity of the principal owners of a business should be collected as three separate forms of information.”
The Congressional Equality Caucus, Ali Forney Center, Center for American Progress, Destination Tomorrow, Drag Out The Vote, Human Rights Campaign, Immigration Equality Action Fund, InterAct, and New Pride Agenda have backed the bill.
Politics
Endocrine Society corrects misinformation about gender affirming care at GOP debate
Presidential candidates clashed in Ala. on Wednesday.
The Endocrine Society, the world’s oldest and largest organization dedicated to the clinical practice of endocrinology, released a statement correcting misinformation about gender affirming healthcare that was spread at the fourth Republican presidential primary debate on Wednesday night.
The group said comments in which Florida Gov. Ron DeSantis (R) characterized care for transgender and gender-diverse youth as child abuse and genital mutilation “do not reflect the health care landscape” and contradict “mainstream medical practice and scientific evidence.”
“Pediatric gender-affirming care is designed to take a conservative approach,” the Endocrine Society wrote. “When young children experience feelings that their gender identity does not match the sex recorded at birth, the first course of action is to support the child in exploring their gender identity and to provide mental health support, as needed.”
The statement continues, “Medical intervention is reserved for older adolescents and adults, with treatment plans tailored to the individual and designed to maximize the time teenagers and their families have to make decisions about their transitions.”
Notwithstanding the remarks by DeSantis, other debate participants, and moderator Megyn Kelly, “gender-affirming genital surgery is rarely offered to anyone under the age of 18,” the statement says.
Additionally, “More than 2,000 scientific studies have examined aspects of gender-affirming care since 1975, including more than 260 studies cited in the Endocrine Societyās Clinical Practice Guideline.”
Other major scientific and medical groups like the American Medical Association, the American Psychological Association and the American Academy of Pediatrics are “in alignment” with the Endocrine Society on “the importance of gender affirming care,” the statement notes.
Further, research shows it “can be life saving for a population with high suicide rates.”
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