Politics
New guidance affords gay couples equal access to Medicaid
Non-marriage equality states can refuse new policy for gay couples
The Centers for Medicare & Medicaid has issued new post-DOMA guidance (Image public domain).
Gay married couples will now have the same eligibility opportunities for Medicaid coverage as straight couples in certain states following the Supreme Court decision against the Defense of Marriage Act, according to new guidance from the Obama administration obtained Friday by the Washington Blade.
In two separate pieces of guidance dated Sept. 27, the Centers for Medicare & Medicaid outlines new policy bringing the agency in line with the ruling against DOMA. They’re published in time for enrollment into insurance exchanges and Medicaid expansion under the health care reform law starting on Tuesday.
One piece of guidance from Gary Cohen, CMS director of the Center for Consumer Information & Insurance Oversight, clarifies gay married couples will be for a spousal tax credit and cost-sharing reductions by signing up for a health insurance exchange — provided they submit a joint tax return for that year.
“In light of the Ruling, the eligibility rules with respect to premium tax credits under Code section 36B treat same-sex spouses in the same manner as opposite-sex spouses,” Cohen writes.
That policy decision has nationwide implications thanks to an Aug. 29 ruling from the Internal Revenue Service that married same-sex couples should be treated the same as opposite-sex couples for tax purposes — regardless of whether or not they reside in a state recognizing the union.
The other piece of guidance from Sept. 27, signed by CMS Director of the Center for Medicaid & CHIP Services Cindy Mann, is more complex and says DOMA is no longer a factor in determining the income-based eligibility of same-sex couples for Medicaid and the Children’s Health Insurance Program.
“[B]ecause Section 3 of DOMA no longer controls the definition of marriage or spouse under the framework for state Medicaid and CHIP programs, DOMA is no longer a bar to states recognizing same-sex marriages in Medicaid or CHIP,” Mann writes.
Medicaid is a health insurance program jointly run by the states and government in which a person is eligible for coverage if have income up to 133 percent of the poverty line. Most individuals apply for Medicaid not on an individual basis, but on a family basis.
With DOMA out of the picture, the new policy would make a gay person more eligible for Medicaid if their spouse’s income is lower and places them lower on the poverty scale. Also, it can make a gay person less eligible if a spouse’s income is higher and the couple seems less in need.
The guidance says that state may begin factoring an applicant’s same-sex marriage into eligibility for Medicaid and CHIP “immediately,” but acknowledges some operational challenges and says it should be implemented “as soon as reasonably practicable.”
States where same-sex marriage is legal will have to adopt the new eligibility requirements, but since the Medicaid is jointly run by the states, CMS isn’t requiring non marriage-equality states to recognize same-sex marriages for the purposes of the purposes of the program. States can elect to opt out of the new policy.
“[A] state is permitted and encouraged, but not required, to recognize same-sex couples who are legally married under the law of the jurisdiction in which the marriage was celebrated as spouses for purposes of Medicaid and CHIP,” Mann writes. “States that do not recognize same-sex marriages are thus free to adopt a different marriage recognition policy for Medicaid and CHIP purposes.”
That’s similar to policy under health care reform. Because of the Supreme Court ruling on Obamacare, states can opt out of participating in the Medicaid expansion under the law.
The guidance also allows states to adopt this eligibility standard for Medicaid and CHIP if the state offers civil unions or domestic partnerships that are the legal equivalent to marriage. Among these states are Colorado and Illinois.
“Consistent with this guidance, a marriage is recognized for Medicaid and CHIP purposes if (it is legally valid under applicable law,” Mann writes. “Thus, if a state or territory recognizes a civil union or domestic partnership as a marriage, that marital status is recognized under the Medicaid and CHIP programs, consistent with this guidance.”
CMS says this guidance isn’t the last word. The agency is awaiting additional guidance on non-income related eligibility for Medicaid and CHIP that hinges on yet-to-be-released guidance from the Social Security Administration in determining eligibility for Supplemental Security Income. Some Social Security spousal benefits are beginning to flow to married gay couples, but the Obama administration hasn’t finalized this post-DOMA policy yet.
“The Centers for Medicare & Medicaid Services (CMS) will issue additional guidance once the SSA announces its post-Windsor SSI marriage recognition policy,” Mann writes.
Despite the effort to bring the Medicaid into alignment with the court ruling against DOMA, the nation’s largest LGBT group is expressing discontent with the guidance and says the eligibility should extend to married gay couples nationwide.
Michael Cole-Schwartz, a spokesperson for the Human Rights Campaign, said the policy decisions “fall short” by allowing states to determine whether they can provide Medicaid coverage to same-sex couples.
“While it might be advantageous for some families to remain unrecognized in order to maintain eligibility for certain programs, as a general rule we oppose different standards for gay versus straight married couples,” Cole-Schwartz said. “Given that there are no impediments to the federal government adopting an across the board standard that recognizes all legally married couples in this instance, we believe that the new rules fall short of the ideal where the sexual orientation of those in a marriage is irrelevant.”
Federal officials insist the new policy is extended in the maximum possibly way because, unlike in other cases where the Department of Health & Human Services has extended standards and benefits to same-sex married couples in non-marriage equality states, there is a special federal-state relationship in Medicaid with the states administering this program.
Congress
Markey reintroduces International Human Rights Act in Senate
Bill would require US to promote LGBTQ, intersex rights abroad
U.S. Sen. Edward Markey (D-Mass.) on Wednesday reintroduced a bill that would require the State Department to promote LGBTQ and intersex rights abroad.
A press release the Massachusetts Democrat released notes the International Human Rights Act would “direct the State Department to monitor and respond to violence against LGBTQ+ people worldwide, while creating a comprehensive plan to combat discrimination, criminalization, and hate-motivated attacks against LGBTQ+ communities.” The bill would also “formally establish a special envoy to coordinate LGBTQ+ policies across the State Department; a role that has been left vacant under the Trump administration.”
Gay California Congressman Robert Garcia introduced the International Human Rights Act in the U.S. House of Representatives last month.
Markey has previously introduced the bill in the U.S. Senate. He reintroduced it on International Human Rights Day, which commemorates the U.N. General Assembly’s ratification of the Universal Declaration of Human Rights on Dec. 10, 1948.
“Today, on International Human Rights Day, we must recommit the United States to the defense of human rights and the promotion of equality and justice around the world,” said Markey in the press release. “It is as important as ever that we stand up and protect LGBTQ+ individuals from the Trump administration’s cruel attempts to further marginalize this community.”
“I am proud to reintroduce the International Human Rights Defense Act and I am proud to continue to fight alongside LGBTQ+ individuals for a world that recognizes that LGBTQ+ rights are human rights,” he added.
Mark Bromley, co-chair of the Council for Global Equality, in the press release that Markey issued said the Trump-Vance administration “is fanning the flames of authoritarianism” at “a time when LGBTQI+ people around the world are facing backlash simply for who they are or whom they love.” Bromley specifically noted the State Department “has deleted reporting on the human rights of LGBTQI+ persons — despite bipartisan reporting dating back three decades — and sought to undercut universal human rights on the world stage.”
“The International Human Rights Defense Act is a clear rebuke of this attempt to erase our lives,” said Bromley. “We are grateful for the leadership of Sen. Markey and his unwavering commitment to equality around the world.”
Congress
MTG resigns after years of anti-LGBTQ attacks amid Trump feud
Greene’s abrupt departure adds fresh uncertainty to an already fractured Republican Party.
Rep. Marjorie Taylor Greene announced on Friday that she is resigning from Congress.
In a post on X (formerly Twitter), the Georgia 14th Congressional District representative announced her sudden decision to resign from office.
The nearly 11-minute-long video shows Rep. Greene stating she will step down from her role representing one of Georgia’s most Republican districts on Jan. 5, 2026. She cited multiple reasons for this decision, most notably her very public separation from Trump.
In recent weeks, Greene — long one of the loudest and most supportive MAGA members of Congress — has butted heads with the president on a slew of topics. Most recently, she supported pushing the DOJ to release the Epstein Files, becoming one of only four Republicans to sign a discharge petition, against Trump’s wishes.
She also publicly criticized her own party during the government shutdown. Rep. Greene had oddly been supportive of Democratic initiatives to protect healthcare tax credits and subsidies that were largely cut out of national healthcare policy as a result of Trump’s “Big Beautiful Bill,” passed in July.
“What I am upset over is my party has no solution,” Greene said in October.
Trump recently said he would endorse a challenger against the congresswoman if she ran for reelection next year, and last week went as far as to declare, “Marjorie ‘Traitor’ Green is a disgrace to our GREAT REPUBLICAN PARTY!” on his Truth Social platform.
Trump told ABC News on Friday night that Greene’s resignation is “great news for the country,” and added that he has no plans to speak with Greene but wishes her well.
Despite her recent split with the head of the Republican Party, Rep. Greene has consistently taken a staunch stance against legislation supporting the LGBTQ community — notably a hardline “no” on any issue involving transgender people or their right to gender-affirming care.
Rep. Greene has long been at odds with the LGBTQ community. Within her first month in office, she criticized Democrats’ attempts to pass the Equality Act, legislation that would bar anti-LGBTQ employment discrimination. She went as far as to suggest an apocalypse-like scenario if Congress passed such a measure.
“God created us male and female,” she said on the House floor. “In his image, he created us. The Equality Act that we are to vote on this week destroys God’s creation. It also completely annihilates women’s rights and religious freedoms. It can be handled completely differently to stop discrimination without destroying women’s rights, little girls’ rights in sports, and religious freedom, violating everything we hold dear in God’s creation.”
Greene, who serves one of the nation’s most deeply red districts in northwest Georgia, attempted to pass legislation dubbed the “Protect Children’s Innocence Act,” which would have criminalized gender-affirming care for minors and restricted federal funding and education related to gender-affirming care in 2023. The bill was considered dead in January 2025 after being referred to the House Committee on the Judiciary.
Her push came despite multiple professional medical organizations, including the nation’s largest and most influential — the American Medical Association — stating that withholding gender-affirming care would do more harm than any such care would.
She has called drag performers “child predators” and described the Democratic Party as “the party of killing babies, grooming and transitioning children, and pro-pedophile politics.”
Greene has also publicly attacked Delaware Rep. Sarah McBride, the nation’s first and only transgender member of Congress. She has repeatedly misgendered and attacked McBride, saying, “He’s a man. He’s a biological male,” adding, “he’s got plenty of places he can go” when asked about bathrooms and locker rooms McBride should use. Greene has also been vocal about her support for a bathroom-usage bill targeting McBride and transgender Americans as a whole.
She has repeatedly cited false claims that transgender people are more violent than their cisgender counterparts, including falsely stating that the 2022 Robb Elementary School shooter in Texas was transgender.
The former MAGA first lady also called for an end to Pride month celebrations. She criticized the fact that the LGBTQ community gets “an entire” month while veterans get “only one day each year” in an X post, despite November being designated as National Veterans and Military Families Month.
Under Georgia law, Gov. Brian Kemp (R) must hold a special election within 40 days of the seat becoming vacant.
The Washington Blade reached out to both the White House and Greene’s office for comment, but has not heard back.
PFLAG honored U.S. Rep. Maxine Waters (D-Calif.) with the “2025 PFLAG National Champion of Justice” award during their annual “Love Takes Justice” event in Washington.
Waters has represented California’s 43rd Congressional District — including much of Los Angeles — since 1991 and has been a vocal advocate for LGBTQ rights since her swearing-in.
Her track record includes opposing the Defense of Marriage Act, which would have made marriage only between a man and a woman; co-sponsoring the Respect for Marriage Act, ultimately requiring all U.S. states to recognize same-sex marriages performed by other states; and is a long time supporter of the Equality Act, which would codify comprehensive protections for LGBTQ Americans.
In addition to her work on marriage equality, she also created the Minority AIDS Initiative to help address the devastating impact of HIV/AIDS on minority communities, particularly communities of color.
The award reception took place Tuesday at the headquarters of the American Federation of Teachers, where Waters was presented with the award by former U.S. Rep. Barney Frank (D-Mass.), the openly gay member of Congress. Frank praised Waters for her unwavering support for the LGBTQ community and her lifelong commitment to advancing equality for all.
“One of the most encouraging developments in the fight for human rights is the failure of those who traffic in any form of bigotry, including bigotry to divide the Black and LGBTQ+ communities,” said Frank, who came out in 1987 while in office. “No one deserves more recognition for strengthening our unity than Maxine Waters.”
During the reception, Waters spoke about her extensive history of LGBTQ advocacy within the halls of Congress, emphasizing that her idea of government centers around uplifting its most vulnerable and threatened communities.
“From the very beginning of my public life I’ve believed that the government must protect those that are vulnerable, including LGBTQ+ people, who have been pushed to the margins, criminalized and told that their lives and their love do not matter,” Waters said. “Discrimination has no place in our laws.”
She continued, adding that the discrimination LGBTQ people have dealt with — and continue to deal with — is unconstitutional and wrong.
“I am proud to stand with LGBTQ+ families against efforts to write discrimination into our constitution, against attempts to deny people jobs, housing, healthcare and basic dignity because of who they are or who they love,” she said.
Waters joins a slew of other LGBTQ advocates who have received this award, beginning with the late-Georgia Congressman John Lewis in 2018. Past honorees include Oakland (Calif.) Mayor Barbara Lee, who was then a member of Congress, U.S. Sen. Tammy Baldwin (D-Wis.), Frank, Colorado Gov. Jared Polis, who was then a member of Congress, and Speaker Emerita Nancy Pelosi (D-Calif.).
PFLAG CEO Brian Bond commented on the continued fight for LGBTQ rights in the U.S. as anti-transgender rhetoric and policies coming from the Trump-Vance White House grow each week.
“LGBTQ+ people and their families — and all of you here — know too well the reality of the political climate, the attitudes of the public, and the sheer lack of respect that LGBTQ+ people are experiencing in the world today. There’s no end to the hostile barrage of harmful laws, city ordinances, and regulations, especially against our trans loved ones,” Bond said. “This particular moment in history calls us to increase and fortify our work, advocating at every level of government.”
He ended with some hope — reminding the LGBTQ community they have been on the receiving end of discrimination and unjust treatment before, but have risen above and changed the laws — saying we can do it again.
“PFLAG members and supporters are uniquely suited for this moment, because we are fighting for and alongside our LGBTQ+ loved ones, we know that our love is louder … and love and liberty are inseparable,” said Bond.
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