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New guidance affords gay couples equal access to Medicaid

Non-marriage equality states can refuse new policy for gay couples

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Centers for Medicare & Medicaid Services, gay news, Washington Blade
Centers for Medicare & Medicaid Services, gay news, Washington Blade

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.

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Congress

Chris Van Hollen says the Democratic Party needs change. Is he the one to lead it?

Senator is backing anti-establishment Democrats across the country

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By LEE O. SANDERLIN | The Democratic Party is having something of an identity crisis — losing to President Donald Trump twice in three elections will do that.

Should the party embrace anti-establishment figures who espouse progressive policy ideas like Medicare for all and rhetoric about unrigging the economy for the 1 percent? Or should Democrats try to appeal to moderates who want to return to semi-normalcy in a time of political upheaval?

Although he’s been in Congress since 2002, with key leadership roles throughout his tenure, Maryland Sen. Chris Van Hollen, 67, counts himself firmly in the anti-establishment camp.

The rest of this article can be found on the Baltimore Banner’s website.

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Politics

Log Cabin Republicans remove transgender rights from mission

Decision made after ‘significant discussion’ with members, board

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From left, former U.S. Ambassador to Germany Richard Grenell and then-Log Cabin Republicans President Charles Moran attend the Log Cabin Republicans Big Tent Event at the 2024 Republican National Convention in Milwaukee. (Washington Blade photo by Michael Key)

Log Cabin Republicans, an organization that formerly represented LGBTQ conservatives, has removed advocating for transgender and queer rights from its “renewed” national advocacy focus.

In an opinion piece written by Log Cabin Republicans President Ross Hemminger for the conservative media outlet Town Hall, he announced that trans rights would no longer be part of what the organization advocates for through conservative leadership and candidates.

In his piece, Hemminger wrote that after “significant discussion” with members and Log Cabin Republicans’ board of directors, the organization’s leadership voted to “refine Log Cabin Republicans’ national advocacy focus to concentrate specifically on issues of sexual orientation and conservative values,” a focus that does not include trans people.

“We have fought for the right to legally marry who we love, serve our country and our communities openly and proudly, and to enjoy the same inalienable rights afforded to all law-abiding Americans — and we succeeded,” Hemminger wrote. “However, the new era of gender identity politics is not the movement we supported and fought for. Gay men and women are losing public support across the country, and support for gay marriage and other once-widely accepted rights is eroding. Why? Because many voters today weren’t alive or cognizant of the politics of gay marriage winding its way through the courts and gaining ground in public opinion. Their view of the gay community is based on today’s radical transgender activists with their unnecessary and discomfiting focus on America’s youth.”

Hemminger then went on to argue that trans advocacy has shifted to focusing primarily on minors — a characterization that does not reflect the breadth of issues trans advocates address.

“They push schools to teach radical gender ideology; they want biological men in women’s sports regardless of the consequences; perhaps most offensively, they support gender reassignment treatments for minors, often without the knowledge or consent of the parents, knowing full well these treatments are mostly irreversible,” he wrote.

Hemminger and many right-wing political leaders have continued to assert this false reality as fact.

A Harvard-affiliated study found approximately 2.1 gender-affirming surgeries occur per 100,000 trans and gender-diverse minors diagnosed with gender dysphoria, underscoring how uncommon these procedures are among minors. In addition to the option of surgery for those who think it’s right for them, there is an array of other medically sound options to treat gender dysphoria, which according to KFF, an independent source for health policy research and polling, includes “medical, surgical, mental health, and non-medical services for transgender and nonbinary people.”

Additionally trans advocacy is not as narrow as Hemminger makes it seem in his opinion piece.

There are a slew of issues the trans community faces — and fights for — on a daily basis that have nothing to do with healthcare. Those include obtaining government documents that accurately reflect one’s gender identity, multiple elements of family law that include the right to marry and adopt children as straight couples can, protections from violence, hate crime protections, the right to serve in the military, access to bathrooms corresponding with their gender, and the right to education.

Despite the overwhelming number of issues trans people — regardless of political affiliation — have to struggle with as a result of systemic gaps in protections that are supposed to be afforded to everyone under the law, they remain vulnerable to unequal treatment.

Despite this shift, Log Cabin Republicans has committed to standing with the Republican Party rather than LGBTQ people as a whole. The organization was initially founded as a loosely connected network of local California social clubs made up of LGBTQ conservatives in the late 1970s before eventually emerging as a national political organization in the early 1990s under its founding executive director, Rich Tafel.

As the organization continued to gain momentum, it endorsed a handful of Republicans who voted against the Respect for Marriage Act, the 2022 law that federally recognized marriage equality for same-sex couples.

The Washington Blade reached out to Log Cabin Republicans for comment but did not hear back by the time of publication.

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White House

Trump-Vance administration’s LGBTQ brain drain: what you need to know

Several high profile figures have left government since January 2025

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Demetre Daskalakis resigned from the Centers for Disease Control and Prevention months after the Trump-Vance administration took office in January 2025. (Screen capture via Zoom)

Uncloseted Media published this article on Aug. 21.

By SPENCER MACNAUGHTON and HOPE PISONI | Since President Donald Trump regained office in January 2025, he and his administration have waged an all-out war against the LGBTQ community.

This has led queer Americans to move to other countries at unprecedented rates — Rainbow Railroad, a Canadian nonprofit that supports LGBTQ asylum seekers, reported receiving a huge increase in inquiries from the U.S. last year.

The same pattern is playing out within the government. And it’s leading to a brain drain of competent queer employees and allies who are either resigning or being fired, often because of their LGBTQ identity or their belief that queer people deserve basic human rights.

Here are six examples of federal workers who had a messy exit from Trump 2.0:

Demetre Daskalakis

  1. WHAT HE DID: Dr. Daskalakis is one of the foremost LGBTQ health professionals in the U.S. Under Trump’s first term, he was appointed director of the Division of HIV/AIDS Prevention at the Centers for Disease Control and Prevention. Under Biden, he also served as the deputy response coordinator for mpox at the White House.
  2. WHAT HAPPENED: While he continued a lot of this work under Trump 2.0, he didn’t last long. In August 2025, he resigned from the CDC, writing in his resignation letter that he was “unable to serve in an environment that treats CDC as a tool to generate policies and materials that do not reflect scientific reality and are designed to hurt rather than to improve the public’s health.”
  3. BOTTOM LINE: I recently interviewed Daskalakis, where he told me that leadership from RFK Jr.’s Health and Human Services Department justified HIV cuts by saying the virus is “just too woke.”

Julia Curlee

  1. WHAT SHE DID: Julia Curlee worked in intelligence for nearly two decades between the CIA and the National Security Council. Earlier this week, she wrote an article in The Atlantic explaining how she had served as Mike Pence’s daily briefer and the NSC’s director for intelligence programs. During Trump 1.0, she briefed the president on Air Force One.
  2. WHAT HAPPENED: Curlee told CNN this week that in Trump’s second term, her treatment by the federal government transformed. She was no longer allowed to use the women’s bathroom on federal property and had to leave her workplace to relieve herself. Her passport was also reissued to read “male,” which led to complications when traveling abroad. In March 2025, less than 70 days into Trump’s second term, Curlee says she received a call while at a rib joint in Virginia with her family informing her that her White House tour was over and that they couldn’t tell her why. She continued to work for the CIA for some months, but she later resigned.
  3. BOTTOM LINE: Curlee wrote that moments after she learned she was fired from the White House, she saw a post from right-wing political activist Laura Loomer that read “A transgender, Biden holdover who hates President Trump is still working in the NSC intel office. I’m told there are several NSC staffers who have complained that this trans Biden holdover hasn’t been fired yet, but nothing is being done about it.”

Marc Seawright

  1. WHAT HE DID: Marc Seawright worked for more than eight years at the U.S. Equal Employment Opportunity Commission. Most recently, he served as the EEOC’s director of information governance and strategy, where he oversaw tech policy to help combat workplace harassment and discrimination.
  2. WHAT HAPPENED: During Trump 2.0, Seawright was ordered to develop technology that would erase any mention of LGBTQ identities from EEOC outreach materials. “[My expertise] was being leveraged to perpetuate discrimination against people like me,” he told the Associated Press. In that article, Seawright and other transgender and gender nonconforming federal employees described their “fear, grief, frustration, and distress working for the federal government at a time when it rejects them — often with no clear path for recourse or support.”
  3. BOTTOM LINE: Seawright quit in June, citing a hostile work environment. “It became overwhelming. It felt insurmountable,” he told the AP. He has now hired lawyers at Katz Banks Kumin and has filed a discrimination complaint.

David Maltinsky

  1. WHAT HE DID: Until 2025, Maltinsky worked for more than 16 years at the FBI as an intelligence specialist. In 2025, he was training to become a special agent, but three weeks ahead of graduation, he was fired.
  2. WHAT HAPPENED: On Oct. 1, he was delivered a letter from FBI Director Kash Patel informing him that he was being fired for an “inappropriate display of political signage.” The signage in question, according to Maltinsky, was a Pride flag displayed in his work station at a previous post in Los Angeles. The flag had been given to him by the FBI’s LA Field Office, and Maltinsky says he had been told by multiple supervisors that displaying it would not be a violation.
  3. BOTTOM LINE: Maltinsky is currently suing the FBI and the Department of Justice, arguing that his firing constituted unlawful discrimination.

Mary Brinkmeyer

  1. WHAT SHE DID: Brinkmeyer had been working as a psychologist for the Department of Veterans Affairs since 2008. She held multiple leadership roles, including the LGBTQ veteran care coordinator at the Hampton VA Medical Center. She established the first military support group for trans servicemembers and was awarded Navy Psychology Civilian Psychologist of the Year in 2016.
  2. WHAT HAPPENED: Following an early Trump executive order directing the federal government to purge any practices promoting “gender ideology,” Brinkmeyer says staff at her workplace were told to remove all LGBTQ-affirming materials from both public and private areas, as well as to identify “anything in medical records, training materials, or patient resources that could be considered ‘gender ideology.’” When she refused to comply and confronted her supervisor, she says her concerns were dismissed.
  3. BOTTOM LINE: Brinkmeyer resigned in February 2025, stating that she “didn’t want to be complicit in something that I knew was wrong.”

Amy Paris

  1. WHAT SHE DID: Paris was the second-highest ranking trans woman in the federal government, serving as a deputy digital services lead in the HHS Department, where she oversaw the safety of organ donations. Prior to that, she worked in a number of tech-related roles across the federal government since the Bush administration. She helped create cross-agency spending trackers, streamlined unemployment insurance during the pandemic and implemented trans-inclusive policies like gender-neutral passports.
  2. WHAT HAPPENED: Paris was fired as part of a string of mass layoffs across the federal government in February 2025. While the HHS did not publicly comment on why she was fired, Paris says she was told it was because of her performance, despite the fact that she got a 4.75 out of five on her last performance review and was praised for her work by multiple Biden administration officials.
  3. BOTTOM LINE: Paris told the 19th she suspected her firing was politically motivated, saying the Trump administration is “trying to sow discord and disrupt confidence in the workings of the federal government.”
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