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Post-DOMA rule proposed for hospice care, nursing homes

Administration seeks to ensure same-sex marriages recognized regardless of state of residence

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

The Centers for Medicare & Medicaid has proposed a new rule for hospice care and nursing homes. (Image public domain).

The Obama administration on Thursday announced a proposed rule that aims to ensure medical care for individuals in same-sex marriages — regardless of the state in which they live — following the Supreme Court decision against the Defense of Marriage Act.

The Centers for Medicare & Medicaid proposes the rule to change conditions for medical care providers and suppliers receiving support from Medicare and Medicaid, including hospitals and hospice care, as well as the requirements for long-term care facilities, or nursing homes.

The thrust of the proposed rule is to ensure same-sex marriages are recognized nationwide, even in states without marriage equality, for programs that in some aspects are administered by the states.

“This proposed rule addresses certain regulations governing Medicare and Medicaid participating providers and suppliers where current regulations look to state law in a matter that implicates (or may implicate) a marital relationship,” the rule states. “Our goal is to provide equal treatment to spouses, regardless of their sex, whenever the marriage was valid in the jurisdiction in which it was entered into, without regard to whether the marriage is also recognized in the state of residence or the jurisdiction in which the health care provider or supplier is located, and where the Medicare program explicitly or impliedly provides for specific treatment of spouses.”

The proposed rule, which can found here, is set for publication in the Federal Register on Friday. Once it’s published, comments must be received by 60 days to be assured consideration before the rule is made final.

Karen Loewy, senior attorney and seniors program strategist for the LGBT group Lambda Legal, said the proposed rules are “a very welcome development” and would “amend references to discriminatory state laws to provide equal treatment to spouses.”

“In practical terms, these changes will mean that a patient’s same-sex spouse will have the same right to access information, make decisions, and be part of admissions processes that a different-sex has in hospitals, hospice care, surgical care centers, long term care settings, labs, and community mental health centers that receive Medicare or Medicaid dollars, even when the laws of the state would not recognize their right to do so,” Loewy said. “These rules would provide important automatic protections for same-sex spouses, ensuring that a patient’s spouse gets to be by his or her side, be informed, and make those difficult decisions in vulnerable health care situations.”

In summary, the proposed rule seeks to established a same-sex spouse should be considered a person’s representative — regardless of state law — for the purposes for care from ambulatory surgical centers, hospice care, exercising a patient’s rights, informing patients of their rights, notification for laboratory services to screen blood and blood products for potentially infectious diseases like HIV and Hepatitis C, care in long-term facilities, pre-admission screening and resident review for long-term care, findings of these evaluations, care in Community Mental Health Centers and client rights at these facilities.

Mark Daley, a spokesperson for the National LGBTQ Task Force, said changes in proposed rule are “common-sense” and would help elders in the LGBT community ensure they receive equal care in medical facilities.

“These new policies help ensure that one of the most vulnerable populations in our country, LGBTQ elders, are able to access federal programs in the same way that non-LGBTQ people access programs,” Daley said. “This means ensuring that same-sex spouses will be treated exactly the same as different-sex spouses in programs like long-term care facilities, Hospice care, and hospitals. What this really means for LGBTQ folks is that same-sex spouses will be able to visit and make medical decisions on behalf of their spouse, just like different-sex couples. It means that LGBTQ elders will have legal rights in the health care context, regardless of whether your state continues to discriminate against you by refusing to recognize your marriage.”

After the Supreme Court decision against DOMA, the Centers for Medicare & Medicaid already issued guidance — once in September 2013 and again in May 2014 — to ensure same-sex marriages are recognized in determining eligibility for Medicaid and the Children’s Health Insurance Program. But the proposed rule says it’s needed because policies it addresses “are administered by different statutes and are administered by state Medicaid agencies and CMS.”

Sarah Warbelow, legal director for the Human Rights Campaign, said the proposed rule will help individuals in same-sex marriages in the medical care situations when they need assistance the most.

“When people are at their most vulnerable, from hospitals to hospice care to nursing homes, they need to know that their spouse will be fully informed, be able to help them make decisions, and be fully regarded as their spouse,” Warbelow said. “The rule proposed by the Centers for Medicare and Medicaid will help to ensure that the marriages of same-sex couples are treated equally regardless of where the couple lives.”

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Commentary

He is 16 and sitting in a Cuban prison

Jonathan David Muir Burgos arrested after participating in anti-government protests

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Jonathan David Muir Burgos remains in a Cuban jail. (Graphic by Ignacio Estrada Cepero)

Jonathan David Muir Burgos is 16-years-old, and that fact alone should force the world to stop and pay attention. He is not an armed criminal, nor a violent extremist, nor someone accused of harming others. He is a Cuban teenager who ended up behind bars after joining recent protests in the city of Morón, in the province of Ciego de Ávila, demonstrations born out of exhaustion, desperation, and the growing collapse of daily life across the island.

Those protests did not emerge from privilege or political theater. They erupted after prolonged blackouts, food shortages, lack of drinking water, unbearable heat, and a level of public frustration that continues to deepen inside Cuba. People took to the streets because ordinary life itself has become increasingly unbearable. Families are surviving for hours and sometimes days without electricity. Parents struggle to find food. Entire communities live trapped between scarcity and silence.

Jonathan became part of that reality.

And today, he is sitting inside a Cuban prison.

The World Health Organization defines adolescence as the stage between approximately 10 and 19 years of age, a period marked by emotional, psychological, and physical development. That matters deeply here because Jonathan is not simply a “young protester.” He is a minor. A teenager still navigating the fragile years in which identity, emotional stability, and personal growth are being formed.

Yet the Cuban government chose to place him inside a high-security prison alongside adults.

There is something profoundly disturbing about a political system willing to expose a 16-year-old boy to the psychological brutality of prison life simply because he exercised the right to protest. A prison is never only walls and bars. It is fear, humiliation, emotional pressure, intimidation, and uncertainty. For a teenager surrounded by adult inmates, those dangers become even more alarming.

The situation becomes even more serious because Jonathan reportedly suffers from severe dyshidrosis and has previously experienced dangerous bacterial infections affecting his health. His condition requires proper medical care, hygiene, and adequate treatment, precisely the kind of stability that is difficult to guarantee inside the Cuban prison system.

Behind this story there is also a family living through a kind of pain impossible to fully describe.

Jonathan is the son of a Cuban evangelical pastor. Behind the headlines there is a mother wondering how her child is sleeping at night inside a prison cell. There is a father trying to hold onto faith while imagining the emotional and physical risks his teenage son may be facing behind bars. Faith does not erase fear. Faith does not prevent parents from trembling when their child is imprisoned.

And this is where another painful contradiction emerges.

While a Cuban pastor watches his son remain incarcerated, there are still political and religious voices outside Cuba romanticizing the Cuban regime from a safe distance. There are people who speak passionately about justice while remaining silent about political prisoners, repression, censorship, and now even the imprisonment of adolescents.

That silence matters.

Because silence protects systems that normalize abuse.

For too long, parts of the international community have spoken about Cuba through ideological nostalgia while refusing to confront the human cost paid by ordinary Cubans. The reality is not romantic. The reality is families surviving in darkness, young people fleeing the country in massive numbers, parents struggling to feed their children, and now a 16-year-old boy sitting inside a prison after joining a protest born from desperation.

No government has the moral right to destroy the emotional and psychological well-being of a teenager for exercising freedom of expression. No ideology should stand above human dignity. And no institution that claims to defend justice should remain indifferent while a child becomes a political prisoner.

Jonathan David Muir Burgos should not be in prison.

A 16-year-old boy should not have to pay for protest with his freedom. 

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Rehoboth Beach

From the Capitol to the coast: Rep. Sarah McBride shares Rehoboth favorites

As summer kicks off, Congresswoman Sarah McBride shares her favorite Rehoboth spots.

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Rep. Sarah McBride (D-Del.) (Washington Blade photo by Michael Key)

Each year for the past 19 years, the Washington Blade has kicked off the summer season with a quintessential tradition — a party in Rehoboth Beach. The annual celebration is well known among Blade readers as the unofficial start of summer and beach season. (This year’s event is May 15, 5-7 p.m. at Diego’s featuring remarks from Ashley Biden.)

Two weeks ago, the Blade sat down with Sarah McBride (D-Del.), the first openly transgender person elected to Congress, to discuss her first year in office. While reflecting on key milestones and challenges ahead, she also shared some of her favorite Rehoboth spots and what the beach town means to her.

“I love Rehoboth,” the state’s sole House member told the Blade, beaming from her office in the Longworth House Office Building. “I love Baltimore Avenue, and love going to Aqua and the Pines.”

Both Aqua and the Pines have long served as staples of Rehoboth’s LGBTQ community. From the Saturday night lines stretching down the street off the main drag to the Sunday tea dances, the venues have helped cement Rehoboth as one of the top LGBTQ beach destinations in the United States dating back to at least the 1940s, when LGBTQ federal workers would escape the pressures — and often prying eyes — of Washington for a queer haven along the Delaware coast.

While attitudes and the community itself have evolved over the decades, Rehoboth today can still feel like an extension of D.C. — only with more Speedos and sandy flip-flops. Conversations that begin in Washington about politics and nightlife often continue beachside, shifting from “What’s Bunker’s theme tonight?” to “Who’s DJing at Aqua?”

When asked where she likes to dine in town, McBride highlighted one longtime favorite while also teasing a new addition she’s eager to try.

“Drift Seafood and Raw Bar is one of my favorite restaurants,” she said. “I actually ran into a Rehoboth restaurateur the other day while I was at Longwood Gardens for the tulips — which were beautiful. The restaurateur just opened a new restaurant on the south end of Baltimore Avenue that I’m excited to try. It sounds like an Indian fusion restaurant.”

When asked whether she frequents Poodle Beach — the longtime LGBTQ section of the shoreline — McBride shared that she prefers a quieter stretch of sand a bit farther north of Rehoboth’s gay beach scene.

“I usually go to Deauville, which is just north. It’s right there in between the boardwalk and Gordon’s Pond and North Shores.”

Regardless of where she chooses to unwind from the pressures of Washington and Dover, McBride was clear about how much both Rehoboth and Delaware mean to her.

“I love Rehoboth. I love the restaurants there. This is the professional privilege of my lifetime, getting to represent Delaware.”

“One of the things that I love is seeing how much goodness there is in this state,” she shared. “I represent more people in the House of Representatives than any other representative. Unlike most members who represent exclusively urban, suburban, or rural districts, I represent all three. Delaware demographically looks like America.”

She went on to say that representing a state whose demographics closely mirror the country as a whole gives her hope for the future — something that can at times feel elusive within the often-divisive halls of Congress.

“That means every day that I’m here, and every time Delawareans come to visit me, I get to see the full diversity of this country and this state on display. I get to see the goodness across that diversity, whether it’s diversity of identity or diversity of thought. It makes me even prouder to represent a state that time and time again judges candidates not based on their identities, but based on their ideals.”

She ended with a simple but hopeful message about her state and its people.

“Our politics are too often defined by hate. I’m glad Delaware and Delawareans are showing that a different kind of politics is possible.”

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The White House

White House counterterrorism strategy targets ‘anti-American, radically pro-transgender’ groups

Administration released document last week

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President Donald Trump at the White House. (Washington Blade photo by Joe Reberkenny)

The White House released the “United States Counterterrorism Strategy” last week, introducing enforcement priorities that include references to people with “extreme transgender ideologies.”

The document is the first executive branch counterterrorism strategy released since former President Joe Biden’s 2021 “National Strategy for Countering Domestic Terrorism,” which largely focused on threats tied to domestic extremism and the Jan. 6 Capitol attack. The Trump-Vance administration’s new strategy instead centers heavily on cartels, Islamist organizations, and what it describes as “violent left-wing extremists.”

The report identifies three primary categories of terror threats facing the U.S.: “Narcoterrorists and Transnational Gangs,” “Legacy Islamist Terrorists,” and “Violent Left-Wing Extremists, including Anarchists and Anti-Fascists.” The strategy repeatedly frames those groups as existential threats to the U.S. and outlines a more aggressive, militarized counterterrorism posture.

The introduction to the report closes with a warning from President Donald Trump referencing counterterrorism operations carried out during his second administration: “We will find you and we will kill you.”

In the section outlining the administration’s counterterrorism priorities, the document argues that federal intelligence, and law enforcement agencies under prior administrations focused on the wrong threats while overlooking violence committed by left-wing extremists. The strategy specifically references transgender ideology while discussing political violence.

“As real threats were ignored or underplayed, Americans have witnessed the politically motivated killings of Christians and conservatives committed by violent left-wing extremists, including the assassination of Charlie Kirk by a radical who espoused extreme transgender ideologies.”

Claims tying a trans person to Kirk’s killing have been disputed, however, and multiple news outlets later retracted or corrected early reports that identified the shooter as trans.

The report later expands on that argument, saying the administration will prioritize targeting “violent secular political groups” it describes as anti-American and “radically pro-transgender.”

“In addition to cartels and Islamist terror groups, our national CT activities will also prioritize the rapid identification and neutralization of violent secular political groups whose ideology is anti-American, radically pro-transgender, and anarchist.”

The rhetoric mirrors claims frequently made by Trump allies and conservative commentators linking trans people and left-wing activism to political violence. However, data compiled by researchers and organizations tracking mass shootings does not support the idea that trans people are responsible for a significant share of such attacks.

Factcheck.org says rhetoric from Trump and several far-right political pundits contradicts available data, noting that the percentage of mass shootings committed by trans people is “exceedingly small.”

Despite the lack of evidence supporting generalized claims about trans people, the president’s son Donald Trump, Jr., told Fox News in September 2025 that he could not “name a mass shooting in the last year or two in America that wasn’t committed by, you know, a transgender lunatic.”

Factcheck.org also found that even if cases involving shooters with unclear gender identities were included in statistics about trans mass shooters, the number would still account for only a fraction of a percent.

Mark Bryant, founding executive director of the Gun Violence Archive, said the number of trans mass shooters could be as high as eight, but would still account for less than 0.1 percent of mass shootings over the last 12 years, according to GVA data. He added that the figure would remain below 0.2 percent even when examining incidents from 2018 to the present.

Beyond domestic extremism, the strategy frames the administration’s broader counterterrorism agenda through the lens of “America First” foreign policy and renewed U.S. dominance in the Western Hemisphere. The report repeatedly references the Monroe Doctrine, the nearly 200-year-old policy warning European powers against interference in the Americas.

“After years of neglect, the United States will reassert and enforce the Monroe Doctrine to restore American preeminence in the Western Hemisphere, and to protect our homeland” Trump said in the report.

The document also breaks down counterterrorism priorities by region, including the Middle East, where it argues the U.S. is “no longer as dependent” on the region because of increased domestic energy production.

“Our growing domestic energy production means the Middle East is no longer as central to America’s stability, yet threats from this region remain, and our counterterrorism goals continue to be specific and rooted in realistic threat analysis.”

The statement comes amid rising gas prices tied in part to instability surrounding the war involving Iran, with fuel costs reaching some of their highest levels since 2022. According to AAA, the national average price for gasoline climbed to $4.52 per gallon as the national average rose “$.25 for a second straight week.

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