News
Post-DOMA rule proposed for hospice care, nursing homes
Administration seeks to ensure same-sex marriages recognized regardless of state of residence

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.”
District of Columbia
Bowser appoints first nonbinary person to Cabinet-level position
Peter Stephan named Office of Disability Rights interim director
D.C. Mayor Muriel Bower has named longtime disability rights advocate Peter L. Stephan, who identifies as nonbinary, as interim director of the D.C. Office of Disability Rights.
The local transgender and nonbinary advocacy group Our Trans Capital and the LGBTQ group Capital Stonewall Democrats issued a joint statement calling Stephan’s appointment an historic development as the first-ever appointment of a nonbinary person to a Cabinet-level D.C. government position.
“This milestone appointment recognizes Stephan’s extensive expertise in disability rights advocacy and marks a historic advancement for transgender and nonbinary representation in District government leadership,” the statement says.
The statement notes that Stephan, an attorney, held the position of general counsel at the Office of Disability Rights immediately prior to the mayor’s decision to name him interim director.
The mayor’s office didn’t immediately respond to a question from the Washington Blade asking if Bowser plans to name Stephan as the permanent director of the Office of Disability Rights. John Fanning, a spokesperson for D.C. Council member Anita Bonds (D-At-Large), said the office’s director position requires confirmation by the Council.
Stephan couldn’t immediately be reached for comment.
“At a time when trans and nonbinary people ae under attack across the country, D.C. continues to lead by example,” said Stevie McCarty, president of Capital Stonewall Democrats. “This appointment reflects what we have always believed that our community is always strongest when every voice is represented in government,” he said.
“This is a historic step forward,” said Vida Rengel, founder of Our Trans Capital. “Interim Director Stephan’s career and accomplishments are a shining example of the positive impact that trans and nonbinary public servants can have on our communities,” according to Rangel.
Bulgaria
Top EU court issues landmark transgender rights ruling
Member states must allow name, gender changes on ID documents
The European Union’s highest court on Thursday ruled member states must allow transgender people to legally change their name and gender on ID documents.
The EU Court of Justice in Luxembourg issued the ruling in the case of “Shipova,” a trans woman from Bulgaria who moved to Italy.
“Shipova” had tried to change her gender and name on her Bulgarian ID documents, but courts denied her requests for nearly a decade.
A ruling the Bulgarian Supreme Court of Cassation issued in 2023 essentially banned trans people from legally changing their name and gender on ID documents. Two Bulgarian LGBTQ and intersex rights groups — the Bilitis Foundation and Deystvie — and ILGA-Europe and TGEU – Trans Europe and Central Asia supported the plaintiff and her lawyers.
“Because her life in Italy also depended on her Bulgarian documents, the lack of documents reflecting her lived gender creates an obstacle to her right to move and reside within EU member states,” said the groups in a press release. “This mismatch between her gender identity and expression and her gender marker in her official documents leads to discrimination in all areas of life where official documents are required. This includes everyday activities such as going to the doctor and paying for groceries by card, finding employment, enrolling in education, or obtaining housing.”
Denitsa Lyubenova, a lawyer with Desytvie, in the press release said the case “concerns the dignity, equality, and legal certainty of trans people in Bulgaria.” TGEU Senior Policy Officer Richard Köhler also praised the ruling.
“Today, the EU Court of Justice has taken an important step towards a right to legal gender recognition in the EU,” said Köhler. “Member states must allow their nationals living in another member state to change their gender data in public registries and identity cards to ensure they can fully enjoy their freedom of movement. National laws or courts cannot stand in their way.”
“Thousands of trans people in the EU are breathing a sigh of relief today,” added Köhler.
Senegal
Senegalese lawmakers approve bill to further criminalize homosexuality
A dozen men arrested in February for ‘unnatural acts’
Senegalese lawmakers on Wednesday approved a bill that would further criminalize consensual same-sex sexual relations in the country.
The Associated Press notes the measure that Prime Minister Ousmane Sonko introduced in February would increase the penalty for anyone convicted of engaging in consensual same-sex sexual relations from one to five years in prison to five to 10 years. The AP further indicates the bill would prohibit the “promotion” or “financing” of homosexuality in the country.
The bill passed with near unanimous support. Only three of 135 MPs abstained.
President Bassirou Diomaye Faye is expected to sign the measure.
The National Assembly in 2021 rejected a bill that would have further criminalized homosexuality in Senegal.
Senegalese police last month arrested a dozen men and charged them with committing “unnatural acts.”
Volker Türk, the U.N. high commissioner for human rights, in a statement described the bill as “deeply worrying.”
“It flies in the face of the sacrosanct human rights we all enjoy: the rights to respect, dignity, privacy, equality and freedoms of expression, association, and peaceful assembly,” he said.
Türk also urged Faye not to sign the bill.
“I urge the president not to sign this harmful law into effect, and for authorities to repeal the existing discriminatory law and to uphold the human rights of all in Senegal, without discrimination,” said Türk.
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