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.”
Texas state Rep. James Talarico won a hard-fought primary Tuesday to become the state’s Democratic nominee for U.S. Senate, defeating U.S. Rep. Jasmine Crockett in one of the year’s most closely watched and competitive Democratic contests.
Talarico, a Presbyterian seminarian and three-term lawmaker from Round Rock, was declared the winner by the Associated Press early Wednesday morning after a closely tracked vote count that drew national attention.
“Tonight, the people of our state gave this country a little bit of hope,” Talarico told the AP. “And a little bit of hope is a dangerous thing.”
With 52.8% of the vote to Crockett’s 45.9%, Talarico secured the nomination outright, avoiding a runoff and capping months of sharp contrasts between the two candidates over strategy, messaging, and how best to compete statewide in Texas. Democrats hope the competitive primary — and the relatively narrow margin — signals growing momentum in a state that has not elected a Democrat to the U.S. Senate since 1988.
Talarico has long expressed support for the LGBTQ community, a position he highlights prominently on his campaign website. Under the “Issues” section, he directly addresses assumptions that might arise from his faith and background as a seminarian in a deeply conservative state.
“My faith in Jesus leads me to reject Christian Nationalism and commit myself to the project of democracy,” his website reads. “Because that’s the promise of America: a democracy where every person and every family — regardless of religion, race, gender, sexual orientation, or any other difference between us — can truly be free and live up to their full potential.”
Crockett struck a conciliatory tone following her defeat, emphasizing party unity ahead of November.
“This morning I called James and congratulated him on becoming the Senate nominee,” Crockett told Politico. “Texas is primed to turn blue and we must remain united because this is bigger than any one person. This is about the future of all 30 million Texans and getting America back on track.”
Talarico also drew national attention earlier in the race when “Late Show” host Stephen Colbert said he was initially unable to air an interview with the state legislator due to potential FCC concerns involving CBS. The episode sparked a broader political debate.
Brendan Carr, chair of the Federal Communications Commission, appointed by President Donald Trump, told reporters the controversy was a “hoax,” though he also acknowledged Talarico’s ability to harness the moment to build support as an underdog candidate. The interview was later released online and garnered millions of views, boosting Talarico’s national profile.
In November, Talarico will face the winner of the Republican primary between incumbent Sen. John Cornyn and Texas Attorney General Ken Paxton, who have been locked in a bruising GOP contest. Rep. Wesley Hunt was also in the Republican primary field. The GOP race is expected to head to a May runoff.
In a joint statement, Senate Minority Leader Chuck Schumer and Democratic Senatorial Campaign Committee Chair Kirsten Gillibrand praised Talarico’s victory and framed him as a candidate capable of broad appeal.
“As an eighth-generation Texan, former middle school teacher, and Presbyterian seminarian, James will be a fighter for Texans from all walks of life and of all political stripes,” they said. “In November, Texans will elect a champion for working people: James Talarico.”
Maryland
Md. Commission on LGBTQIA+ Affairs released updated student recommendations
LGBTQ students report higher rates of bullying, suicide
The Maryland Commission on LGBTQIA+ Affairs has released updated recommendations on how the state’s schools can support LGBTQ students.
The updated 16-page document outlines eight “actionable recommendations” for Maryland schools, supplemented with data and links to additional resources. The recommendations are:
- Developing and passing a uniform statewide and comprehensive policy aimed at protecting “transgender, nonbinary, and gender expansive students” against discrimination. The recommendation lists minimum requirements for the policy to address: name, pronoun usage, and restroom access.
- Requiring all educators to receive training about the specific needs of LGBTQ students, by trained facilitators. The training’s “core competencies” include instruction on terminology, data, and support for students.
- Implementing LGBTQ-inclusive curricula and preventing book bans. The report highlights a “comprehensive sexual education curriculum” as specifically important in the overall education curriculum. It also states the curriculum will “provide all students with life-saving information about how to protect themselves and others in sexual and romantic situations.”
- Establishing Gender Sexuality Alliances “at all schools and in all grade levels.” This recommendation includes measures on how to adequately establish effective GSAs, such as campaign advertising, and official state resources that outline how to establish and maintain a GSA.
- Providing resources to students’ family members and supporters. This recommendation proposes partnering with local education agencies to provide “culturally responsive, LGBTQIA+ affirming family engagement initiatives.”
- Collecting statewide data on LGBTQ youth. The data on Maryland’s LGBTQ youth population is sparse and non-exhaustive, and this recommendation seeks to collect information to inform policy and programming across the state for LGBTQ youth.
- Hiring a full-time team at the Maryland Department of Education that focuses on LGBTQ student achievement. These employees would have specific duties that include “advising on local and state, and federal policy” as well as developing the LGBTQ curriculum, and organizing the data and family resources.
- Promoting and ensuring awareness of the 2024 guidelines to support LGBTQ students.
The commission has 21 members, with elections every year, and open volunteer positions. It was created in 2021 and amended in 2023 to add more members.
The Governor’s Office of Communication says the commission’s goal is “to serve LGBTQIA+ Marylanders by galvanizing community voices, researching and addressing challenges, and advocating for policies to advance equity and inclusion.”
The commission is tasked with coming up with yearly recommendations. This year’s aim “to ensure that every child can learn in a safe, inclusive, and supportive environment.”
The Human Rights Campaign’s most recent report on LGBTQ youth revealed that 46.1 percent of LGBTQ youth felt unsafe in some school settings. Those numbers are higher for transgender students, with 54.9 percent of them saying they feel unsafe in school.
Maryland’s High School Youth Risk Behavior Survey reveals a disparity in mental health issues and concerns among students who identify as LGBTQ, compared to those who are heterosexual. LGBTQ students report higher rates of bullying, feelings of hopelessness, and suicidal thoughts. Nearly 36 percent of LGBTQ students report they have a suicide plan, and 26.7 percent of respondents say they have attempted to die by suicide.
The commission’s recommendations seek to combat the mental health crisis among the state’s LGBTQ students. They are also a call for local and state governments to work towards implementing them.
Virginia
Va. lawmakers consider partial restoration of Ryan White funds
State Department of Health in 2025 cut $20 million from Part B program
The Virginia General Assembly is considering the partial restoration of HIV funding that the state’s Department of Health cut last year.
The Department of Health in 2025 cut $20 million — or 67 percent of total funding — from the Ryan White Part B program.
The funding cuts started with the Trump-Vance administration passing budget cuts to federal HIV screening and protection programs. Rebate issues between the Virginia Department of Health and the company that provides HIV medications began.
Advocates say the funding cuts have disproportionately impacted lower-income people.
The Ryan White HIV/AIDS Program, a federal program started in 1990, provides medical services, public education, and essential services. Part B offers 21 services, seven of which remained funded after the budget cuts.
Equality Virginia notes “in 2025, a 67 percent reduction severely destabilized HIV services across the commonwealth.”
Virginia lawmakers have approved two bills — House Bill 30 and Senate Bill 30 — that would partially restore the funding. The Ryan White cuts remain a concern among community members.
Both chambers of the General Assembly must review their proposed changes before lawmakers can adopt the bills.
“While these amendments aren’t a full restoration of what community-based organizations lost, this marks a critical step toward stabilizing care for thousands of Virginians living with HIV,” said Equality Virginia Executive Director Narissa Rahaman. “Equality Virginia plans to continue their contact with lawmakers and delegates through the conference and up until the passing of the budget.”
“We appreciate lawmakers from both sides of the aisle who recognized the urgency of this moment and will work to ensure funding remains in the final version signed by the governor,” added Rahaman.
An undeclared war of distraction by the felon
Talarico beats Crockett in Texas primary
35 years after ‘Truth or Dare,’ Slam is still dancing
Md. Commission on LGBTQIA+ Affairs released updated student recommendations
