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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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District of Columbia

Capital Stonewall Democrats endorses Janeese Lewis George for D.C. mayor

Group also backed D.C. Council, Congressional delegate, AG candidates

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Janeese Lewis George (Washington Blade photo by Michael Key)

The Capital Stonewall Democrats, D.C.’s largest local LGBTQ political organization, announced on May 14 that it has endorsed D.C. Councilmember Janeese Lewis George (D-Ward 4) for mayor in the city’s June 16 Democratic primary.

Lewis George along with former D.C. Councilmember Kenyan McDuffie (D-At-Large) are considered by political observers to be the two leading candidates among the seven candidates competing in the Democratic primary election for mayor.

Both have strong, long-standing records of support on LGBTQ issues, indicating Capital Stonewall Democrats members, like LGBTQ voters across the city, are likely choosing a candidate based on non-LGBTQ related issues.

In a May 14 statement, the group announced its endorsements in seven other Democratic primary races, including D.C. Council Chair Phil Mendelson, who is running unopposed in the primary. Also endorsed is D.C. Councilmember Robert White (D-At-Large), who is one of five Democratic candidates competing for the position of D.C. delegate to the U.S. House of Representatives.

D.C. Councilmember Brooke Pinto (D-Ward 2) is among the four candidates competing with White for that pos, and who like White has a strong record of support on LGBTQ issues.

In the At-Large D.C. Council race for which incumbent Anita Bonds is not running for re-election, Capital Stonewall Democrats has endorsed community activist and LGBTQ ally Oye Owolewa in a nine candidate race.    

For the Ward 1 D.C. Council election, in which five LGBTQ supportive candidates are competing, the group did not make an endorsement because none of the candidate received a required 60 percent of the endorsement vote cast by Capital Stonewall Democrats members, according to the group’s former president, Howard Garrett.   

The statement announcing its endorsements shows that it decided to list its “Preferred Ranking” of each of the Ward 1 Democratic candidates as part of the city’s newly implemented ranked choice voting system. It lists gay candidate Miguel Trindade Deramo as first, bisexual candidate Aparna Raj second, Jackie Reyes Yanes third, Rashida Brown fourth, and Terry Lynch fifth.

In the remaining ward Council races, Capital Stonewall Democrats endorsed Councilmember Matt Fruman (D-Ward 3), who is running unopposed for re-election; Councilmember Zachary Parker (D-Ward ), the Council’s only gay member who is being challenged by two opponents; and Councilmember Charles Allen (D-Ward 6), who is running unopposed for re-election.

The group also chose not to make an endorsement in the special election for another At-Lage D.C. Council seat that became vacant when then-Independent Councilmember McDuffie resigned to enable him to run for mayor as a Democrat. Under the city’s Home Rule Charge adopted by Congress, that at large sweat is restricted to a “non-majority party” candidate, meaning a non-Democrat.

The three candidates running for the seat, all Independents, include incumbent Doni Crawford, who was appointed to the seat earlier this year; former D.C. Councilmember Elissa Silverman; and Jacque Patterson. All three have expressed support on LGBTQ related issues.

“The organization’s endorsement process included candidate questionnaires, public forums, and direct voting by active CSD members,” the statement announces its endorsements says. “Each endorsement reflects the collective voice of 173 LGBTQ+ Democrats who voted in the process and are committed to building lasting political power in the District,” according to the statement. “Candidates that reached 60 percent support received the endorsement.”

Garrett, the group’s former president, acknowledged that with nearly all candidates running in D.C. elections expressing strong support for the LGBTQ community, many if not most of the group’s members most likely chose a candidate based on issues other than LGBTQ related issues.

He said he believes Lewis George, who he is supporting and is viewed as a progressive candidate who self-identifies as a Democratic Socialist, compared to McDuffie, who is viewed as a moderate Democrat, captured the group’s endorsement based on the view that she is the best person to lead the city going forward.

“I believe that Capital Stonewall members voted for Janeese Lewis George because we’re tired of the status quo and we need a new, bold leader to not only move or city forward but also to stand up to Donald Trump and his administration,” Garrett told the Washington Blade.

McDuffie’s LGBTQ supporters, including former Capital Stonewall Democrats presidents David Meadows and Kurt Vorndran, have argued that McDuffie’s positions on a wide range of issues, including LGBTQ issues, show him to be the best candidates to lead the city at this time and In future years.

The group’s endorsement of Lewis George comes one week after GLAA DC, a nonpartisan LGBTQ advocacy group, awarded her its highest candidate rating of +10.    

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United Kingdom

UK government makes trans-inclusive conversion therapy ban a legislative priority

King Charles III on Wednesday delivered King’s Speech

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(Photo by Rob Wilson via Bigstock)

King Charles III on Wednesday said a transgender-inclusive ban on so-called conversion therapy in England and Wales is among the British government’s legislative priorities.

“My government will bring forward a bill to speed up remediation for people living in homes with unsafe cladding [Remediation Bill] and a draft bill to ban abusive conversion practices [Draft Conversion Practices Bill],” said Charles in his King’s Speech that he delivered in the British House of Lords.

The government writes the King’s Speech, which outlines its legislative agenda. The British monarch delivers it at Parliament’s ceremonial opening.

“Conversion practices are abuse, and the government will deliver the manifesto commitment to bring forward a trans-inclusive ban on conversion practices,” said the government in an addendum to the speech.

Then-Prime Minister Theresa May’s government in 2018 announced it would “bring forward proposals to end the practice of conversion therapy in the U.K.”

Then-Prime Minister Boris Johnson’s government in 2022 said it would support a ban that did not include gender identity. The decision sparked outrage among British advocacy groups, and prompted them to boycott a government-sponsored LGBTQ conference that was ultimately cancelled.

Prime Minister Keir Starmer’s Labour Party ahead of the 2024 elections included a conversion therapy ban in its manifesto. Charles delivered the King’s Speech against the backdrop of growing calls for Starmer to resign after the Labour Party lost more than 1,000 council seats in local and regional elections that took place on May 7.

Stonewall, a British advocacy group, on April 30 said the government “has failed to meet its own timeline to publish a draft bill to ban conversion practices.”

“We should not have to wait any longer,” said Stonewall CEO Simon Blake in his group’s statement. “Conversion practices are abuse. LGBTQ+ people do not need fixing or changing. They need to hear and feel that government is going to protect their safety and dignity. Not at some random date in the future. No more delays.”

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Commentary

‘Live Your Pride’ is much more than a slogan

Waves Ahead forced to cancel May 17 event in Puerto Rico

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(Courtesy image)

On May 5, I spoke by phone with Wilfred Labiosa, executive director of Waves Ahead, a Puerto Rico-based LGBTQ community organization that for years has provided mental health services, support programs, and safe spaces for vulnerable communities across the island. During our conversation, Labiosa confirmed every concern described in the organization’s public statement announcing the cancellation of “Live Your Pride,” an event scheduled for Sunday in the northwestern municipality of Isabela. But beyond the financial struggles and organizational challenges, what stayed with me most was the emotional weight behind his words. There was pain in his voice while describing what it means to watch spaces like these slowly disappear.

This was not simply the cancellation of a community event.

“Live Your Pride” had been envisioned as a celebration and affirming gathering for LGBTQ older adults and their allies in Puerto Rico. In a society where many LGBTQ elders spent decades hiding parts of themselves in order to survive, spaces like this carry enormous emotional and social significance. They become places where people can finally exist openly, without fear, apology, or shame.

That is why this cancellation matters far beyond Isabela.

What is happening in Puerto Rico cannot be separated from the broader political climate unfolding across the U.S. and its territories, where programs connected to diversity, inclusion, education, mental health, and LGBTQ visibility increasingly find themselves under political attack. These changes do not always arrive through dramatic announcements. More often, they happen quietly. Funding disappears. Community organizations weaken. Safe spaces become harder to sustain. Eventually, the absence itself begins to feel normal.

That normalization is dangerous.

For years, organizations like Waves Ahead have stepped into gaps left behind by institutions and governments, particularly in communities where LGBTQ people continue facing discrimination, social isolation, economic instability, and mental health struggles. Their work has never been limited to organizing events. It has involved accompanying people through loneliness, trauma, rejection, depression, aging, and survival itself.

“Live Your Pride” represented much more than entertainment. It represented visibility for LGBTQ older adults, many of whom survived decades of family rejection, religious exclusion, workplace discrimination, violence, and silence. These are individuals who came of age during years when living openly could cost someone employment, housing, relationships, or personal safety. Many learned to survive by making themselves invisible.

When spaces like this disappear, something deeply human is lost.

A gathering is canceled, yes, but so is an opportunity for healing, connection, recognition, and dignity. For many LGBTQ older adults, especially in smaller municipalities across Puerto Rico, these events are not secondary luxuries. They are reminders that their lives still matter in a society that too often treats aging and queer existence as disposable.

There are still political and religious sectors that portray the rainbow as some kind of ideological threat. But the rainbow does not erase anyone. It illuminates people and stories that society has often tried to ignore. It reflects the lives of young people forced out of their homes, transgender individuals targeted by violence, older adults aging in silence, and families that spent years defending their right to exist openly.

Perhaps that is precisely why the rainbow unsettles some people so deeply.

Its colors expose abandonment, hypocrisy, inequality, and fear. They force societies to confront realities that are easier to ignore than to address honestly. They reveal how fragile human dignity becomes when political agendas decide that certain communities are no longer worthy of protection, funding, or visibility.

The greatest concern here is not solely the cancellation of one event in one Puerto Rican town. The deeper concern is the message quietly taking shape behind decisions like these — the idea that some communities can wait, that some lives deserve fewer resources, and that safe spaces for vulnerable people are expendable during moments of political tension.

History has shown repeatedly how social regression begins. Rarely with one dramatic act. More often through exhaustion, silence, budget cuts, and the slow dismantling of organizations doing essential community work.

Even so, Waves Ahead made one thing clear in its statement. Although “Live Your Pride” has been canceled, the organization will continue providing mental health and community support services through its centers across Puerto Rico. That commitment matters because people do not survive on slogans alone. They survive because somewhere there are still open doors, trained professionals, supportive communities, and people willing to remain present when the world becomes colder and more hostile.

Puerto Rico should pay close attention to what this moment represents. No healthy society is built by weakening the organizations that care for vulnerable people. No government should feel comfortable watching community groups struggle to survive while attempting to provide services and compassion that public institutions themselves often fail to offer.

The rainbow has never been the problem.

The real problem is the discomfort created when its colors force society to confront the wounds, inequalities, and human realities that too many people would rather keep hidden.

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