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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

Key lifestyle changes can help patients cope with diabetes

Small daily choices make a big difference in one’s health

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Dr. Marcy Oppenheimer (Courtesy photo)

One Tuesday evening after my family finished dinner, I noticed my grandmother sitting on the couch, sweating more than usual. The family room wasn’t hot, and she hadn’t eaten a lot of salty food that day, so seeing her like that made me worry. 

My grandmother, Shirley Mitchell, is a 72-year-old who lives with Type 2 diabetes, and moments like this, when her blood sugar gets dangerously low, can happen without warning. Watching her reach for her glucose tablets reminded me how serious her condition is.

Each day, millions of people living with diabetes face a choice that can either play a role in protecting their health or putting it at risk– namely, what they eat. Nationally, 12 percent of the population lives with diabetes, according to the Centers for Disease Control. In D.C., nine percent of residents are known to have diabetes, with likely many more undiagnosed, said Dr. Marcy Oppenheimer, a family medicine doctor who practices in Northeast D.C. 

“It’s super common, especially as you get older,” she said, estimating that 15 to 20 percent of her patients have diabetes, and another 20 percent have pre-diabetes, where blood sugar is higher than normal but not yet at the level to trigger a diabetes diagnosis. 

What is diabetes?

Diabetes is a long-term condition that affects how the body controls blood sugar. When blood sugar levels are not managed properly, they can rise too high and cause serious damage to the body. This happens when the body does not make enough insulin or cannot use insulin correctly, which means sugar stays in the blood instead of being moved into the body’s cells where it’s needed for energy. 

Having high levels of sugar in the blood over long periods of time causes damage to just about every body system, said Oppenheimer. “It can pretty much cause any part of your body to start failing over the long term, if you have high sugar for a long time.”

While food isn’t the only factor that affects diabetes — genetics play an even bigger role — certain foods can worsen diabetes by spiking the amount of sugar in the blood. 

What foods should you eat if you have diabetes? 

Healthy food choices play a major role in helping people with diabetes manage their condition. Foods such as vegetables, whole grains, lean proteins like fish and chicken, beans, nuts, and healthy fats digest slowly and provide steady energy. These foods help prevent sudden spikes in blood sugar, which are dangerous for people with diabetes. 

Many people with diabetes learn that planning meals, watching portion sizes, and choosing healthier options can make a big difference in how they feel each day.

“I had to slow down and pay attention to what I ate because everything affected my sugar levels,” says Mitchell.  

Even small choices, like drinking a lot of soda or eating too much white bread, can cause blood sugar levels to rise quickly, said Oppenheimer. 

Which foods can increase the risk or harm of diabetes?

Unhealthy food choices like these can seriously harm those with diabetes. Sugary foods such as candies, cake, cookies, and sweetened drinks cause blood sugar to spike quickly. Processed foods, white bread, and fast food are also harmful because they can be high in unhealthy saturated fats and refined carbohydrates. 

When these foods are eaten often, they can lead to weight gain and they make diabetes harder to control and increase the risk of long-term health problems, said Oppenheimer.

Over time, poor eating habits that lead to prolonged high blood sugar can lead to heart disease, nerve damage, kidney problems, and even vision loss.

“Basically, diabetes is an all-body condition or disease, and it just varies from person to person in how it affects you,” said Oppenheimer. “If you have uncontrolled diabetes, it definitely has a negative impact on both your daily life and your long-term health.”

Anyone with diabetes can develop serious complications like blindness — or diabetic retinopathy — and the risk factors are higher for Black, Latino and American Indian or Alaska Native groups, according to the CDC.

What you or a loved one can do to manage diabetes

Mitchell warns others not to ignore the impact of food on their health. “Don’t ignore your health,” she says. “Fix your problems early before they get worse.” 

Making lifestyle changes is key because, after all, diabetes changes your entire lifestyle, says Mitchell. “Walking throughout the day has helped me feel better.” 

Daniel Dow, a middle school coach at Friendship Blow Pierce Elementary & Middle School in Northeast D.C. who also has diabetes agreed with Mitchell. 

“Don’t wait to change your habits, start right away,” he says. “I learned that what I eat before practice affects my sugar for the whole day.” 

Mitchell’s and Dow’s experiences show that small daily choices can make a big difference in one’s health. By paying attention to what you eat and how your body responds, you can prevent problems before they get worse. Starting healthy habits early can help you stay strong, focused, and in control of your well-being.

(This article was written by a student in the journalism program at Bard High School Early College DC. This work is part of a partnership between the Washington Blade Foundation and Youthcast Media Group, funded through the FY26 Community Development Grant from the Office of D.C. Mayor Muriel Bowser.)

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District of Columbia

How Pepper the courthouse dog helps victims of abuse

Reshaping how the legal system balances compassion with procedure

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Abby Stavitsky and Pepper (Courtesy photo)

Deborah Kelly’s blind husband, Alton, was dragged for blocks to his death by a hit-and-run driver who had already plowed into her on Alabama Ave., S.E., in June 2024. 

But her trauma had only just begun. It took 10 months before the driver, Kenneth Trice, Jr., was arrested, and another six months before he was sentenced to just six months behind bars.  

As she heaved and sobbed in the courtroom in November, Kelly had a steady four-legged presence by her side: Pepper the Courthouse Dog, as the black Labrador retriever is known in D.C. Superior Court.

Abby Stavitsky, a former federal prosecutor who now serves as a victims’ advocate, is the owner and handler of nine-year-old Pepper. She says that one of the things that has made Pepper such a great asset in the court in the past six years is the emotional support and comfort she provides to victims.  

“She absorbs all of the feelings and the emotions around her, but she’s very good at handling it,” Stavitsky said. 

Pepper and Stavitsky started working in Magistrate Judge Mary Grace Rook’s courtroom — and now works in Magistrate Judge Janet Albert’s — to provide support for youth who suffer trauma, especially young survivors of commercial sexual exploitation.

These specially trained dogs offer emotional support to trauma victims of all ages. Courthouse dogs can reduce victims’ and witnesses’ anxiety and stress, making it easier for them to provide clear statements in the courtroom, according to a 2019 report in the Criminal Justice Review. 

“Having something to pet and interact with is a distraction that results in victims being calmer when testifying in court,” says Stavitsky. “This gives them an extra level of comfort.” 

What brought Stavitsky and Pepper together

Stavitsky, who spent 25 years as an assistant U.S attorney, handled a lot of victim-based crimes, mostly domestic violence and sex offenses. She was also a dog lover, and once she learned about courthouse dogs and their use, she was inspired.

In 2019, Pepper was given to Stavitsky by a Massachusetts-based organization, NEADS, formerly known as the National Education for Assistance Dog Services. Although Pepper was originally trained to be a service dog, evaluators determined her character was best suited for a courthouse dog.

Pepper now works regularly in various treatment court cases involving juveniles, many of whom have experienced trauma or are involved in the child welfare system. She also sits with victims while they are testifying in a trial.

“She loves people, especially children,” Stavitsky said. “She loves that interaction.”

Courthouse dogs have a long history 

In courthouses across the U.S. specially trained “facility dogs” are becoming an important part of how the justice system supports vulnerable victims and witnesses.

Since the late 1980s, these dogs were used to help trauma survivors and anxious children during testimonies and interviews. The first dog to make an appearance in a courtroom was Sheba, a German shepherd who assisted child sexual abuse victims in the Queens (N.Y.) District Attorney’s Office. Courthouse dogs help them communicate more clearly, especially in these settings that make them anxious and stressed.

Unlike service dogs, courthouse facility dogs are professionally trained through accredited assistance dog organizations and work daily alongside prosecutors, victim advocates, and forensic interviewers. For example, courthouse dogs can have more social interaction, unlike service dogs.

Courthouse dogs’ growing use has prompted state laws and professional guidelines to recognize the dogs as a trauma-informed tool that helps victims participate in the justice process without compromising courtroom fairness.

As more jurisdictions adopt these programs, courthouse dogs are reshaping how the legal system balances compassion with procedure, ensuring that victims’ voices can be heard in environments that might otherwise silence them.

Pepper makes it easy to see why. 

“I really love people, especially kids, and can provide emotional support and comfort during all stages of the court process,” reads the business card Stavitsky hands out with Pepper’s picture. “I’m calm, quiet and can stay in place for several hours.” 

(This article was written by a student in the journalism program at Bard High School Early College DC. This work is part of a partnership between the Washington Blade Foundation and Youthcast Media Group, funded through the FY26 Community Development Grant from the Office of D.C. Mayor Muriel Bowser.)

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Rehoboth Beach

Women’s FEST returns to Rehoboth Beach next week

Golf tournament, mini-concerts, meetups planned for silver anniversary festival

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(Washington Blade file photo by Daniel Truitt)

Women’s+ FEST 2026 will begin on Thursday, April 9 at CAMP Rehoboth Community Center.

The festival will celebrate a remarkable milestone in 2026: its silver anniversary. For 25 years, Women’s+ FEST has brought fun and entertainment for all those on the spectrum of the feminine spirit. There will be a variety of events including a golf tournament, mini-concerts and happy hour meetups.

For more information, visit Camp Rehoboth’s website.

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