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
How Pepper the courthouse dog helps victims of abuse
Reshaping how the legal system balances compassion with procedure
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.)
Rehoboth Beach
Women’s FEST returns to Rehoboth Beach next week
Golf tournament, mini-concerts, meetups planned for silver anniversary festival
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.
Belarus
Belarusian lawmakers approve bill to crackdown on LGBTQ rights
Country’s president known as ‘Europe’s last dictator’
Lawmakers in Belarus on Thursday approved a bill that would allow the government to crack down on LGBTQ advocacy.
The Associated Press notes the bill would punish anyone found guilty of “propaganda of homosexual relations, gender change, refusal to have children, and pedophilia” with fines, community labor, and 15 days in jail.
The House of Representatives, the lower house of the Belarusian National Assembly, last month approved the bill. The Council of the Republic, which is the parliament’s upper chamber, passed it on Thursday.
President Alexander Lukashenko is expected to sign it.
Belarus borders Poland, Ukraine, Russia, Latvia, and Lithuania. Lukashenko — known as “Europe’s last dictator” is a close ally of Russian President Vladimir Putin.
Kazakhstan is among the countries that have enacted Russian-style anti-LGBTQ propaganda laws in recent years.
Vika Biran, a Belarusian LGBTQ activist, is among those arrested during anti-Lukashenko protests that took place in 2020 after he declared victory in the country’s presidential election.
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