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.”
State Department
State Department implements anti-trans bathroom policy
Memo notes directive corresponds with White House executive order
The State Department on April 20 announced employees cannot use bathrooms that correspond with their gender identity.
The Daily Signal, a conservative news website, reported the State Department announced the new policy in a memo titled “Updates Regarding Biological Sex and Intimate Spaces, Including Restrooms.”
The State Department has not responded to the Washington Blade’s request for comment on the directive.
“The administration affirms that there are two sexes — male and female — and that federal facilities should operate on this objective and longstanding basis to ensure consistency, privacy, and safety in shared spaces,” State Department spokesperson Tommy Piggot told the Daily Signal. “In line with President Trump’s executive order this provides clear, uniform guidance to the department by grounding policy in biological sex as determined at birth.”
President Donald Trump shortly after he took office in January 2025 issued an executive order that directed the federal government to only recognize two genders: male and female. The sweeping directive also ordered federal government agencies to “effectuate this policy by taking appropriate action to ensure that intimate spaces designated for women, girls, or females (or for men, boys, or males) are designated by sex and not identity.”
The Daily Signal notes the new State Department policy “does not prohibit single-occupancy restrooms.”
National
I’m telling the scared little girl I once was it’s okay to feel free
This week is Lesbian Visibility Week
Uncloseted Media published this article on April 23.
By SOPHIE HOLLAND | At 13 years old, I remember looking in the mirror in my Toronto bathroom and thinking, “Yeah, I’m a lesbian.” At the time, I thought it was a dirty word. Thinking back, it could be because the first time I heard it was when a family member said, “I don’t know what a lesbian is, they are like aliens.”
And although I walked around in camouflage Crocs with a rainbow My Little Pony charm, plaid knee-length shorts and a shark tooth necklace (yes, these are all, in my opinion, stereotypically lesbian apparel!), I didn’t feel like I fit the mold. The longer I thought about it, the worse I felt, so I buried my feelings deep inside.
Now I am 25, and I have been out since I was 22. Three years ago, I never could have imagined that I’d be working for a queer news publication and celebrating Lesbian Visibility Week, an annual event meant to honor and uplift lesbian perspectives and highlight the hardships our community faces. To me, LVW is so important because, frankly, it has been an absolute shit show getting here, to a place where I feel love and joy most days.
I think back to the frustration of constantly being asked, “Do you have a boyfriend?” Of watching princess movies and seeing a broken girl only find herself when her prince charming arrives. I remember listening to music that was always about heterosexual relationships. I remember feeling left out in high school when, one by one, my friends got boyfriends.
I tried the boyfriend, and I tried really hard for it to work at a large detriment to my wellbeing. I brainwashed myself into thinking I was probably bisexual, which I told my closest friends around 16 and unsuccessfully told my parents at the same age. I was probably subconsciously using this as a litmus test of their acceptance and to soothe the anxiety I felt around my sexuality.
Learning to love who I am did not only come from me unraveling my internalized lesbophobia and dissecting the oppressive societal messages of heteronormativity. It came from meeting an awesome community of lesbians and queers. I found people who understood my worldview and who showed me the ropes. I no longer had to stutter over concepts like lesbian loneliness or my frustration with misogynistic straight men.
They all just got it.
Without this community, I am not sure if I could be as warm and confident in myself as I am today.
And while I still experience homophobia, like being spat on while walking with an ex in downtown Toronto or having a stranger yell in my face “Are you fucking lesbians?” in Kensington Market, the joy and love still outweighs the nasty.
So, as the sentimental dyke that I have become, I decided to ask a set of lesbians in my orbit — including my friends as well as Uncloseted staffers, board members and followers — if they would share a little bit about what makes them love being a lesbian. And now, I can share it with all of you. Here they are. Happy LVW!
Timi Sotire
Falling in love with her was a reset. I felt like a kid again, hopeful about the future. We’ve had to overcome many obstacles to be together, but I’d choose her in every lifetime. I was sick with a long-term health condition when we met, and hanging out with Sophia really helped me with my recovery after my surgery.
Bella Sayegh
Being a lesbian is one of the most beautiful things in the world. To be authentically yourself in resistance and joy is so special within the lesbian community.
Parker Wales
When I met Liv, I finally understood why almost every song is about love.
Gillian Kilgour
There is no connection quite as perfect as between lesbians, no one sees me like my lesbians do.
Chyna Price
There’s many things I love about being a lesbian. But here are my top three:
- There’s just a deeper understanding when it comes to being loved by another woman.
- The next one would be the sense of community, especially being a POC masculine-presenting lesbian. I don’t feel like I’m cosplaying as someone else like I felt like I was doing before I came out.
- There’s so much history going back to the 1800s on how we found and fought for our love. That fight makes me proud because it shows me … that we’ve [found] ways to express our love even when it was misunderstood, illegal and deemed as madness.
Hope Pisoni
Before I knew I was a lesbian, romantic relationships seemed suffocating — it felt like everyone would expect me to act my part in the meticulous performance that is heterosexuality. But meeting my spouse and discovering our identities together showed me just how freeing it could be to love without a script to follow.
Leital Molad
It was the joy of watching the New York Sirens defeat the Toronto Sceptres at our first professional women’s hockey game — surrounded by hundreds (maybe thousands?) of cheering lesbians.
Angela Earl
I spent years building a life that looked right. But I never felt settled, and eventually I started asking what would actually make me happy. Coming out was about more than who I love, it was letting go of everything I was told to be. The last few years have felt like coming home to a life that had been waiting for me.
Tali Bray
What I love about being a lesbian is what I love about being in love … the wonder and joy of “oh, this is what it’s supposed to feel like.” I love moving through the world with women.
Izzy Stokes
I didn’t fall in love until I realized that queerness was an option. My queer friends have helped me see so much more than I grew up seeing. I’m so proud of us, and I’m so grateful for my lesbian community.
Nandika Chatterjee
When I met my fiancée is when I started to feel most like myself. That meant loving myself for who I am and embracing my identity as a lesbian. I felt free in a way I have never before. That’s the long and short of it.
Liz Lucking
The love and joy of being a lesbian is getting to live the life I dreamed of but never thought I would get to have!
Reflections
As I read these beautiful entries, it’s not lost on me that we’re still living in a world where lesbians are more likely to struggle with maternity problems, fetishization, and compulsory heterosexuality — not to mention the intersectional pressures of racism from both inside and outside the queer community. That’s part of why, according to a 2024 survey, 22 percent of LGBTQ women have attempted suicide, and 66 percent have sought treatment for trauma.
So if you are a lesbian who isn’t out or doesn’t feel safe, I hope you read this and can glean some hope from these messages. So when you look in the mirror, you know that it’s okay to release the weight — which can feel so heavy — of a heteronormative world.
We still have a long fight until all lesbians can feel safe to be themselves, but this is a community that does not back away from the tough, from the joy, from being loud and from all the other things that it takes to start a small revolution.
Hell yeah, lesbians! Here’s to you.
*I am signing off with my cat on my lap and a pride flag over my head <3.

Cuba
Trans parent charged with kidnapping, allegedly fled to Cuba with child
Cuban authorities helped locate Rose Inessa-Ethington
Federal authorities have charged a transgender woman with kidnapping after she allegedly fled to Cuba with her 10-year-old child.
An affidavit that Federal Bureau of Investigation Special Agent Jennifer Waterfield filed in U.S. District Court for the District of Utah on April 16 notes the child is a “biological male who identifies as a female” and “splits time living with divorced parents who share custody” in Cache County, Utah.
Waterfield notes the child on March 28 “was supposed to be traveling by car to” Calgary, Alberta, “for a planned camping trip with his transgender mother, Rose Inessa-Ethington, Rose’s partner, Blue Inessa-Ethington, and Blue’s 3-year-old child.”
The affidavit notes the group instead flew from Vancouver, British Columbia, to Mexico City on March 29. Waterfield writes the Inessa-Ethingtons and the two children then flew from Mérida, Mexico, to Havana on April 1.
The 10-year-old child called her biological mother on March 28 after they arrived in Canada. The custody agreement, according to the affidavit, required Rose Inessa-Ethington to return the child to her former spouse on April 3.
“Interviews of MV [Minor Victim] 1’s family members provided significant concerns for MV 1’s well-being, as MV 1 was born a male, however, identifies as a female child, which is largely believed to be due to manipulation by Rose Inessa-Ethington,” reads the affidavit. “Concerns exist that MV 1 was transported to Cuba for gender reassignment surgery prior to puberty.”
The affidavit indicates authorities found a note in the Inessa-Ethingtons’ home with “instruction from a mental health therapist located in Washington, D.C., including instruction to send the therapist the $10,000.00 and instructions on gender-affirming medical care for children.”
The affidavit does not identify the specific “mental health therapist” in D.C.
A Utah judge on April 13 ordered Rose Inessa-Ethington to “immediately” return the child to her former spouse. The former spouse also received sole custody.
“Your affiant believes that due to the extensive planning and preparation exhibited by both Rose Inessa-Ethington and Blue Inessa-Ethington to isolate MV 1 and take MV 1 to Havana, Cuba, without notifying or requesting permission from MV 1’s mother indicates they are likely not planning to return to the United States,” wrote Waterfield.
The affidavit notes Cuban authorities found the Inessa-Ethingtons and the child.
A press release the U.S. Attorney’s Office for the District of Utah issued notes the Inessa-Ethingtons “were deported from Cuba” on Monday “with the assistance of the FBI.”
The couple has been charged with International Parental Kidnapping. The Inessa-Ethingtons were arraigned in Richmond, Va., on Monday. The press release notes a federal court in Salt Lake City will soon handle the case.
The New York Times reported the child is now back with their biological mother.
“We are grateful to law enforcement for working swiftly to return the child to the biological mother,” said First Assistant U.S. Attorney Melissa Holyoak of the District of Utah in the press release.
The case is unfolding against the backdrop of increased tensions between Washington and Havana after U.S. forces on Jan. 3 seized now former Venezuelan President Nicolás Maduro and his wife, Cilia Flores.
President Donald Trump shortly after he took office in January 2025 issued an executive order that directed the federal government to only recognize two genders: male and female. A second White House directive banned federally-funded gender-affirming care for anyone under 19.
The U.S. Supreme Court last year in the Skrmetti decision upheld a Tennessee law that bans gender-affirming care for minors.
Cuba’s national health care system has offered free sex-reassignment surgeries since 2008.
Activists who are critical of Mariela Castro, the daughter of former President Raúl Castro who spearheads LGBTQ issues as director of Cuba’s National Center for Sexual Education, have previously told the Washington Blade that access to these procedures is limited. The Blade on Wednesday asked a contact in Havana to clarify whether Cuban law currently allows minors to undergo sex-reassignment surgery.
