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
Mayor Bowser signs bill requiring insurers to cover PrEP
‘This is a win in the fight against HIV/AIDS’
D.C. Mayor Muriel Bowser on March 20 signed a bill approved by the D.C. Council that requires health insurance companies to cover the costs of HIV prevention or PrEP drugs for D.C. residents at risk for HIV infection.
Like all legislation approved by the Council and signed by the mayor, the bill, called the PrEP D.C. Amendment Act, was sent to Capitol Hill for a required 30-day congressional review period before it takes effect as D.C. law.
Gay D.C. Council member Zachary Parker (D-Ward 5) last year introduced the bill.
Insurance coverage for PrEP drugs has been provided through coverage standards included in the Affordable Care Act, known as Obamacare. But AIDS advocacy organizations have called on states and D.C. to pass their own legislation requiring insurance coverage of PrEP as a safeguard in case federal policies are weakened or removed by the Trump administration, which has already reduced federal funding for HIV/AIDS-related programs.
Like legislation passed by other states, the PrEP D.C. Amendment Act requires insurers to cover all PrEP drugs approved by the U.S. Food and Drug Administration.
Studies have shown that PrEP drugs, which can be taken as pills or by injection just twice a year, are highly effective in preventing HIV infection.
“I think this is a win for our community,” Parker said after the D.C. Council voted unanimously to approve the bill on its first vote on the measure in February. “And this is a win in the fight against HIV/AIDS.”
Vice President JD Vance and his wife, second lady Usha Vance, will visit Hungary next week.
An announcement the White House released on Thursday said the Vances will be in Budapest, the Hungarian capital, from April 7-8.
JD Vance “will hold bilateral meetings with” Hungarian Prime Minister Viktor Orbán. The announcement further indicates the vice president “will also deliver remarks on the rich partnership between the United States and Hungary.”
The Vances will travel to Hungary less than a week before the country’s parliamentary elections take place on April 12.
Orbán, who has been in office since 2010, and his Fidesz-KDNP coalition government have faced widespread criticism over its anti-LGBTQ crackdown.
The Associated Press notes polls indicate Orbán is trailing Péter Magyar and his center-right Tisza party.
President Donald Trump removed Attorney General Pam Bondi from her post Thursday, following growing criticism over how she and the Department of Justice handled a range of issues, including matters related to sex offender and Trump ally Jeffrey Epstein.
Trump announced Bondi’s removal on Truth Social, where he also said Todd Blanche will serve as acting head of the Justice Department.
“Pam Bondi is a great American patriot and a loyal friend, who faithfully served as my attorney general over the past year,” Trump wrote on the platform. “Pam did a tremendous job overseeing a massive crackdown on crime across our country, with murders plummeting to their lowest level since 1900.”
Trump was seen as recently as Wednesday with the now-former attorney general at a Supreme Court hearing on citizenship.
The decision contrasts with Trump’s previous public praise of Bondi, the 87th U.S. attorney general and former 37th attorney general of Florida, who served in that role from 2011-2019 before joining the Trump-Vance administration. He has frequently lauded her loyalty and said he speaks with her often. Bondi was also one of president’s defense lawyers during his first impeachment trial.
Privately, however, Trump had grown frustrated that Bondi was not “moving quickly enough” to prosecute critics and political adversaries he wanted to face criminal charges, according to multiple sources. The New York Times reported that her inability to charge former FBI Director James B. Comey and New York Attorney General Letitia James with any crimes is a large factor in the president’s choice to fire her from the government’s primary law enforcement agency.
The move comes as Trump has sought to minimize public turmoil within his administration, avoiding the perception of a revolving-door Cabinet that defined his first term.
Lee Zeldin, a former Republican congressman from New York who unsuccessfully ran for governor, has emerged as a leading contender to lead the Justice Department. He has been one of Trump’s most reliable allies.
“He’s our secret weapon,” Trump said of Zeldin in February during a White House event promoting the coal industry, adding, “He’s getting those approvals done in record-setting time.”
Bondi has also growing faced scrutiny from Congress.
The House Oversight Committee recently subpoenaed her to testify about the department’s handling of certain files, where she declined to answer key questions during a contentious House Judiciary Committee hearing in February.
The Tampa native has a long history of opposing LGBTQ rights through her roles in government. As Florida attorney general, she fought against the legalization of same-sex marriage, arguing it would cause “serious public harm,” pushing forward a legal battle that cost taxpayers nearly half a million dollars. She also asked the Florida Supreme Court to overturn a lower court ruling that found the state’s same-sex marriage ban unconstitutional.
More recently, Bondi established a “Title IX Special Investigations Team” within the Justice Department focused on restricting transgender women and girls from participating in women’s and girls’ sports teams and accessing facilities aligned with their gender identity. She also told Children’s Hospital of Philadelphia to turn over the medical records of anyone under 19 who received gender-affirming care.
Her removal follows Trump’s decision last month to oust another controversial female Cabinet figure, Kristi Noem.
Mayor Bowser signs bill requiring insurers to cover PrEP
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