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.”
Ecuador
Justicia reconoce delito de odio en caso de bullying en Instituto Nacional Mejía de Ecuador
Johana B se suicidó el 11 de abril de 2023
A casi tres años del suicidio de Johana B., quien estudió en el Instituto Nacional Mejía, colegio emblemático de Quito, el Tribunal de la Corte Nacional de Justicia ratificó la condena para el alumno responsable del acoso escolar que la llevó a quitarse la vida.
Según información de la Fiscalía, el fallo de última instancia deja en firme la condena de cuatro años de internamiento en un centro para adolescentes infractores, en una audiencia de casación pedida por la defensa del agresor, tres meses antes de que prescriba el caso.
Con la sentencia, este caso es uno de los primeros en el país en reconocer actos de odio por violencia de género, delito tipificado en el artículo 177 del Código Orgánico Penal Integral (COIP).
El suicidio de Johana B. ocurrió el 11 abril de 2023 y fue consecuencia del acoso escolar por estereotipos de género que enfrentó la estudiante por parte de su agresor, quien constantemente la insultaba y agredía por su forma de vestir, llevar el cabello corto o practicar actividades que hace años se consideraban exclusivamente para hombres, como ser mando de la Banda de Paz en el Instituto Nacional Mejía.
Desde la muerte de Johana, su familia buscaba justicia. Su padre, José, en una entrevista concedida a edición cientonce para la investigación periodística Los suicidios que quedan en el clóset a causa de la omisión estatal afirmó que su hija era acosada por su compañero y otres estudiantes con apodos como “marimacha”, lo que también fue corroborado en los testimonios recogidos por la Unidad de Justicia Juvenil No. 4 de la Fiscalía.
Los resultados de la autopsia psicológica y del examen antropológico realizados tras la muerte de Johana confirmaron las versiones de sus compañeras y docentes: que su agresor la acosó de manera sistemática durante dos años. Los empujones, jalones de cabello o burlas, incluso por su situación económica, eran constantes en el aula de clase.
La violencia que recibió Johana escaló cuando su compañero le dio un codazo en la espalda ocasionándole una lesión que le imposibilitó caminar y asistir a clases.
Días después del hecho, la adolescente se quitó la vida en su casa, tras escuchar que la madre del agresor se negó a pagar la mitad del valor de una tomografía para determinar la lesión en su espalda, tal como lo había acordado previamente con sus padres y frente al personal del DECE (Departamento de Consejería Estudiantil del colegio), según versiones de su familia y la Fiscalía.
#AFONDO | Johana se suicidó el 11 de abril de 2023, tras ser víctima de acoso escolar por no cumplir con estereotipos femeninos 😢.
Dos semanas antes, uno de sus compañeros le dio un codazo en la espalda, ocasionándole una lesión que le imposibilitó caminar 🧵 pic.twitter.com/bXKUs9YYOm
— EdicionCientonce (@EdCientonce) September 3, 2025
“Era una chica linda, fuerte, alegre. Siempre nos llevamos muy bien, hemos compartido todo. Nos dejó muchos recuerdos y todos nos sentimos tristes; siempre estamos pensando en ella. Es un vacío tan grande aquí, en este lugar”, expresó José a Edición Cientonce el año pasado.
Para la fiscal del caso y de la Unidad de Justicia Juvenil de la Fiscalía, Martha Reino, el suicidio de la adolescente fue un agravante que se contempló durante la audiencia de juzgamiento de marzo de 2024, según explicó a este medio el año pasado. Desde entonces, la familia del agresor presentó un recurso de casación en la Corte Nacional de Justicia, que provocó la dilatación del proceso.
En el fallo de última instancia, el Tribunal también dispuso que el agresor pague $3.000 a la familia de Johana B. como reparación integral. Además, el adolescente deberá recibir medidas socioeducativas, de acuerdo al artículo 385 del Código Orgánico de la Niñez y Adolescencia, señala la Fiscalía.
El caso de Johana también destapó las omisiones y negligencias del personal del DECE y docentes del Instituto Nacional Mejía. En la etapa de instrucción fiscal se comprobó que no se aplicaron los protocolos respectivos para proteger a la víctima.
De hecho, la Fiscalía conoció el caso a raíz de la denuncia que presentó su padre, José, y no por el DECE, aseguró la fiscal el año pasado a Edición Cientonce.
Pese a estas omisiones presentadas en el proceso, el fallo de última instancia sólo ratificó la condena para el estudiante.
U.S. Military/Pentagon
4th Circuit rules against discharged service members with HIV
Judges overturned lower court ruling
A federal appeals court on Wednesday reversed a lower court ruling that struck down the Pentagon’s ban on people with HIV enlisting in the military.
The conservative three-judge panel on the 4th U.S. Circuit Court of Appeals overturned a 2024 ruling that had declared the Defense Department and Army policies barring all people living with HIV from military service unconstitutional.
The 4th Circuit, which covers Maryland, North Carolina, South Carolina, Virginia, and West Virginia, held that the military has a “rational basis” for maintaining medical standards that categorically exclude people living with HIV from enlisting, even those with undetectable viral loads — meaning their viral levels are so low that they cannot transmit the virus and can perform all duties without health limitations.
This decision could have implications for other federal circuits dealing with HIV discrimination cases, as well as for nationwide military policy.
The case, Wilkins v. Hegseth, was filed in November 2022 by Lambda Legal and other HIV advocacy groups on behalf of three individual plaintiffs who could not enlist or re-enlist based on their HIV status, as well as the organizational plaintiff Minority Veterans of America.
The plaintiffs include a transgender woman who was honorably discharged from the Army for being HIV-positive, a gay man who was in the Georgia National Guard but cannot join the Army, and a cisgender woman who cannot enlist in the Army because she has HIV, along with the advocacy organization Minority Veterans of America.
Isaiah Wilkins, the gay man, was separated from the Army Reserves and disenrolled from the U.S. Military Academy Preparatory School after testing positive for HIV. His legal counsel argued that the military’s policy violates his equal protection rights under the Fifth Amendment’s Due Process Clause.
In August 2024, a U.S. District Court sided with Wilkins, forcing the military to remove the policy barring all people living with HIV from joining the U.S. Armed Services. The court cited that this policy — and ones like it that discriminate based on HIV status — are “irrational, arbitrary, and capricious” and “contribute to the ongoing stigma surrounding HIV-positive individuals while actively hampering the military’s own recruitment goals.”
The Pentagon appealed the decision, seeking to reinstate the ban, and succeeded with Wednesday’s court ruling.
Judge Paul V. Niemeyer, one of the three-judge panel nominated to the 4th Circuit by President George H. W. Bush, wrote in his judicial opinion that the military is “a specialized society separate from civilian society,” and that the military’s “professional judgments in this case [are] reasonably related to its military mission,” and thus “we conclude that the plaintiffs’ claims fail as a matter of law.”
“We are deeply disappointed that the 4th Circuit has chosen to uphold discrimination over medical reality,” said Gregory Nevins, senior counsel and employment fairness project director for Lambda Legal. “Modern science has unequivocally shown that HIV is a chronic, treatable condition. People with undetectable viral loads can deploy anywhere, perform all duties without limitation, and pose no transmission risk to others. This ruling ignores decades of medical advancement and the proven ability of people living with HIV to serve with distinction.”
“As both the 4th Circuit and the district court previously held, deference to the military does not extend to irrational decision-making,” said Scott Schoettes, who argued the case on appeal. “Today, servicemembers living with HIV are performing all kinds of roles in the military and are fully deployable into combat. Denying others the opportunity to join their ranks is just as irrational as the military’s former policy.”
New York
Lawsuit to restore Stonewall Pride flag filed
Lambda Legal, Washington Litigation Group brought case in federal court
Lambda Legal and Washington Litigation Group filed a lawsuit on Tuesday, challenging the Trump-Vance administration’s removal of the Pride flag from the Stonewall National Monument in New York earlier this month.
The suit, filed in the U.S. District Court for the Southern District of New York, asks the court to rule the removal of the Pride flag at the Stonewall National Monument is unconstitutional under the Administrative Procedures Act — and demands it be restored.
The National Park Service issued a memorandum on Jan. 21 restricting the flags that are allowed to fly at National Parks. The directive was signed by Trump-appointed National Park Service Acting Director Jessica Bowron.
“Current Department of the Interior policy provides that the National Park Service may only fly the U.S. flag, Department of the Interior flags, and the Prisoner of War/Missing in Action flag on flagpoles and public display points,” the letter from the National Park Service reads. “The policy allows limited exceptions, permitting non-agency flags when they serve an official purpose.”
That “official purpose” is the grounds on which Lambda Legal and the Washington Litigation Group are hoping a judge will agree with them — that the Pride flag at the Stonewall National Monument, the birthplace of LGBTQ rights movement in the U.S., is justified to fly there.
The plaintiffs include the Gilbert Baker Foundation, Charles Beal, Village Preservation, and Equality New York.
The defendants include Interior Secretary Doug Burgum; Bowron; and Amy Sebring, the Superintendent of Manhattan Sites for the National Park Service.
“The government’s decision is deeply disturbing and is just the latest example of the Trump administration targeting the LGBTQ+ community. The Park Service’s policies permit flying flags that provide historical context at monuments,” said Alexander Kristofcak, a lawyer with the Washington Litigation Group, which is lead counsel for plaintiffs. “That is precisely what the Pride flag does. It provides important context for a monument that honors a watershed moment in LGBTQ+ history. At best, the government misread its regulations. At worst, the government singled out the LGBTQ+ community. Either way, its actions are unlawful.”
“Stonewall is the birthplace of the modern LGBTQ+ rights movement,” said Beal, the president of the Gilbert Baker Foundation. The foundation’s mission is to protect and extend the legacy of Gilbert Baker, the creator of the Pride flag.
“The Pride flag is recognized globally as a symbol of hope and liberation for the LGBTQ+ community, whose efforts and resistance define this monument. Removing it would, in fact, erase its history and the voices Stonewall honors,” Beal added.
The APA was first enacted in 1946 following President Franklin D. Roosevelt’s creation of multiple new government agencies under the New Deal. As these agencies began to find their footing, Congress grew increasingly worried that the expanding powers these autonomous federal agencies possessed might grow too large without regulation.
The 79th Congress passed legislation to minimize the scope of these new agencies — and to give them guardrails for their work. In the APA, there are four outlined goals: 1) to require agencies to keep the public informed of their organization, procedures, and rules; 2) to provide for public participation in the rule-making process, for instance through public commenting; 3) to establish uniform standards for the conduct of formal rule-making and adjudication; and 4) to define the scope of judicial review.
In layman’s terms, the APA was designed “to avoid dictatorship and central planning,” as George Shepherd wrote in the Northwestern Law Review in 1996, explaining its function.
Lambda Legal and the Washington Litigation Group are arguing that not only is the flag justified to fly at the Stonewall National Monument, making the directive obsolete, but also that the National Park Service violated the APA by bypassing the second element outlined in the law.
“The Pride flag at the Stonewall National Monument honors the history of the fight for LGBTQ+ liberation. It is an integral part of the story this site was created to tell,” said Lambda Legal Chief Legal Advocacy Officer Douglas F. Curtis in a statement. “Its removal continues the Trump administration’s disregard for what the law actually requires in their endless campaign to target our community for erasure and we will not let it stand.”
The Washington Blade reached out to the NPS for comment, and received no response.
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