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.”
The White House
Report: Grenell wants Russian ambassadorship
Country’s anti-LGBTQ record a reported barrier
Richard Grenell, President Donald Trump’s special envoy for “special missions,” is making it known that he is interested in the Russian ambassadorship.
According to reporting by the Daily Mail, Grenell has “floated” his interest in the role to coworkers, but issues surrounding the former German ambassador’s sexuality have made securing the position more difficult.
“He had an interest in the job — or at least he floated the idea to select colleagues. But Putin’s regime is extremely anti–LGBTQ, so I’m sure they didn’t take that thought too seriously,” one source close to Grenell told the Daily Mail. “That would never happen anyway.”
Grenell has long been one of Trump’s closest allies and was the first openly gay person to hold a Cabinet-level position. He was ousted last month as acting director of the Kennedy Center, a position he had held since Trump reestablished the board to be composed of his political supporters in 2025.
In addition to leading the nation’s cultural arts center, Grenell previously served as the U.S. ambassador to Germany from 2018 to 2020, and as the special presidential envoy for Serbia and Kosovo peace negotiations from 2019 to 2021. He was also a State Department spokesperson to the U.N. under the George W. Bush administration and a Fox News contributor.
Russia has a longstanding history of being anti-LGBTQ.
In 2013, the country passed a law banning any public endorsement of “nontraditional sexual relations” among minors. In December 2022, Putin signed legislation expanding the ban, making it illegal to promote same-sex relationships or suggest that non-heterosexual orientations are “normal” for people of any age, widening censorship across media and public life.
The Russian courts have also supported the restriction of LGBTQ identity in the country. In November 2023, Russia’s Supreme Court granted a request from the Justice Ministry to outlaw the “international LGBT movement” as “extremist,” allowing authorities to criminalize advocacy and potentially prosecute individuals for expressions of LGBTQ+ identity or support.
In addition to LGBTQ rights issues, the war between Russia and Ukraine has become a global concern. Ukraine, which was part of the former Soviet Union, includes the territory known as Crimea, which Russia annexed in 2014. The annexation remains a major point of international dispute over sovereignty. Since 2022, Russia’s large-scale invasion of Ukraine has escalated the conflict, drawing global attention and sanctions while straining U.S.-Russia relations.
The U.S. has spent $188 billion in total related to the war in Ukraine since the Russian invasion in February 2022, according to the Council on Foreign Relations.
The Russian ambassadorship seems to be a difficult role to fill, according to additional information presented by the Daily Mail. With Trump already being seen as relatively positive by Russian President Vladimir Putin, and with close ties to members of his Cabinet and family — like son-in-law Jared Kushner — the ambassadorship is complicated and viewed as less critical than in previous administrations.
“There is no rush to fill that role because it has now been deemed unnecessary,” another source told the U.K.-based publication.
Bob Foresman, a seasoned businessman with decades-long ties to the Kremlin, was reportedly once the frontrunner, according to the Daily Mail. Foresman served as vice chair of UBS Investment Bank and Deputy Chairman of Renaissance Capital between 2006 and 2009, and earlier led investment banking for Russia at Dresdner Kleinwort Wasserstein from 1997 to 2000.
“This is a pattern, especially in the Trump administration — special envoys big–footing the ambassadors,” a source told the Daily Mail. “It is shocking that we are already in April and we don’t have an ambassador to one of the most important countries in the world.”
Politics
Log Cabin Republicans to honor Scott Presler
Event to take place at Capitol Hill Club on Friday
The Log Cabin Republicans, a group representing LGBTQ conservatives and their allies within the Republican Party, is set to honor gay conservative commentator and activist Scott Presler on Friday.
Presler will receive the organization’s 2026 “Game Changer Award” during its Spring Forward Cocktail Reception at the Capitol Hill Club, a private club steps from the U.S. Capitol that regularly hosts Republican political events.
Presler has risen to prominence through a combination of pro-LGBTQ conservative activism, political organizing, and a series of controversial affiliations.
He first gained national attention in 2017 for organizing the “March Against Sharia” rallies across the country. The demonstrations came amid heightened tensions in Portland, Ore., following a deadly attack on a metro train, in which Jeremy Joseph Christian killed two people and injured others after harassing Muslim women for wearing a hijab.
The rallies were organized in partnership with ACT for America, which advocates against what it describes as “the threat of radical Islam” in the U.S. and has been labeled a hate group by the Southern Poverty Law Center. Presler volunteered with the organization for three months.
He has said he was first motivated to “fight Muslim extremism” following the Pulse nightclub massacre, he told NPR, in which a gunman who pledged allegiance to ISIS killed 49 people at an LGBTQ nightclub in Orlando, Fla. The site now serves as a memorial to the victims of the attack.
Born May 15, 1988, in Jacksonville, Fla., Presler is the son of a U.S. Navy captain and was raised in both Florida and Fairfax County. He later attended George Mason University, where he earned a degree in criminal justice.
In addition to his anti-Islam activism, Presler has been involved in a number of other high-profile and controversial efforts. He co-founded “Gays for Trump” and attended their 2017 DeploraBall in Maryland for the first inauguration of Trump. According to a 2021 report from Media Matters for America, he also promoted the QAnon conspiracy movement through social media posts in 2018 and 2019.
He has also faced criticism tied to his early political work. According to a 2023 report from Politico Playbook, Presler’s work with the Republican Party of Virginia in 2016 ended after he allegedly engaged in sexual activity in a shared office space and posted explicit images online.
Beyond ideological activism, Presler has also organized community-focused initiatives. In 2019, he led a widely publicized cleanup effort in Baltimore that drew more than 100 volunteers and resulted in approximately 29 tons of trash being removed. The event was a result of criticism from President Donald Trump, calling the area, represented by then-U.S. Rep. Elijah Cummings (D-Md.) a “rodent infested mess.”
Presler has also been active in election-related organizing, leading a two-day “Stop the Steal” demonstration at the Pennsylvania State Capitol following the 2020 presidential election. He has appeared on the “War Room” podcast hosted by former Trump strategist and well-known right-wing populist conspiracy theorist Steve Bannon.
He has also expressed a controversial stance within the LGBTQ community for supporting then-candidate Trump for President over Hillary Clinton. He told prioritizing Second Amendment rights over certain LGBTQ policy goals, saying he is more supportive of gun rights than efforts to codify same-sex marriage, and adding, “I 100 percent believe in the notion that armed gays don’t get bashed. It is our right to feel safe.”
Presler voiced his support for the Florida Parental Rights in Education Act, more commonly referred to as the “Don’t Say Gay” law, signed into law by Republican Gov. Ron DeSantis in 2022.
Cuba
Cuba bajo presión y sin respuestas
Cubanos no hablan en términos geopolíticos. Hablan de sobrevivir
Las tensiones entre Estados Unidos y Cuba han vuelto a subir de tono. No es algo nuevo, pero este momento se siente distinto. Las medidas más recientes desde Washington buscan cerrar aún más los espacios financieros del gobierno cubano, limitar sus fuentes de ingreso y presionar sectores clave de la economía. No es simbólico. Es una política directa.
Desde Estados Unidos, el mensaje es claro. Se busca provocar cambios que no han ocurrido en más de seis décadas. También hay un componente interno, una presión política que responde a sectores del exilio que llevan años exigiendo una postura más dura. Todo eso forma parte del escenario.
Pero esa es solo una parte.
Del lado cubano, la respuesta sigue un patrón conocido. El gobierno habla de agresión externa, de guerra económica, de un embargo que se endurece. Cada medida se convierte en argumento para reforzar su narrativa y cerrar filas. No hay espacio para reconocer errores propios. Todo apunta hacia afuera.
Mientras tanto, la vida en la isla va por otro camino.
La crisis energética que hoy vive Cuba no empezó con estas medidas. Lleva años acumulándose. El sistema eléctrico está deteriorado, sin mantenimiento suficiente, con fallas constantes. Los apagones no son nuevos. Lo que ha cambiado es la frecuencia y la duración.
Durante años entró petróleo a Cuba, especialmente desde Venezuela. Hubo acuerdos. Hubo suministro. Y aun así, la vida del cubano no mejoró. La electricidad seguía fallando, el combustible seguía racionado, el transporte seguía siendo un problema diario.
Entonces la pregunta sigue siendo la misma.
Si el petróleo estaba entrando, ¿por qué nada cambiaba?
¿Dónde fue a parar ese recurso?
¿Dónde está el dinero que generó?
Hoy se habla de restricciones al petróleo como si fueran la causa principal de la crisis. No lo son. Empeoran una situación ya frágil, pero no la explican completamente.
Hay una historia más larga que no se puede ignorar.
Lo mismo ocurre con las brigadas médicas.
Durante años se presentaron como un gesto de solidaridad internacional. Y en muchos casos lo fueron. Médicos cubanos trabajaron en condiciones difíciles, salvaron vidas, sostuvieron sistemas de salud en otros países. Eso es real.
Pero también funcionaron como una de las principales fuentes de ingreso del Estado cubano.
Muchos de esos profesionales no recibían el salario completo por su trabajo. Una parte significativa quedaba en manos del gobierno. En algunos casos, ni siquiera tenían control sobre el dinero que generaban.
Y hay algo más duro.
Si uno de esos médicos decidía no regresar a Cuba, ese dinero no llegaba a su familia. Se quedaba retenido.
Hoy varios países están revisando o cancelando esos acuerdos. Y otra vez, la respuesta oficial es señalar hacia afuera. Pero la pregunta sigue siendo inevitable.
¿Se está perdiendo un modelo de cooperación o un sistema que dependía del control sobre sus propios profesionales?
Dentro de Cuba, la conversación suena diferente.
La gente no habla en términos geopolíticos. Habla de sobrevivir. De cómo llegar al final del día. De los apagones, de la comida que no alcanza, del transporte que no aparece, de una vida que cada vez se hace más difícil.
Hay quienes miran las medidas de Estados Unidos con cierta expectativa. No porque quieran más escasez, sino porque sienten que el sistema no cambia por sí solo. Hay una sensación de estancamiento que pesa.
Pero esa expectativa convive con una realidad concreta.
Las sanciones no golpean primero a quienes toman decisiones. Golpean al ciudadano común. Al que hace la fila. Al que pierde la comida por falta de electricidad. Al que no tiene cómo moverse.
Esa es la contradicción.
El gobierno cubano pide solidaridad internacional. Y la recibe. Países que envían ayuda, organizaciones que se movilizan, voces que defienden a la isla.
Pero hay otra pregunta que también está ahí.
¿Esa ayuda llega realmente al pueblo?
La falta de transparencia en la distribución de recursos es parte del problema. Porque no se trata solo de lo que entra, sino de lo que realmente llega a quienes lo necesitan.
Reducir lo que pasa en Cuba a un conflicto entre dos gobiernos es no querer ver el cuadro completo.
Aquí hay responsabilidades compartidas, pero no iguales.
Estados Unidos ejerce presión con efectos reales sobre la economía cubana. Eso no se puede negar. Pero dentro de la isla hay un sistema que ha tenido décadas para corregir, para abrir, para responder a su gente, y no lo ha hecho.
Esa parte no se puede seguir esquivando.
Yo escribo esto como cubano. Desde lo que vi, desde lo que viví y desde la gente que sigue allá tratando de resolver el día.
Porque al final, más allá de lo que se diga entre gobiernos, la realidad es otra.
Cuba hoy está más apretada, sí. Pero también lleva años arrastrando problemas que nadie ha querido enfrentar de verdad.
Y mientras eso siga así, da igual lo que venga de afuera. El problema sigue estando adentro.
Report: Grenell wants Russian ambassadorship
Log Cabin Republicans to honor Scott Presler
Cuba bajo presión y sin respuestas
Tenn. lawmakers pass transgender “watch list” bill
