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
‘No Kings’ protests set for D.C.
Anti-Trump demonstrations to take place across country on Saturday
As President Donald Trump and his administration escalate rhetoric targeting transgender youth and student athletes, push efforts to restrict voting access for millions of Americans, and pursue foreign policy decisions that critics say bypass congressional authority, organizers across the country are once again mobilizing in protest.
For many LGBTQ advocates, the moment feels especially urgent.
In recent months, activists have pointed to a surge in anti-trans legislation, attacks on gender-affirming care, and efforts to roll back nondiscrimination protections as direct threats to the safety and visibility of queer and trans communities. Organizers say the demonstrations are not just about policy, but about defending the right of LGBTQ people — particularly trans youth and people of color — to live openly and safely.
Thousands of “No Kings” protests are planned nationwide, with multiple demonstrations set to take place in D.C.
One of the primary events, “No Kings Washington,” will be held in Anacostia, an overwhelmingly Black area of D.C. that is often at the center of conversations around racial justice, policing, and access to resources in the nation’s capital.
The protest in Anacostia is focused on what organizers describe as the “power behind the throne,” specifically Stephen Miller, the White House Deputy Chief of Staff for Policy and Homeland Security Advisor. Miller has been closely associated with the administration’s “zero tolerance” immigration policy, including the family separation practice that resulted in thousands of children being separated from their parents at the Southern border.
Activists have also linked immigration enforcement policies to broader concerns about LGBTQ migrants, including queer asylum seekers who often face heightened risks of violence and discrimination both in their home countries and within detention systems.
Anacostia protest details:
Participants are asked to gather starting at 1:30 p.m. on the southeast side of the Frederick Douglass Bridge. The closest Metro station is Anacostia on the Green Line, about an 8-minute walk from the starting point. Organizers strongly encourage attendees to use public transportation, as street parking is limited.
The march will proceed past Fort McNair and conclude near the Waterfront Metro station.
D.C. icon and LGBTQ activist Rayceen Pendarvis is set to speak at the protest around 2 p.m.
Kalorama protest details:
A separate protest will take place earlier in the day in Kalorama, a neighborhood long associated with political power and home to presidents, cabinet officials, and foreign ambassadors. Demonstrators are expected to gather at 10 a.m., with a march running until approximately noon near the intersection of Connecticut Avenue and Kalorama Road.
Arlington/National Mall protest details:
Another group is expected to assemble at Memorial Circle near Arlington National Cemetery at 10 a.m. before crossing the Memorial Bridge into D.C., passing the Lincoln Memorial and continuing on to the Washington Monument. Organizers say the march is intended to defend “American democracy, the rule of law, and a healthy planet.”
Unlike last June — when organizers discouraged large-scale demonstrations in D.C. due Trump’s military/birthday parade — activists are now explicitly calling on people to show up in the nation’s capital and surrounding areas.
The protests also coincide with Transgender Day of Visibility weekend, which includes additional gatherings and celebrations on the National Mall. At the same time, peak bloom for the National Cherry Blossom Festival is expected to draw large crowds to the city. With multiple major events happening simultaneously, officials and organizers anticipate significant congestion, increased traffic, and crowded public transit throughout the weekend.
Organizers are urging participants to plan ahead and come prepared.
“Bring your signs, noisemakers, music, and creative ideas, and gather in joyful, nonviolent protest,” they said. “Children are very welcome.”
For more information, visit nokings.org.
Pennsylvania
Pa. House passes bill to codify marriage equality in state law
Governor supports gay state Rep. Malcolm Kenyatta’s measure
The Pennsylvania House of Representatives on Wednesday passed a bill that would codify marriage equality in state law.
House Bill 1800 passed by a 127-72 vote margin. Twenty-six Republicans voted for the measure.
The Republican-controlled Pennsylvania Senate will now consider the bill that state Rep. Malcolm Kenyatta (D-Philadelphia), who is the first openly gay person of color elected to the state’s General Assembly, introduced. Democratic Gov. Josh Shapiro supports the measure.
“Here in Pennsylvania, we believe in your freedom to marry who you love,” said Shapiro on Wednesday. “Today, the House has stepped up to protect that right.”
BREAKING: The Pennsylvania House just passed @RepKenyatta's bill to codify marriage equality into law in PA — and they did it with broad bipartisan support.
— Governor Josh Shapiro (@GovernorShapiro) March 25, 2026
Here in Pennsylvania, we believe in your freedom to marry who you love. Today, the House has stepped up to protect that…
Florida
DeSantis signs emergency bill that restores Fla. ADAP funding
Temporary funds to last through June 30
After the Florida Department of Health made huge cuts to the AIDS Drug Assistance Program in January, Republican Gov. Ron DeSantis has signed emergency legislation restoring HIV access to more than 12,000 Floridians.
Two months ago, as the Washington Blade reported, the Sunshine State cut the vast majority of those in ADAP by shifting the income levels required for eligibility — without following standard procedure when changing government policy outside of legislative or executive action.
The bill, signed by DeSantis on Tuesday, passed both chambers of the Florida Legislature unanimously and appropriates $30.9 million in emergency bridge funding through June 30, 2026. It restores Florida’s ADAP income eligibility to 400 percent of the Federal Poverty Level — the level it was prior to the January cuts. The legislation also requires the FDOH to submit detailed monthly financial reports to legislative leadership beginning April 1.
Under the old policy, eligibility would have been limited to those making no more than 130 percent of the federal poverty level, or $20,345 per year.
“For 10 weeks, 12,000 Floridians living with HIV did not know if they could fill their next prescription. Today, they can,” Esteban Wood, director of advocacy and legislative affairs at AIDS Healthcare Foundation, said in a statement.
The detailed reports now required to be sent to legislative leadership must include all federal revenues and expenditures, including manufacturer rebates; enrollment figures by county and insurance status; prescription utilization by drug class; and any projected funding shortfalls. This is the first time the Legislature has required this level of financial transparency from the program.
DeSantis signed the legislation one day after a Leon County Circuit Court judge denied AIDS Healthcare Foundation’s request for an injunction to block the significant changes the DeSantis administration is making to the program, which it claims faces a $120 million shortfall for calendar year 2026.
AIDS Healthcare Foundation, a national organization focused on protecting and expanding HIV healthcare access and prevention methods, filed a lawsuit over the change in eligibility, arguing the Florida Department of Health did not follow the laid out path for formally changing policy and was acting outside established procedures.
Typically, altering eligibility for a statewide program requires either legislative action or adherence to a multistep rule-making process, including: publishing a Notice of Proposed Rule; providing a statement of estimated regulatory costs; allowing public comment; holding hearings if requested; responding to challenges; and formally adopting the rule. According to AIDS Healthcare Foundation, none of these steps occurred.
The long-term structure of ADAP will be determined by the 2026–2027 fiscal year state budget, something that lawmakers have until June 30 to finish.
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