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.”
Photos
PHOTOS: Helen Hayes Awards
Gay Men’s Chorus, local drag artists have featured performance at ceremony
The 41st Helen Hayes Awards were held at The Anthem on Monday, May 19. Felicia Curry and Mike Millan served as the hosts.
A performance featuring members of the Gay Men’s Chorus of Washington and local drag artists was held at the end of the first act of the program to celebrate WorldPride 2025.
The annual awards ceremony honors achievement in D.C.-area theater productions and is produced by Theatre Washington.
(Washington Blade photos by Michael Key)
District of Columbia
Laverne Cox, Reneé Rapp, Deacon Maccubbin named WorldPride grand marshals
Three LGBTQ icons to lead parade
WorldPride organizers announced Thursday that actress and trans activist Laverne Cox, powerhouse performer Reneé Rapp, and LGBTQ trailblazer Deacon Maccubbin will serve as grand marshals for this year’s WorldPride parade.
The Capital Pride Alliance, which is organizing WorldPride 2025 in Washington, D.C., revealed the honorees in a press release, noting that each has made a unique contribution to the fabric of the LGBTQ community.
Cox made history in 2014 as the first openly transgender person nominated for a Primetime Emmy Award in an acting category for her role in Netflix’s “Orange Is the New Black.” She went on to win a Daytime Emmy in 2015 for her documentary “Laverne Cox Presents: The T Word,” which followed seven young trans people as they navigated coming out.
Rapp, a singer and actress who identifies as a lesbian, rose to prominence as Regina George in the Broadway musical “Mean Girls.” She reprised the role in the 2024 film adaptation and also stars in Max’s “The Sex Lives of College Girls,” portraying a character coming to terms with her sexuality. Rapp has released an EP, “Everything to Everyone,” and an album, “Snow Angel.” She announced her sophomore album, “Bite Me,” on May 21 and is slated to perform at the WorldPride Music Festival at the RFK Festival Grounds.
Deacon Maccubbin, widely regarded as a cornerstone of Washington’s LGBTQ+ history, helped organize D.C.’s first Gay Pride Party in 1975. The event took place outside Lambda Rising, one of the first LGBTQ bookstores in the nation, which Maccubbin founded. For his decades of advocacy and activism, he is often referred to as “the patriarch of D.C. Pride.”
“I am so honored to serve as one of the grand marshals for WorldPride this year. This has been one of the most difficult times in recent history for queer and trans people globally,” Cox said. “But in the face of all the rhetorical, legislative and physical attacks, we continue to have the courage to embrace who we truly are, to celebrate our beauty, resilience and bravery as a community. We refuse to allow fear to keep us from ourselves and each other. We remain out loud and proud.”
“Pride is everything. It is protection, it is visibility, it is intersectional. But most importantly, it is a celebration of existence and protest,” Rapp said.
The three will march down 14th Street for the WorldPride Parade in Washington on June 7.
Congress
House passes reconciliation with gender-affirming care funding ban
‘Big Beautiful Bill’ now heads to the Senate
The Republican-led U.S. House of Representatives on Thursday voted 215-214 for passage of the “One Big Beautiful Bill Act” reconciliation package, which includes provisions that would prohibit the use of federal funds to support gender-affirming care.
But for an 11th hour revision of the bill late Wednesday night by conservative lawmakers, Medicaid and CHIP would have been restricted only from covering treatments and interventions administered to patients younger than 18.
The legislation would also drop requirements that some health insurers must cover gender-affirming care as an “essential health benefit” and force states that currently mandate such coverage to find it independently. Plans could still offer coverage for transgender care but without the EHB classification patients will likely pay higher out of pocket costs.
To offset the cost of extending tax cuts from 2017 that disproportionately benefited the wealthiest Americans, the reconciliation bill contains significant cuts to spending for federal programs like Medicaid and the Supplemental Nutrition Assistance Program.
The Human Rights Campaign criticized House Republicans in a press release and statement by the group’s president, Kelley Robinson:
“People in this country want policies and solutions that make life better and expand access to the American Dream. Instead, anti-equality lawmakers voted to give handouts to billionaires built on the backs of hardworking people — with devastating consequences for the LGBTQ+ community.
“If the cuts to programs like Medicaid and SNAP or resources like Planned Parenthood clinics weren’t devastating enough, House Republicans added a last minute provision that expands its attacks on access to best practice health care to transgender adults.
“This cruel addition shows their priorities have never been about lowering costs or expanding health care access–but in targeting people simply for who they are. These lawmakers have abandoned their constituents, and as they head back to their districts, know this: they will hear from us.”
Senate Republicans are expected to pass the bill with the budget reconciliation process, which would allow them to bypass the filibuster and clear the spending package with a simple majority vote.
Changes are expected as the bill will be reviewed and amended by committees, particularly the Finance Committee, and then brought to the floor for debate — though modifications are expected to focus on Medicaid reductions and debate over state and local tax deductions.
PHOTOS: Helen Hayes Awards
Laverne Cox, Reneé Rapp, Deacon Maccubbin named WorldPride grand marshals
House passes reconciliation with gender-affirming care funding ban
PHOTOS: D.C. Trans Pride
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Looking back at 50 years of Pride in D.C
WorldPride events round-up
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