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
Trump tells Fox News he won the ‘gay vote’ — but polls tell a different story
Trump falsely claims LGBTQ support on Fox despite polling showing overwhelming opposition.
President Donald Trump claimed he won the “gay vote” in 2024, despite evidence showing otherwise.
While appearing by phone on Fox News’s panel show “The Five” on Thursday, Trump falsely claimed he performed particularly well among gay voters while discussing the ongoing war in Iran — a conflict he initiated without formal congressional approval.
“Now I think I did very well with the gay vote, OK? I even played the gay national anthem as my walk-off, OK?” Trump said on air.
“And I think it probably helped me. But I did great. No Republican’s ever gotten the gay vote like I did and I’m very proud of it, I think it’s great. Perhaps it’s because I’m from New York City, I don’t know…”
His claim contradicts 2024 polling from NBC News, which found that the GOP presidential ticket captured fewer than 1 in 5 LGBTQ male voters — a figure that may also include bisexual and transgender men. Trump’s support among LGBTQ female voters was even lower, at just 8%.
White LGBTQ voters favored Vice President Kamala Harris over Trump by a margin of 82% to 16%, while LGBTQ voters of color backed Harris by an even wider 91% to 5%.
Trump also used the appearance to criticize “Gays for Palestine,” saying: “Look at ‘Gays for Palestine’… they kill gays, they kill them instantly, they throw them off buildings, and I’m saying, ‘Who are the gays for Palestine?’”
He further pointed to his campaign’s use of the song “Y.M.C.A.” by the Village People — which he has repeatedly described as a “gay national anthem” — noting that it was frequently used as a walk-off song at rallies, as an indication that he and his campaign were supported by the gay community. The track, long associated with camp and hyper-masculine gay imagery, became a staple of Trump campaign events.
The Village People were later booked to perform at Turning Point USA’s inaugural ball celebrating Trump’s second inauguration. Lead singer Victor Willis previously criticized Trump’s use of the song dating back to 2020 and considered legal action to block it, but ultimately said there was “not much he can do about it.” He later acknowledged the renewed exposure was “beneficial” and “good for business,” boosting the song’s popularity and chart performance.
Despite Trump’s claims of strong support from gay voters, polling has consistently shown otherwise — even as several prominent gay men have held roles in or around his orbit, sometimes dubbed the “A-gays.” These include Richard Grenell, former executive director of the Kennedy Center and Special Presidential Envoy for Special Missions; Treasury Secretary Scott Bessent; Under Secretary of State Jacob Helberg; Department of Energy official Charles T. Moran; and longtime supporter Peter Thiel, co-founder and CEO of Palantir.
His efforts to portray himself as aligned with the gay community stand in conflict with policies advanced under his leadership. These include removing LGBTQ-related data from State Department reports, attempting to narrowly redefine gender identity in federal policy, restricting access to gender-affirming health care, and rolling back anti-discrimination protections. His administration also rescinded initiatives focused on LGBTQ health equity, data collection, and nondiscrimination in health care and education — moves advocates say contribute to stigma and worsen mental health outcomes.
Additionally, some HIV programs and community health centers have lost funding from the federal government after supporting initiatives inclusive of transgender people as a direct result of Trump-Vance policies.
National
Anti-trans visa ruling echoes Nazi regime destroying trans documents
Trump administration escalates attacks on queer community
The Lemkin Institute for Genocide Prevention and Human Security earlier this month released its third Red Flag Alert for the United States about the Trump administration’s anti-trans legislation. As the Lemkin Institute shared in the press release, “the Administration has moved from identifying transgender people as as threat to the family and to the nation’s military prowess to claiming that transgender people constitute a cosmic threat to the spiritual health of the nation and the great direct threat to the US national security in the world.”
The news came the same day that the State Department issued a new rule, “Enhancing Vetting and Combatting Fraud in the Immigrant Visa Program.” Under this new guidance, all visa applicants are required to disclose their “biological sex at birth” during all stages of the process, “even if that differs from the sex listed on the applicant’s foreign passport or identifying documentation.”
This rule also orders that applicants to the green card lottery program share their passport information, so in knowingly collecting passport information that the agency knows will not match a person’s biological sex at birth, it’s creating grounds to deny trans peoples’ biases on the basis of “fraud,” Aleksandra Vaca of Transitics explains.
As is written in the new ruling, “the Department is replacing ‘gender’ with ‘sex’ in accordance with E.O. 14168, Defending Women From Gender Ideology Extremism and Restoring Biological Truth to the Federal Government, which provides that the term ‘sex’ shall refer to an individual’s sex at birth. Only male and female sex options are available for entrants completing the Diversity Visa entry form.”
Along with outright denying the existence of nonbinary, genderqueer and gender expansive people, this policy creates a precedence for trans people to be stripped of their visas and deported because under 8 U.S.C. § 1182(a)(6)(C)(i), any foreigner found to have obtained or possess a visa “by fraud or willfully misrepresenting a material fact” will have their visa revoked and face deportation.
By requesting information on “biological sex at birth,” the State Department is forcing a mismatch between documents and enabling officials to accuse trans, nonbinary, and gender expansive immigrants of fraud. Thus, trans and nonbinary immigrants can have their visas revoked and can be deported, and information gathered from immigrants during the visa request process can be added to federal databases and used by immigration authorities, including ICE agents.
With the Supreme Court’s decision this past year allowing ICE officers to use racial profiling, Vaca argues that “now, The Trump administration has given ICE the reason it needs. Under this rule, ICE agents now have the enforcement rationale to assert that trans people–especially those belonging to racial minority groups–are more likely than cis people to have ‘misrepresented’ themselves during the visa process, and therefore, are more likely to enter the country ‘unlawfully.’”
This would enable ICE agents to target trans individuals specifically for being trans. If the goal of this were unclear, a day later the Trump administration released its statement for Women’s History Month 2026, writing that “we are keeping men out of women’s sports, enforcing Title IX as it was originally written and ensuring colleges preserve–and, where possible, expand–scholarships and roster opportunities for female athletes. We are restoring public safety and upholding the rule of law in every city so women, children, and families can feel safe and secure.”
And this is not the first time that ICE has targeted and harmed trans and nonbinary immigrants. Last June, Vera reported that ICE is not including trans people in detection in their public reports, and back in 2020, AFSC reported that trans people held in ICE detention faced “dreadful, ugly” conditions.
While it seems like a new development in Trump’s anti-trans escalation, it echoes a deeply upsetting history of denying and destroying transgender people’s documents following members of the Nazi party seizing power in 1933.
In the early 20th century, Weimar, Germany was an epicenter for gender affirming care with Maganus Hirschfeld’s Institute for Sexual Science. One of the first book burnings of the rising Nazi regime destroyed the Institute’s extensive clinical records and library on trans health and history by Nazi students and stormtroopers. In doing so, the Nazis effectively destroyed the world’s first trans health clinic and one of the richest and most comprehensive collective of information about trans healthcare.
Similarly, the Nazi government invalidated or refused to recognize what was called “transvestite passes,” or passing certificates that allowed trans people to avoid arrest under Paragraph 175 which prohibited cross-dressing. During the Weimar Republic — the regime that preceded the Third Reich — recognized and affirmed the identities of trans people (in limited ways) with specific documentation that helped prevent them from arrest. Invalidating and disregarding these passes allowed police and Nazi officials to target trans people and harass, extort and arrest them, and the record of passes themselves helped officials target trans people.
The changes to visa guidelines — alongside Kansas’s move to revoke trans drivers’ licenses last month — is reflective of this escalation of violence against trans people during the Nazi’s rise to power, which scholars like Dr. Laurie Marhoefer is just beginning to uncover. And along with the revocation of identification documents this past week, a recent Fourth Circuit Court ruled that states can deny Medicaid coverage for gender-affirming surgery.
The Fourth Circuit Court decision affirmed the Supreme Court’s decision in Skrmetti, which ruled that bans on gender affirming healthcare for young people are constitutional. This ruling extends this ban to include adult healthcare bans, allowing West Virginia’s exclusion of Medicaid coverage for adult gender affirming healthcare to take full effect. Even more upsetting was what the ruling itself said, calling gender affirming healthcare “dangerous.”
As was written in the Fourth Circuit Opinion, “it’s not irrational for a legislature to encourage citizens ‘to appreciate their sex’ and not ‘become disdainful of their sex’ by refusing to fund experimental procedures that may have the opposite effect.”
In reality, what this ruling and the opinion reflect, is the next step in government regulation and oversight over marginalized peoples’ bodies. From the overturn of Roe v. Wade, which removed federal protection of access to abortion, this next step represents the denial of people’s access to vital, lifesaving care–and to be clear, gender affirming care is not just for trans, nonbinary, and intersex people. It’s a dangerous escalation and one that echoes previous violence against trans people under fascist regimes; the Lemkin Institute is right to raise concern.
Japan
Japanese Supreme Court to consider marriage equality
Japan only G7 country that does not legally recognize same-sex couples
The Japanese Supreme Court on Wednesday said it will consider six marriage equality lawsuits.
NHK, the country’s public broadcaster, noted all 15 of the court’s justices will consider the case.
Japan is the only G7 country that does not legally recognize same-sex couples, despite several court rulings in recent years that found the denial of marriage benefits to gays and lesbians unconstitutional.
Tokyo High Court Judge Ayumi Higashi last November upheld Japan’s legal definition of a family as a man and a woman and their children.
Prime Minister Sanae Takaichi, who became the country’s first female head of government last October, opposes marriage rights for same-sex couples. She has also reiterated the constitution’s assertion that the family is an institution based around “the equal rights of husband and wife.”
Same-sex couples can legally marry in Taiwan, Nepal, and Thailand.
NHK reported the Supreme Court is expected to issue its ruling in early 2027.
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