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.”
Maryland
Salisbury, Md. rainbow crosswalk removed on Veterans Day
Mayor’s order denounced by LGBTQ activists as act of bigotry
Under the directive of its mayor and over strong objections from LGBTQ rights advocates and their supporters, the city of Salisbury, Md. on Nov. 11 removed a rainbow crosswalk from a prominent intersection across from the mayor’s office and the city’s public library.
Salisbury LGBTQ rights advocate Mark DeLancey, who witnessed the crosswalk removal, said instead of painting over it as other cities have done in removing rainbow crosswalks, a powerful grinding machine was used to rip apart the asphalt pavement under the crosswalk in what he believes was an effort by the mayor to “make a point.”
Like officials in other locations that have removed rainbow crosswalks, Salisbury Mayor Randy Taylor said the crosswalk removal was required under U.S. Department of Transportation regulations put in place by the Trump administration that do not allow “political” messages on streets and roadways.
“Since taking office, I’ve been transparent about my concerns regarding the Pride crosswalks installed in Downtown Salisbury,” Taylor said in a statement. “While I have made every effort to respect the decisions of previous administrations and the folks that supported them, it has become clear that a course of correction – as planned – is necessary to align with current Department of Transportation standards for roadway markings,” he said in his Nov. 7 statement that was posted on the city’s Facebook page.
DeLancey is among the activists and local public officials in many cities and states that dispute that the federal Department of Transportation has legal authority to ban the Pride crosswalks. D.C. and the Northern Virginia jurisdictions of Arlington and Alexandria are among the localities that have refused to remove rainbow crosswalks from their streets.
“He decided to take this on himself,” DeLancey said of Taylor’s action. “It’s not a law. It’s not a ruling of any kind. He just said that was something that should happen.”
DeLancey points out that Salisbury became the first jurisdiction in Maryland to install a rainbow crosswalk on a public street in September 2018.
“This is another blatant attempt by our Republican mayor to remove any references to groups that don’t fit with his agenda,” Salisbury LGBTQ advocate Megan Pomeroy told the local publication Watershed Observer. “The rainbow crosswalk represents acceptance for everyone. It tells them, ‘You matter. You are valued. You are welcome here,’” she was quoted as saying.
The publication Delmarva Now reports that a longtime Salisbury straight ally to the LGBTQ community named K.T. Tuminello staged a one-person protest on Nov. 10 by sitting on the sidewalk next to the rainbow crosswalk holding a sign opposing its removal.
“Tuminello said Nov. 10 he had been at the embattled crosswalk since 12 a.m. that morning, and only three things could make him leave: ‘I get arrested, I have to get into an ambulance because of my medical difficulties, or Randy Taylor says you can keep that one rainbow crosswalk,’” the Delaware Now article states.
DeLancey said he has known Tuminello for many years as an LGBTQ ally and saw him on the night he staged his sit-in at the site of the crosswalk.
“I actually went to him last night trying to give him some water,” DeLancey told the Washington Blade. “He was on a hunger strike as well. He was there for a total of 40 hours on strike, not eating, no sleeping in the freezing cold”
Added DeLancey, “He has been supporting our community for decades. And he is a very strong ally, and we love his contribution very much.”
Political observers have pointed out that Salisbury for many years has been a progressive small city surrounded by some of Maryland’s more conservative areas with mostly progressive elected officials.
They point out that Taylor, a Trump supporter, won election as mayor in November 2023 with 36.6 percent of the vote. Two progressive candidates split the vote among themselves, receiving a combined total of 70.8 percent of the vote.
Kazakhstan
Kazakh lawmakers advance anti-LGBTQ propaganda bill
Measure likely to pass in country’s Senate
Lawmakers in Kazakhstan on Wednesday advanced a bill that would ban so-called LGBTQ propaganda in the country.
Reuters notes the measure, which members of the country’s lower house of parliament unanimously approved, would ban “‘LGBT propaganda’ online or in the media” with “fines for violators and up to 10 days in jail for repeat offenders.”
The bill now goes to the Kazakh Senate.
Reuters reported senators will likely support the measure. President Kassym-Jomart Tokayev has also indicated he would sign it.
Kazakhstan is a predominantly Muslim former Soviet republic in Central Asia that borders Russia, Turkmenistan, Uzbekistan, Kyrgyzstan, and China.
Consensual same-sex sexual relations are decriminalized in Kazakhstan, but the State Department’s 2023 human rights report notes human rights activists have “reported threats of violence and significant online and in-person verbal abuse towards LGBTQI+ individuals.” The document also indicates discrimination based on sexual orientation and gender identity remains commonplace in the country. (Jessica Stern, the former special U.S. envoy for the promotion of LGBTQ and intersex rights under the Biden-Harris administration who co-founded the Alliance for Diplomacy and Justice, in August condemned the current White House for the “deliberate erasure” of LGBTQ and intersex people from the State Department’s 2024 human rights report.)
Russia, Georgia, and Hungary are among the other countries with propaganda laws.
Virginia
Ghazala Hashmi names Equality Virginia executive director to transition team
Narissa Rahaman will join Adam Ebbin, Mark Sickles on LG-elect’s committee.
Virginia Lt. Gov.-elect Ghazala Hashmi has named Equality Virginia Executive Director Narissa Rahaman to her transition team.
State Sen. Adam Ebbin (D-Alexandria) and state Del. Mark Sickles (D-Fairfax County) are among those who Hashmi also named to her Transition Committee.
“I am honored to have this diverse group of leaders join our transition,” said Hashmi in a statement. “Their experience, perspective, and commitment to public service will help build an Office of the Lieutenant Governor that is responsive, innovative, and relentlessly focused on improving the lives of every Virginia resident.”
“Together, we will develop a thoughtful roadmap for the work ahead — one that ensures we are engaging communities, strengthening partnerships across the state, and preparing this office to serve with purpose and conviction from Day One,” she added. “I am grateful to each member for bringing time, expertise, and passion to this effort.”
Hashmi, a Democrat, defeated Republican John Reid, who is openly gay, on Nov. 4.
Hashmi will succeed outgoing Lt. Gov. Winsome Earle-Sears on Jan. 17.
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