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Post-DOMA rule proposed for hospice care, nursing homes

Administration seeks to ensure same-sex marriages recognized regardless of state of residence

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Centers for Medicare & Medicaid Services, gay news, Washington Blade

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.”

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Florida

AIDS Healthcare Foundation sues Fla. over ‘illegal’ HIV drug program cuts

Tens of thousands could lose access to medications

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(Photo by Catella via Bigstock)

Following the slashing of hundreds of thousands of dollars from Florida’s AIDS Drug Assistance Program, AIDS Healthcare Foundation filed a lawsuit against the Florida Department of Health over what it says was an illegal change to income eligibility thresholds for the lifesaving program.

The Florida Department of Health announced two weeks ago that it would make sweeping cuts to ADAP, dramatically changing how many Floridians qualify for the state-funded medical coverage — without using the formal process required to change eligibility rules. As a result, AHF filed a petition Tuesday in Tallahassee with the state’s Division of Administrative Hearings, seeking to prevent more than 16,000 Floridians from losing coverage.

The medications covered by ADAP work by suppressing HIV-positive people’s viral load — making the virus undetectable in blood tests and unable to be transmitted to others.

Prior to the eligibility change, the Florida Department of Health covered Floridians earning up to 400 percent of the federal poverty level — or $62,600 annually for an individual. Under the new policy, eligibility would be limited to those making no more than 130 percent of the federal poverty level, or $20,345 per year.

The National Alliance of State and Territorial AIDS Directors estimates that more than 16,000 patients in Florida will lose coverage under the state’s ADAP because of this illegal change in department policy. Florida’s eligibility changes would also eliminate access to biktarvy, a widely used once-daily medication for people living with HIV/AIDS.

Under Florida law, when a state agency seeks to make a major policy change, it must either follow a formal rule-making process under the Florida Administrative Procedure Act or obtain direct legislative authorization.

AHF alleges the Florida Department of Health did neither.

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 AHF, none of these steps occurred.

“Rule-making is not a matter of agency discretion. Each statement that an agency like the Department of Health issues that meets the statutory definition of a rule must be adopted through legally mandated rule-making procedures. Florida has simply not done so here,” said Tom Myers, AHF’s chief of public affairs and general counsel. “The whole point of having to follow procedures and rules is to make sure any decisions made are deliberate, thought through, and minimize harm. Floridians living with HIV and the general public’s health are at stake here and jeopardized by these arbitrary and unlawful DOH rule changes.”

AHF has multiple Ryan White CARE Act contracts in Florida, including four under Part B, which covers ADAP. More than 50 percent of people diagnosed with HIV receive assistance from Ryan White programs annually.

According to an AHF advocacy leader who spoke with the Washington Blade, the move appears to have originated at the state level rather than being driven by the federal government — a claim that has circulated among some Democratic officials.

“As far as we can tell, Congress flat-funded the Ryan White and ADAP programs, and the proposed federal cuts were ignored,” the advocacy leader told the Blade on the condition of anonymity. “None of this appears to be coming from Washington — this was initiated in Florida. What we’re trying to understand is why the state is claiming a $120 million shortfall when the program already receives significant federal funding. That lack of transparency is deeply concerning.”

Florida had the third-highest rate of new HIV infections in the nation in 2022, accounting for 11 percent of new diagnoses nationwide, according to KFF, a nonprofit health policy research organization.

During a press conference on Wednesday, multiple AHF officials commented on the situation, and emphasized the need to use proper methods to change something as important as HIV/AIDS coverage availability in the sunshine state. 

“We are receiving dozens, hundreds of calls from patients who are terrified, who are confused, who are full of anxiety and fear,” said Esteban Wood, director of advocacy, legislative affairs, and community engagement at AHF. “These are working Floridians — 16,000 people — receiving letters saying they have weeks left of medication that keeps them alive and costs upwards of $45,000 a year. Patients are asking us, ‘What are we supposed to do? How are we supposed to survive?’ And right now, we don’t have a good answer.”

“This decision was not done in the correct manner. County health programs, community-based organizations, providers across the state — none of them were consulted,” Wood added. “Today is Jan. 28, and we have just 32 days until these proposed changes take effect. Nearly half of the 36,000 people currently on ADAP could be disenrolled in just over a month.”

“Without this medication, people with HIV get sicker,” Myers said during the conference. “They end up in emergency rooms, they lose time at work, and they’re unable to take care of their families. Treatment adherence is also the best way to prevent new HIV infections — people who are consistently on these medications are non-infectious. If these cuts go through, you will have sicker people, more HIV infections, and ultimately much higher costs for the state.”

“Patients receiving care through Ryan White and ADAP have a 91 percent viral suppression rate, compared to about 60 percent nationally,” the advocacy leader added. “That’s as close to a functional cure as we can get, and it allows people to live healthy lives, work, and contribute to their communities. Blowing a hole in a program this successful puts lives at risk and sets a dangerous precedent. If Florida gets away with this, other states facing budget pressure could follow.”

The lawsuit comes days after the Save HIV Funding campaign pressed Congress to build bipartisan support for critical funding for people living with or vulnerable to HIV. In May of last year, President Donald Trump appeared to walk back his 2019 pledge to end HIV as an epidemic, instead proposing the elimination of HIV prevention programs at the Centers for Disease Control and Prevention and housing services in his budget request to Congress.

House appropriators, led by the Republican majority, went further, calling for an additional $2 billion in cuts — including $525 million for medical care and support services for people living with HIV. 

While Senate appropriators ultimately chose to maintain level funding in their version of the spending bills, advocates feared final negotiations could result in steep cuts that would reduce services, increase new HIV infections, and lead to more AIDS-related deaths. The final spending package reflected a best-case outcome, with funding levels largely mirroring the Senate’s proposed FY26 allocations.

“What the state has done in unilaterally announcing these changes is not following its own rules,” Myers added. “There is a required process — rule-making, notice and comment, taking evidence — and none of that happened here. Before you cut 16,000 people off from lifesaving medication, you have to study the harms, ask whether you even have the authority to do it, and explore other solutions. That’s what this lawsuit is about.”

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China

Two Chinese men detained over AI-generated picture of pandas engaging in same-sex behavior

Arrests part of increased online surveillance, LGBTQ rights crackdown

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(Photo by Aylandy/Bigstock)

Chinese authorities have detained two men after they shared an artificially altered image that linked queer identity with a specific city.

The Washington Post on Jan. 21 reported the men — who are 29 and 33 — circulated an AI-generated picture depicting pandas engaging in same-sex behavior in Chengdu, a major city in southwestern China often referred to as the “panda capital” due to its association with giant panda conservation. Local officials described the sharing of the image as “malicious,” and police in Chengdu took the men into custody.

Authorities also suspended the two men’s social media accounts, accusing them of spreading misinformation presented as legitimate news. According to the Post, the artificially generated image was posted alongside a fabricated headline, giving the appearance of an authentic news report. The image depicted two male pandas mating.

According to an official police report, police said the fabricated image was presented in the format of a legitimate news article and accompanied by a false headline. The caption read, “Chengdu: Two male Sichuan giant pandas successfully mate for the first time without human intervention,” authorities said.

Chinese regulators have in recent years tightened oversight of AI and online content. 

Under the Interim Measures for the Administration of Generative Artificial Intelligence Services, issued in 2023, providers and users of generative AI systems are required to comply with existing laws, adhere to social and ethical standards, and refrain from producing or disseminating false or misleading information. Additional rules that took effect on Sept. 1, 2025, require online platforms to clearly label AI-generated content, a measure authorities have said is intended to curb misinformation and maintain order in digital spaces.

Police under Chinese law are permitted to impose administrative detention of up to 15 days for offenses deemed to disrupt public order, a category that includes the fabrication or dissemination of false information online. Such cases are handled outside the criminal court system and do not require formal prosecution.

According to a statement the Chengdu Public Security Bureau’s Chenghua branch released, police opened an investigation after receiving public reports that online accounts were spreading false information about the city. Authorities said officers collected evidence shortly afterward and placed the two individuals under administrative detention.

The detentions are not an isolated case. 

The Washington Blade in July 2025 reported a Chinese female writer was arrested and subjected to a strip search after publishing gay erotic fiction online. At least 30 other writers — most of them women in their 20s — in the months that followed publicly described similar encounters with law enforcement, including home raids and questioning related to their online writing.

ShanghaiPRIDE, a Chinese LGBTQ advocacy group that organized annual Pride events in the city, has remained indefinitely suspended since 2021. In the same period, dozens of LGBTQ-focused accounts have been removed from WeChat, China’s largest social media platform, as authorities intensified oversight of online content related to sexual orientation and gender identity.

Authorities in 2021 detained the founder of LGBT Rights Advocacy China. They later released them on the condition that he shut down the organization, which ceased operations shortly afterward.

China decriminalized homosexuality in 1997 when it removed consensual same-sex sexual relations from the country’s criminal code. The Chinese Society of Psychiatry in 2001 formally removed homosexuality from its list of mental disorders. Despite those changes, same-sex relationships remain unrecognized under Chinese law, and there are no legal protections against discrimination based on sexual orientation or gender identity. Public advocacy for LGBTQ rights remains tightly restricted, with authorities continuing to limit community organizing, public events and online expression related to sexual minority issues.

Within China’s LGBTQ community, transgender and gender non-conforming people remain among the most vulnerable. Under current regulations, access to gender-affirming surgery is subject to strict requirements, including being at least 18 years old, unmarried, obtaining parental consent and having no criminal record — procedures that are required in order to legally change one’s gender on official documents.

China’s system of online governance places responsibility on both users and platforms to prevent the spread of prohibited content. Social media companies are required to conduct real-name verification, monitor user activity and remove posts that violate regulations, while individuals can be punished for content authorities determine to have caused public misunderstanding or social disruption.

“Actually, at least three similar incidents have occurred in Chengdu recently, all involving netizens posting on social media linking Chengdu with homosexuality, resulting in legal repercussions. This isn’t just about giant pandas. I think the local police’s reaction was somewhat excessive,” said Renn Hao, a Chinese queer activist. “The content was actually praising Chengdu’s inclusivity, and there was no need to punish them with regulations like ‘maliciously spreading false information.’” 

“This situation reflects the strict censorship of LGBT related content in the area,” they added. “This censorship makes LGBT-related content increasingly invisible, and people are even more afraid to post or mention it. This not only impacts the LGBTQ+ community in China but also hinders public understanding and awareness of this group.”

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National

Federal authorities arrest Don Lemon

Former CNN anchor taken into custody two weeks after Minn. church protest

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Don Lemon (Screenshot via YouTube)

Federal authorities on Thursday arrested former CNN anchor Don Lemon in Los Angeles.

CNN reported authorities arrested Lemon after 11 p.m. PT while in the lobby of a hotel in Beverly Hills, Calif., while he “was leaving for an event.” Lemon’s lawyer, Abbe Lowell, in a statement said his client was in Los Angeles to cover the Grammy Awards.

Authorities arrested Lemon less than two weeks after he entered Cities Church in St. Paul, Minn., with a group of protesters who confronted a pastor who works for U.S. Immigration and Customs Enforcement. (An ICE agent on Jan. 7 shot and killed Renee Good, a 37-year-old Minneapolis woman who left behind her wife and three children. U.S. Customs and Border Protection agents on Jan. 24 shot and killed Alex Pretti, a 37-year-old nurse who worked for the Department of Veterans Affairs, in Minneapolis.)

Lemon insists he was simply covering the Cities Church protest that interrupted the service. A federal magistrate last week declined to charge the openly gay journalist in connection with the demonstration.

“Don Lemon was taken into custody by federal agents last night in Los Angeles, where he was covering the Grammy awards,” said Lowell in his statement. “Don has been a journalist for 30 years, and his constitutionally protected work in Minneapolis was no different than what he has always done. The First Amendment exists to protect journalists whose role it is to shine light on the truth and hold those in power accountable.”

“Instead of investigating the federal agents who killed two peaceful Minnesota protesters, the Trump Justice Department is devoting its time, attention and resources to this arrest, and that is the real indictment of wrongdoing in this case,” Lowell added. “This unprecedented attack on the First Amendment and transparent attempt to distract attention from the many crises facing this administration will not stand. Don will fight these charges vigorously and thoroughly in court.”

Attorney General Pam Bondi on X confirmed federal agents “at my direction” arrested Lemon and three others — Trahern Jeen Crews, Georgia Fort, and Jamael Lydell Lundy — “in connection with the coordinated attack on Cities Church in St. Paul, Minnesota.”

Fort is also a journalist.

Lemon, who CNN fired in 2023, is expected to appear in court in Los Angeles on Friday.

“Freedom of the press is a cornerstone of a free society; it is the tool by which Americans access the truth and hold power to account. But Donald Trump and Pam Bondi are at war with that freedom — and are threatening the fundamentals of our democracy,” said Human Rights Campaign President Kelley Robinson on Friday in a statement. “Don Lemon and Georgia Fort were doing their jobs as reporters. Arresting them is not law enforcement it is an attack on the Constitution at a moment when truthful reporting on government power has never been more important. These are the actions of a despot, the tactics of a dictator in an authoritarian regime.”

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