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.”
Brazil
2026 International AIDS Conference to take place in Rio
US funding cuts have significantly impacted global HIV/AIDS fight
The 2026 International AIDS Conference will take place next week in Rio de Janeiro.
Francisco Ruiz, the former director of the White House Office of National AIDS Policy, and UNAIDS Executive Director Winnie Byanyima are among those scheduled to speak at the conference that will take place in the Brazilian city from July 26-31. Other scheduled speakers include Spanish Health Secretary Javier Padilla, World Health Organization Director-General Tedros Adhanom Ghebreyesus, South African Deputy Health Minister Mathume Joseph “Joe” Phaahla, and Alexus D’Marco of the United Caribbean Trans Network.
The International AIDS Society-organized AIDS 2026’s theme is “Rethink. Rebuild. Rise.”
AIDS 2026 will take place against the backdrop of U.S. funding cuts that have significantly impacted the global HIV/AIDS fight.
Secretary of State Marco Rubio shortly after the Trump-Vance administration took office issued a waiver that allowed PEPFAR and other “life-saving humanitarian assistance” programs to continue to operate during a freeze on nearly all U.S. foreign aid spending. HIV/AIDS service providers around the world with whom the Washington Blade has spoken say PEPFAR cuts and the loss of funding from the U.S. Agency for International Development, which officially closed on July 1, 2025, has severely impacted their work.
The International AIDS Society in a press release it issued on Tuesday noted PEPFAR “has saved more than 26 million lives” since President George W. Bush implemented it in 2003, “and changed the trajectory of the HIV pandemic.”
“PEPFAR was a success under the first Trump administration, with major progress toward the 95-95-95 goals,” it said.
The UNAIDS’s 95-95-95 goals are 95 percent of people with HIV knowing their status, 95 percent of people with HIV having access to antiretroviral therapy, and 95 percent of those receiving ART having suppressed viral loads by 2030.
“Since the start of the second Trump administration, however, it has undergone major disruptions,” added the International AIDS Society.
Eswatini is among the African countries that have received doses of lenacapavir, a groundbreaking HIV prevention drug that users inject twice a year, through PEPFAR since the Trump-Vance administration took office.
The White House last month announced it will end PEPFAR funding for South Africa.
President Ronald Reagan in 1985 implemented the global gag rule, also known as the “Mexico City” policy, that banned U.S. foreign aid for groups that support abortion and/or offer abortion-related services. The Trump-Vance administration earlier this year expanded the prohibition to include groups that promote “gender ideology” and support gender-affirming care and diversity, equity, and inclusion programs.
The International AIDS Society in its press release notes 52 percent of “all implementing partners had at least once terminated award,” while 77 percent of them “had been asked to restrict their work to comply with an additional U.S. policy.” The International AIDS Society notes 1,010 public health facilities, 325 “access points” and 126 “drop-in centers” around the world have closed because of U.S. funding cuts.
“Science is moving fast, giving us more powerful HIV prevention and treatment tools. But these advances cannot save lives if they never reach the people who need them,” said International AIDS Society President Beatriz Grinsztejn, who co-chairs AIDS 2026 and is the director of Rio de Janeiro’s Evandro Chagas National Institute of Infection Diseases’ HIV/AIDS Clinical Research Unit. “That requires robust, stable financing and steadfast political commitment.”
Congress
House blocks effort to codify transgender servicemember ban into law
Lawmakers approved two anti-trans NDAA amendments
The U.S. House of Representatives on Tuesday rejected an amendment to the National Defense Authorization Act that would have codified a ban transgender servicemembers in the military.
The bipartisan vote was 212-217.
The NDAA is for the 2027 fiscal year and sets policies for the Defense Department programs and activities and the national security programs of the Department of Energy.
U.S. Rep. Lauren Boebert (R-Colo.) proposed the amendment on July 21. It stated that all personnel are required to serve in accordance with their biological sex, citing military readiness and discipline.
Human Rights Campaign Senior Director of Government Affairs Jennifer Pike Bailey stated that she is grateful for the bipartisan vote that rejected President Donald Trump and Defense Secretary Pete Hegseth’s “dangerous and discriminatory policy that has kicked brave transgender servicemembers out of the military and weakened our national security.”
“Everyone who meets the same rigorous standards should be able to serve their country. We should honor that patriotism, particularly in this moment where we are witnessing brave servicemembers making the ultimate sacrifice for our country, instead of ending their careers and politicizing their existence. We’re grateful that a permanent extension of this ban failed, and we will keep fighting to reverse this senseless policy,” Bailey said.
Mark Takano, chair of the Congressional Equality Caucus, stated that he and his members put in countless hours of work to kill the amendment.
“When Americans know they or their families are going to be targeted by or not supported by the military, that leads them to avoid signing up to serve or staying in the service — making it harder to keep the ranks of the armed services full and our nation safe. My colleagues in the Equality Caucus and I will continue working to prevent these attacks on our servicemembers and their families from becoming law,” Takano said.
According to the Congressional Equality Caucus, two other bills could potentially be passed that would also target the transgender community, both of which were proposed by U.S. Rep. Nancy Mace (R-S.C.).
The first was a bill that would have prohibited gender-related medical care under TRICARE and to prevent TRICARE from covering certain gender-related medical procedures and treatments, which was approved in a vote of 219-208.
The second was a bill that would have prohibited male participation in female sports at DoDEA schools. DoDEA schools are Department of Defense Dependents Schools, which is a network of primary and secondary schools.
The amendment was approved in a vote of 221-203.
District of Columbia
D.C. Council approves increased funding for Mayor’s Office of LGBTQ Affairs
Increase attached to 2027 budget bill
The D.C. Council on July 14 gave final approval for the city’s fiscal year 2027 budget that includes an amendment calling for increasing the number and size of funding grants that the Mayor’s Office of LGBTQ Affairs provides for local organizations providing services for the LGBTQ community.
The amendment, called the “LGBTQ Community Grant Amendment Act of 2026,” was introduced earlier this year by D.C. Council member Zachary Parker (D-Ward 5), the Council’s only gay member.
The D.C. LGBTQ Budget Coalition called the Parker amendment “a historic measure that establishes the District’s most sustainable model for a vehicle for investing in LGBTQ communities.”
The Council approved the version of the FY 2027 budget bill with the attached Parker amendment in its first of two required votes on June 9. Shortly after voting unanimously to give final approval of an earlier version of the two-part budget measure on July 7 that includes the Parker amendment, the Council sent the bill to Mayor Muriel Bowser for her signature.
Bowser has expressed strong opposition to several provisions in the $22 billion budget measure passed by the Council that are unrelated to the Parker amendment regarding the Office of LGBTQ Affairs. The mayor has yet to say whether she will sign, veto, or choose not to sign the bill.
The latter option would allow the bill to become law if Congress does not choose to overturn it during its required 30-day legislative review period for all D.C. bills. Political observers believe the Council will vote to override a veto if Bowser chooses to veto the bill.
When contacted by the Washington Blade on July 22 to determine where the mayor stands on the budget bill, mayoral spokesperson Daniel Gleick said only, there was “no update on the budget just yet.”
Among other things, the Parker amendment calls for the Mayor’s Office of LGBTQ Affairs to issue a $980,000 grant in FY 2027 to a private, nonprofit organization in partnership with the office “for the purpose of supporting programs that promote the welfare of the lesbian, gay, bisexual, transgender, and questioning community.”
It says the organization selected would also initiate its own fundraising effort to expand the amount of funds beyond the amount the office would provide, enabling it to provide larger grants to a greater number of local LGBTQ organizations.
“The legislation arrives at a critical moment, as LGBTQ-serving organizations face unprecedented uncertainty,” the D.C. Budget Coalition said in its comment on the Parker amendment. “Growing demand for services is colliding with shrinking resources, federal attacks on LGBTQ programs, and ongoing threats to local funding streams,” the coalition’s statement says.
In what some observers have called a highly controversial action; the budget bill approved by the Council reverses and restores millions of dollars in budget cuts proposed by Bowser in the budget she submitted to the Council earlier this year.
Among other things, the Council’s budget preserves the current level of funding for housing vouchers, childcare, paid family leave, and other programs slated to be cut in the mayor’s proposed budget, according to a report by the Washington Post.
Bowser points out that the Council approved budget bill calls for using $150 million from the city’s reserve fund, which she and others have said could put the city in jeopardy in future years. The mayor has said the cuts were needed to prevent a major funding shortfall brought about by the action by Republicans in Congress to cut the city’s budget by over a billion dollars.
