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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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Mexico

Mexican Senate approves bill to ban conversion therapy

Measure passed by 77-4 vote margin

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(Washington Blade photo by Michael K. Lavers)

The Mexican Senate on Thursday approved a bill that would ban so-called conversion therapy in the country.

Yaaj México, a Mexican LGBTQ rights group, on X noted the measure passed by a 77-4 vote margin with 15 abstentions.  The Chamber of Deputies, the lower house of Mexico’s congress, approved the bill last month that, among other things, would subject conversion therapy practitioners to between two and six years in prison and fines.

The Senate on its X account described conversion therapy as “practices that have incentivized the violation of human rights of the LGBTTTIQ+ community.”

“The Senate moved (to) sanction therapies that impede or annul a person’s orientation or gender identity,” it said. “There are aggravating factors when the practices are done to minors, older adults and people with disabilities.”

Mexico City and the states of Oaxaca, Quintana Roo, Jalisco and Sonora are among the Mexican jurisdictions that have banned the discredited practice. 

The Senate in 2022 passed a conversion therapy ban bill, but the House of Deputies did not approve it. It is not immediately clear whether President Andrés Manuel López Obrador supports the ban.

Canada, Brazil, Belgium, Germany, France, and New Zealand are among the countries that ban conversion therapy. Virginia, California, and D.C. are among the U.S. jurisdictions that prohibit the practice for minors.  

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The White House

Four states to ignore new Title IX rules protecting transgender students

Biden administration last Friday released final regulations

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March for Queer and Trans Youth Autonomy in D.C. in 2023. (Washington Blade photo by Michael Key)

BY ERIN REED | Last Friday, the Biden administration released its final Title IX rules, which include protections for LGBTQ students by clarifying that Title IX forbids discrimination based on sexual orientation and gender identity. 

The rule change could have a significant impact as it would supersede bathroom bans and other discriminatory policies that have become increasingly common in Republican states within the U.S. 

As of Thursday morning, however, officials in at least four states — Oklahoma, Louisiana, Florida, and South Carolina — have directed schools to ignore the regulations, potentially setting up a federal showdown that may ultimately end up in a protracted court battle in the lead-up to the 2024 elections.

Louisiana State Superintendent of Education Cade Brumley was the first to respond, decrying the fact that the new Title IX regulations could block teachers and other students from exercising what has been dubbed by some a “right to bully” transgender students by using their old names and pronouns intentionally. 

Asserting that Title IX law does not protect trans and queer students, Brumley states that schools “should not alter policies or procedures at this time.” Critically, several courts have ruled that trans and queer students are protected by Title IX, including the 4th U.S. Circuit Court of Appeals in a recent case in West Virginia.

In South Carolina, Schools Supt. Ellen Weaver wrote in a letter that providing protections for trans and LGBTQ students under Title IX “would rescind 50 years of progress and equality of opportunity by putting girls and women at a disadvantage in the educational arena,” apparently leaving trans kids out of her definition of those who deserve progress and equality of opportunity. 

She then directed schools to ignore the new directive while waiting for court challenges. While South Carolina does not have a bathroom ban or statewide “Don’t Say Gay or Trans” law, such bills continue to be proposed in the state.

Responding to the South Carolina letter, Chase Glenn of Alliance For Full Acceptance stated, “While Supt. Weaver may not personally support the rights of LGBTQ+ students, she has the responsibility as the top school leader in our state to ensure that all students have equal rights and protections, and a safe place to learn and be themselves. The flagrant disregard shown for the Title IX rule tells me that our superintendent unfortunately does not have the best interests of all students in mind.”

Florida Education Commissioner Manny Diaz also joined in instructing schools not to implement Title IX regulations. In a letter issued to area schools, Diaz stated that the new Title IX regulations were tantamount to “gaslighting the country into believing that biological sex no longer has any meaning.” 

Governor Ron DeSantis approved of the letter and stated that Florida “will not comply.” Florida has notably been the site of some of the most viciously anti-queer and anti-trans legislation in recent history, including a “Don’t Say Gay or Trans” law that was used to force a trans female teacher to go by “Mr.”

State Education Supt. Ryan Walters of Oklahoma was the latest to echo similar sentiments. Walters has recently appointed the right-wing media figure Chaya Raichik of Libs of TikTok to an advisory role “to improve school safety,” and notably, Raichik has posed proudly with papers accusing her of instigating bomb threats with her incendiary posts about LGBTQ people in classrooms.

The Title IX policies have been universally applauded by large LGBTQ rights organizations in the U.S. Lambda Legal, a key figure in fighting anti-LGBTQ legislation nationwide, said that the regulations “clearly cover LGBTQ+ students, as well as survivors and pregnant and parenting students across race and gender identity.” The Human Rights Campaign also praised the rule, stating, “rule will be life-changing for so many LGBTQ+ youth and help ensure LGBTQ+ students can receive the same educational experience as their peers: Going to dances, safely using the restroom, and writing stories that tell the truth about their own lives.”

The rule is slated to go into effect Aug. 1, pending any legal challenges.

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Erin Reed is a transgender woman (she/her pronouns) and researcher who tracks anti-LGBTQ+ legislation around the world and helps people become better advocates for their queer family, friends, colleagues, and community. Reed also is a social media consultant and public speaker.

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The preceding article was first published at Erin In The Morning and is republished with permission.

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South America

Argentina government dismisses transgender public sector employees

Country’s Trans Labor Quota Law enacted in 2021

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Sofia Diaz protests her dismissal from her job at Argentina's National Social Security Administration. (Photo courtesy of Sofia Diaz)

Protests have broken out across Argentina in recent weeks after the dismissal of transgender people from their government jobs.

President Javier Milei’s action is in stark contract with the progress seen in 2023, where the government’s hiring of trans people increased by 900 percent within the framework of the Trans Labor Quota Law that had been in place since 2021. 

Among those affected is Sofia Diaz, a “survivor” who shared her testimony with the Washington Blade hours after she traveled from Chaco Province to Buenos Aires to protest her dismissal.

Presentes, an LGBTQ news agency, reported the government dismissed more than 85 trans employees in less than two weeks.

Diaz, 49, holds a degree in combined arts. She joined the National Social Security Administration (ANSES) in 2022 under the Trans Labor Inclusion Law. The layoffs began in January and left many people feeling uncertain and anguished. It was her turn a few days ago.

Diaz in an interview recounted how the situation became progressively more complicated, with difficulties in accessing information about her employment status and the eventual confirmation of dismissals through WhatsApp messages. This government action, according to Diaz, violates the law.

“We were on a Friday, I think on March 24, in the office and we have a WhatsApp group of other colleagues from all over Argentina who entered through the trans labor quota and they tell us if we can get our pay stubs on the intranet,” Diaz recalled. “So, I tried to enter, I could not, I talked to two other colleagues and they told me no, they could not, and so we went to another person. He couldn’t either.”

“Some people told us that it could be a system error. Well, we were never calm, let’s say not how this issue of installing fear and the perversion with which they do it ends,” she added. “This sadism of … inflicting pain and speculating with your misfortune and so on … is something that characterizes Javier Milei’s government.”

Diaz recalled a list of those dismissed from the agency began to circulate from the union in the afternoon. A colleague passed it on to her, “and well, unfortunately I was also on that list.” 

“At that moment the whole weekend went by with anguish, crying, and talking with other colleagues from other places, not only trans, but everyone, everyone and everyone,” she said. “On Monday when we went to try to enter, we could not enter with the biometric, which is the thumb we had to use every morning to enter.”

Despite the difficult moment through which she is going, the trans activist stressed to the Blade that she will continue protesting and will even sue the government because her dismissal is illegal and “violates the constitution itself.”

The LGBTQ community and its allies have mobilized and organized demonstrations, highlighting the importance of defending the rights won and fighting against discrimination and exclusion. Diaz emphasized the fight is not only for the people affected today, but also for future generations, saying the historical memory of the struggles for inclusion and social justice must be kept alive.

“The Argentine government thus faces a key challenge in human and labor rights, where public pressure and social mobilization can play a determining role in protecting the rights of LGBTQ+ people,” Diaz said. 

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