Politics
New guidance affords gay couples equal access to Medicaid
Non-marriage equality states can refuse new policy for gay couples
The Centers for Medicare & Medicaid has issued new post-DOMA guidance (Image public domain).
Gay married couples will now have the same eligibility opportunities for Medicaid coverage as straight couples in certain states following the Supreme Court decision against the Defense of Marriage Act, according to new guidance from the Obama administration obtained Friday by the Washington Blade.
In two separate pieces of guidance dated Sept. 27, the Centers for Medicare & Medicaid outlines new policy bringing the agency in line with the ruling against DOMA. They’re published in time for enrollment into insurance exchanges and Medicaid expansion under the health care reform law starting on Tuesday.
One piece of guidance from Gary Cohen, CMS director of the Center for Consumer Information & Insurance Oversight, clarifies gay married couples will be for a spousal tax credit and cost-sharing reductions by signing up for a health insurance exchange — provided they submit a joint tax return for that year.
“In light of the Ruling, the eligibility rules with respect to premium tax credits under Code section 36B treat same-sex spouses in the same manner as opposite-sex spouses,” Cohen writes.
That policy decision has nationwide implications thanks to an Aug. 29 ruling from the Internal Revenue Service that married same-sex couples should be treated the same as opposite-sex couples for tax purposes — regardless of whether or not they reside in a state recognizing the union.
The other piece of guidance from Sept. 27, signed by CMS Director of the Center for Medicaid & CHIP Services Cindy Mann, is more complex and says DOMA is no longer a factor in determining the income-based eligibility of same-sex couples for Medicaid and the Children’s Health Insurance Program.
“[B]ecause Section 3 of DOMA no longer controls the definition of marriage or spouse under the framework for state Medicaid and CHIP programs, DOMA is no longer a bar to states recognizing same-sex marriages in Medicaid or CHIP,” Mann writes.
Medicaid is a health insurance program jointly run by the states and government in which a person is eligible for coverage if have income up to 133 percent of the poverty line. Most individuals apply for Medicaid not on an individual basis, but on a family basis.
With DOMA out of the picture, the new policy would make a gay person more eligible for Medicaid if their spouse’s income is lower and places them lower on the poverty scale. Also, it can make a gay person less eligible if a spouse’s income is higher and the couple seems less in need.
The guidance says that state may begin factoring an applicant’s same-sex marriage into eligibility for Medicaid and CHIP “immediately,” but acknowledges some operational challenges and says it should be implemented “as soon as reasonably practicable.”
States where same-sex marriage is legal will have to adopt the new eligibility requirements, but since the Medicaid is jointly run by the states, CMS isn’t requiring non marriage-equality states to recognize same-sex marriages for the purposes of the purposes of the program. States can elect to opt out of the new policy.
“[A] state is permitted and encouraged, but not required, to recognize same-sex couples who are legally married under the law of the jurisdiction in which the marriage was celebrated as spouses for purposes of Medicaid and CHIP,” Mann writes. “States that do not recognize same-sex marriages are thus free to adopt a different marriage recognition policy for Medicaid and CHIP purposes.”
That’s similar to policy under health care reform. Because of the Supreme Court ruling on Obamacare, states can opt out of participating in the Medicaid expansion under the law.
The guidance also allows states to adopt this eligibility standard for Medicaid and CHIP if the state offers civil unions or domestic partnerships that are the legal equivalent to marriage. Among these states are Colorado and Illinois.
“Consistent with this guidance, a marriage is recognized for Medicaid and CHIP purposes if (it is legally valid under applicable law,” Mann writes. “Thus, if a state or territory recognizes a civil union or domestic partnership as a marriage, that marital status is recognized under the Medicaid and CHIP programs, consistent with this guidance.”
CMS says this guidance isn’t the last word. The agency is awaiting additional guidance on non-income related eligibility for Medicaid and CHIP that hinges on yet-to-be-released guidance from the Social Security Administration in determining eligibility for Supplemental Security Income. Some Social Security spousal benefits are beginning to flow to married gay couples, but the Obama administration hasn’t finalized this post-DOMA policy yet.
“The Centers for Medicare & Medicaid Services (CMS) will issue additional guidance once the SSA announces its post-Windsor SSI marriage recognition policy,” Mann writes.
Despite the effort to bring the Medicaid into alignment with the court ruling against DOMA, the nation’s largest LGBT group is expressing discontent with the guidance and says the eligibility should extend to married gay couples nationwide.
Michael Cole-Schwartz, a spokesperson for the Human Rights Campaign, said the policy decisions “fall short” by allowing states to determine whether they can provide Medicaid coverage to same-sex couples.
“While it might be advantageous for some families to remain unrecognized in order to maintain eligibility for certain programs, as a general rule we oppose different standards for gay versus straight married couples,” Cole-Schwartz said. “Given that there are no impediments to the federal government adopting an across the board standard that recognizes all legally married couples in this instance, we believe that the new rules fall short of the ideal where the sexual orientation of those in a marriage is irrelevant.”
Federal officials insist the new policy is extended in the maximum possibly way because, unlike in other cases where the Department of Health & Human Services has extended standards and benefits to same-sex married couples in non-marriage equality states, there is a special federal-state relationship in Medicaid with the states administering this program.
Congress
McBride, other US lawmakers travel to Denmark
Trump’s demand for Greenland’s annexation overshadowed trip
Delaware Congresswoman Sarah McBride is among the 11 members of Congress who traveled to Denmark over the past weekend amid President Donald Trump’s continued calls for the U.S. to take control of Greenland.
McBride, the first openly transgender person elected to Congress, traveled to Copenhagen, the Danish capital, with U.S. Sens. Chris Coons (D-Del.), Thom Tillis (R-N.C.), Jeanne Shaheen (D-N.H.), Dick Durbin (D-Ill.), and Lisa Murkowski (R-Alaska) and U.S. Reps. Steny Hoyer (D-Md.), Gregory Meeks (D-N.Y.), Madeleine Dean (D-Pa.), Don Bacon (R-Neb.), and Sarah Jacobs (D-Calif.). The lawmakers met with Danish Prime Minister Mette Frederiksen and Greenlandic MP Pipaluk Lynge, among others.
“I’m grateful to Sen. Coons for his leadership in bringing together a bipartisan, bicameral delegation to reaffirm our support in Congress for our NATO ally, Denmark,” said McBride in a press release that detailed the trip. “Delaware understands that our security and prosperity depend on strong partnerships rooted in mutual respect, sovereignty, and self-determination. At a time of growing global instability, this trip could not be more poignant.”
Greenland is a self-governing territory of Denmark with a population of less than 60,000 people. Trump maintains the U.S. needs to control the mineral-rich island in the Arctic Ocean between Europe and North America because of national security.
The Associated Press notes thousands of people on Saturday in Nuuk, the Greenlandic capital, protested against Trump. British Prime Minister Keir Starmer is among those who have criticized Trump over his suggestion the U.S. would impose tariffs against countries that do not support U.S. annexation of Greenland.
A poll that Sermitsiaq, a Greenlandic newspaper, and Berlingske, a Danish newspaper, commissioned last January indicates 85 percent do not want Greenland to become part of the U.S. The pro-independence Demokraatit party won parliamentary elections that took place on March 12, 2025.
“At this critical juncture for our countries, our message was clear as members of Congress: we value the U.S.-Denmark partnership, the NATO alliance, and the right of Greenlanders to self-determination,” said McBride on Sunday in a Facebook post that contained pictures of her and her fellow lawmakers meeting with their Danish and Greenlandic counterparts.
Congress
Van Hollen speaks at ‘ICE Out for Good’ protest in D.C.
ICE agent killed Renee Nicole Good in Minneapolis on Jan. 7
U.S. Sen. Chris Van Hollen (D-Md.) is among those who spoke at an “ICE Out for Good” protest that took place outside U.S. Customs and Border Protection’s headquarters in D.C. on Tuesday.
The protest took place six days after a U.S. Immigration and Customs Enforcement agent shot and killed Renee Nicole Good, a 37-year-old woman in Minneapolis.
Good left behind her wife and three children.
(Video by Michael K. Lavers)
Congress
Advocates say MTG bill threatens trans youth, families, and doctors
The “Protect Children’s Innocence” Act passed in the House
Georgia Congresswoman Marjorie Taylor Greene has a long history of targeting the transgender community as part of her political agenda. Now, after announcing her resignation from the U.S. House of Representatives, attempting to take away trans rights may be the last thing she does in her official capacity.
The proposed legislation, dubbed “Protect Children’s Innocence Act” is among the most extreme anti-trans measures to move through Congress. It would put doctors in jail for up to 10 years if they provide gender-affirming care to minors — including prescribing hormone replacement therapy to adolescents or puberty blockers to younger children. The bill also aims to halt gender-affirming surgeries for minors, though those procedures are rare.
Greene herself described the bill on X, saying if passed, “it would make it a Class C felony to trans a child under 18.”
According to KFF, a nonpartisan source for health policy research, polling, and journalism, 27 states have enacted policies limiting youth access to gender-affirming care. Roughly half of all trans youth ages 13–17 live in a state with such restrictions, and 24 states impose professional or legal penalties on health care practitioners who provide that care.
Greene has repeatedly introduced the bill since 2021, the year she entered Congress, but it failed to advance. Now, in exchange for her support for the National Defense Authorization Act, the legislation reached the House floor for the first time.
According to the 19th, U.S. Rep. Sarah McBride (D-Del.), the first trans member of Congress, rebuked Republicans on the Capitol steps Wednesday for advancing anti-trans legislation while allowing Affordable Care Act tax credits to expire — a move expected to raise health care costs for millions of Americans.
“They would rather have us focus in and debate a misunderstood and vulnerable one percent of the population, instead of focusing in on the fact that they are raiding everyone’s health care,” McBride said. “They are obsessed with trans people … they are consumed with this.”
Polling suggests the public largely opposes criminalizing gender-affirming care.
A recent survey by the Human Rights Campaign and Global Strategy Group found that 73 percent of voters in U.S. House battleground districts oppose laws that would jail doctors or parents for providing transition-related care. Additionally, 77 percent oppose forcing trans people off medically recommended medication. Nearly seven in 10 Americans said politicians are not informed enough to make decisions about medical care for trans youth.
The bill passed the House and now heads to the U.S. Senate for further consideration.
According to reporting by Erin Reed of Erin In The Morning, three Democrats — U.S. Reps. Henry Cuellar and Vicente Gonzalez of Texas and Don Davis of North Carolina — crossed party lines to vote in favor of the felony ban, joining 213 Republicans. A total of 207 Democrats voted against the bill, while three lawmakers from both parties abstained.
Advocates and lawmakers warned the bill is dangerous and unprecedented during a multi-organizational press call Tuesday. Leaders from the Human Rights Campaign and the Trevor Project joined U.S. Rep. Becca Balint (D-Vt.), Dr. Kenneth Haller, and parents of trans youth to discuss the potential impact of restrictive policies like Greene’s — particularly in contrast to President Donald Trump’s leniency toward certain criminals, with more than 1,500 pardons issued this year.
“Our MAGA GOP government has pardoned drug traffickers. They’ve pardoned people who tried to overthrow the government on January 6, but now they want to put pediatricians and parents into a jail cell for caring for their kids,” said Human Rights Campaign President Kelley Robinson. “No one asked for Marjorie Taylor Greene or Dan Crenshaw or any politician to be in their doctor’s office, and they should mind their own business.”
Balint, co-chair of the Congressional Equality Caucus, questioned why medical decisions are being made by lawmakers with no clinical expertise.
“Parents and doctors already have to worry about state laws banning care for their kids, and this bill would introduce the risk of federal criminal prosecution,” Balint said. “We’re talking about jail time. We’re talking about locking people up for basic medical care, care that is evidence-based, age-appropriate and life-saving.”
“These are decisions that should be made by doctors and parents and those kids that need this gender-affirming care, not certainly by Marjorie Taylor Greene.”
Haller, an emeritus professor of pediatrics at St. Louis University School of Medicine, described the legislation as rooted in ideology rather than medicine.
“It is not science, it is just blind ideology,” Haller said.
“The doctor tells you that as parents, as well as the doctor themselves, could be convicted of a felony and be sentenced up to 10 years in prison just for pursuing a course of action that will give your child their only chance for a happy and healthy future,” he added. “It is not in the state’s best interests, and certainly not in the interests of us, the citizens of this country, to interfere with medical decisions that people make about their own bodies and their own lives.”
Haller’s sentiment is echoed by doctors across the country.
The American Medical Association, the nation’s largest organization that represents doctors across the country in various parts of medicine has a longstanding support for gender-affirming care.
“The AMA supports public and private health insurance coverage for treatment of gender dysphoria and opposes the denial of health insurance based on sexual orientation or gender identity,” their website reads.
Rodrigo Heng-Lehtinen, senior vice president of public engagement campaigns at the Trevor Project, agreed.
“In Marjorie Taylor Greene’s bill [it] even goes so far as to criminalize and throw a parent in jail for this,” Heng-Lehtinen said. “Medical decisions should be between patients, families, and their doctors.”
Rachel Gonzalez, a parent of a transgender teen and LGBTQ advocate, said the bill would harm families trying to act in their children’s best interests.
“No politician should be in any doctor’s office or in our living room making private health care decisions — especially not Marjorie Taylor Greene,” Gonzalez said. “My daughter and no trans youth should ever be used as a political pawn.”
Other LGBTQ rights activists also condemned the legislation.
Tyler Hack, executive director of the Christopher Street Project, called the bill “an abominable attack on the transgender community.”
“Marjorie Taylor Greene’s last-ditch effort to bring her 3-times failed bill to a vote is an abominable attack on the transgender community and further cements a Congressional career defined by hate and bigotry,” they said. “We are counting down the days until she’s off Capitol Hill — but as the bill goes to the floor this week, our leaders must stand up one last time to her BS and protect the safety of queer kids and medical providers. Full stop.”
Hack added that “healthcare is a right, not a privilege” in the U.S., and this attack on trans healthcare is an attack on queer rights altogether.
“Marjorie Taylor Greene has no place in deciding what care is necessary,” Hack added. “This is another attempt to legislate trans and queer people out of existence while peddling an agenda rooted in pseudoscience and extremism.”
U.S. Rep. Mark Takano (D-Calif.), chair of the Congressional Equality Caucus, also denounced the legislation.
“This bill is the most extreme anti-transgender legislation to ever pass through the House of Representatives and a direct attack on the rights of parents to work with their children and their doctors to provide them with the medical care they need,” Takano said. “This bill is beyond cruel and its passage will forever be a stain on the institution of the United States Congress.”
The bill is unlikely to advance in the Senate, where it would need 60 votes to pass.
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