Politics
New guidance affords gay couples equal access to Medicaid
Non-marriage equality states can refuse new policy for gay couples
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
New Equality Caucus vice chair endorses Equality Act, federal trans bill of rights
Salinas talks about her personal road to LGBTQ advocacy
Rep. Andrea Salinas, the new vice chair of the Equality Caucus, sat down with the Blade to discuss the battles ahead as she demands protections for LGBTQ Americans.
Salinas is no stranger to government service. The daughter of a Mexican immigrant, she graduated from the University of California, Berkeley, and soon became a valued member of multiple Democratic offices — including working as a congressional aide to U.S. Sen. Harry Reid (D-Nev.) and U.S. Reps. Pete Stark (D-Calif.) and Darlene Hooley (D-Ore.). From there, she served six years in the Oregon House of Representatives before being elected to Congress, representing areas south of Salem and parts of southern Portland. With her new role in the Equality Caucus, Salinas vows to push protections for LGBTQ Americans in every room she enters.
The Washington Blade spoke with Salinas last week following her leadership announcement to discuss what the role means to her, why she — as a straight woman— feels it is her duty to fight for LGBTQ protections, and how she views the current state of the country.
When asked why she decided to take on a leadership role within the Equality Caucus, Salinas explained that she was already doing the work — but that the timing of the caucus’s outreach, coupled with what she described as a growing threat posed by the Trump-Vance administration, made the moment feel especially urgent.
“I was actually asked to take on this role because of the work I’ve already been doing. I didn’t seek out a title— the Congressional Equality Caucus came to me, and I was honored by that,” the Oregon representative told the Blade. “I’ve been a lifetime advocate, first as a mother and then as a legislator. With Trump back in office and the shackles off, kids are vulnerable right now, and they’re being attacked. We need champions, and with or without a title, I was going to do this work anyway.”
That work includes passing LGBTQ-related education policy during her time in the Oregon House of Representatives, requiring the Oregon Department of Education to train teachers on how to better support LGBTQ students. She also backed legislation aimed at preventing LGBTQ-related bullying and harassment, while using her platform to ensure educators had the skills needed to address trauma in the classroom. Salinas also pushed for Oregon’s 2013 conversion therapy ban and played a role in defending it.
Salinas said her personal motivation for expanding and protecting LGBTQ rights is rooted in the experiences of her daughter, Amelia.
“My daughter is queer, and she has known who she is since she was a child,” Salinas said. “She presents very masculine, and I’ve had to advocate for her her entire life — from whispers on soccer sidelines to fears about using the bathroom when she was just three or four years old. That kind of bullying and harassment stays with you as a parent. It became part of who I am, part of my ‘mama bear’ advocacy. When I entered public office, continuing that fight was the most natural thing in the world.”
That “mama bear” advocacy, she said, now extends far beyond her own family.
“Across this country, kids are vulnerable right now, and Trump is attacking them,” she said. “My daughter was devastated after the 2024 election— she said, ‘They’re coming after us,’ and she was right. That fear is real, especially for transgender youth. Civil rights should be expanding, not being stripped away from certain communities. That’s why this fight feels so urgent.”
Since returning to the White House in 2024, the Trump administration has moved to roll back anti-discrimination protections, particularly those affecting transgender people. These efforts include barring transgender people from serving openly in the military, blocking access to gender-affirming medical care in federal health programs, challenging state laws that protect transgender students on religious grounds, and arguing that the Constitution entitles employers to discriminate against LGBTQ people based on religious beliefs — even in states with nondiscrimination laws.
For Salinas, the Equality Caucus’s most urgent task under the Trump-Vance administration is advancing what she called a long-sought but non-negotiable priority: the Equality Act.
The Equality Act would add explicit protections based on sexual orientation and gender identity to federal law. Despite more than five decades of debate on Capitol Hill, no version of the bill has yet become law.
“We have to keep pushing the Equality Act— there’s no way around that. No one should be discriminated against in housing, employment, credit, or healthcare because of who they are,” Salinas said. “Republicans are making LGBTQ identity a political wedge because they think it’s expedient, and that’s unacceptable. Sexual orientation and gender identity should not matter in determining someone’s access to opportunity. Yet here we are, still having to fight for that basic principle.”
Salinas added that advancing legislation like the Equality Act requires compassion— even when that compassion is not returned— and a commitment to education.
“We have to meet people where they are— Democrats, Republicans, independents, all of them. Until you know a family, or understand someone’s lived experience, it can feel abstract and overwhelming,” she said. “Education, compassion, and empathy are essential to moving the dial. When people understand this is about human rights, not politics, conversations start to change. That’s how we build broader support.”
She also emphasized the need for a federal transgender bill of rights, which would provide explicit protections for transgender Americans amid what she described as an increasingly hostile federal environment.
“A transgender bill of rights would clarify that discrimination against transgender and nonbinary people is illegal — in employment, housing, credit, and healthcare,” Salinas said. “What’s happening right now, with efforts to criminalize doctors for providing evidence-based care, is unheard of and dangerous. We also need to ban conversion therapy nationwide, because states are increasingly trying to undo those protections through the courts. These safeguards are about ensuring people can live safely and with dignity. That should not be controversial.”
Mental health is another central focus of Salinas’s work. She said ensuring children have access to support— particularly LGBTQ youth— is critical to their long-term wellbeing.
After the Trump administration eliminated the LGBTQ-specific option from the 988 Suicide and Crisis Lifeline, Salinas said her reaction was one of outrage.
“When Trump shut down the 988 press-three option for LGBTQ youth, I was apoplectic,” she said. “It is one of the simplest, most upstream ways to save lives, and it felt arbitrary, cruel, and inhumane. We know the suicide risk among transgender youth is far higher than among non-LGBTQ kids. Connecting them with someone who understands their experience can be life-saving. This should be bipartisan, and I’m going to keep pushing to restore it.”
“You cannot be what you cannot see….” she added while reflecting on the handful of LGBTQ leaders who have— and continue to— navigate the halls of Congress to protect their community. “When Sarah McBride was elected, my daughter met with her and walked out glowing… joyful, hopeful, and excited about the future. That kind of representation changes lives. Electing LGBTQ leaders changes the trajectory for people across the country. Grassroots organizing and electoral power go hand in hand, and we need both.”
With Salinas’s experience in both the Oregon House of Representatives and the U.S. House of Representatives, she said that while one arena may reach more people, change often begins locally, especially when combating anti-LGBTQ attacks.
“I’ve seen how misinformation fuels fear at the local level— whether it’s school board fights or bathroom debates rooted in baseless claims. There is no data to support these scare tactics,” she said, echoing her past work with the Oregon Department of Education. “What actually helps is facts, education, and training teachers to better support LGBTQ students. I passed legislation in Oregon to give educators real tools to prevent bullying and harassment. That kind of work matters just as much as what we do in Congress.”
Despite just being named vice chair of the Equality Caucus, the Blade asked Salinas what legacy she hopes to leave, particularly when it comes to LGBTQ advocacy.
“I want people to be able to live authentically, without fear from their government or their neighbors. That means passing real legislation— the Equality Act and a transgender bill of rights— so protections are not dependent on who’s in power. Civil and human rights are meant to expand, not contract.
“I’ve been doing this work since I became a mother, and I’ll keep doing it for as long as it takes. My daughter deserves it, and so does every LGBTQ person in this country.”
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)
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