Federal Government
Rulemaking on Older Americans Act targets seniors who are LGBTQ, living with HIV
Monday was National HIV/AIDS and Aging Awareness Day
Ahead of Monday’s National HIV/AIDS and Aging Awareness Day, the Washington Blade spoke with Aaron Tax, director of federal government relations for SAGE, to discuss what proposed updates to the Older Americans Act might mean for LGBTQ elders and older adults living with HIV.
The conversation followed the conclusion of the public comment period for a Notice of Proposed Rulemaking filed by the Administration for Community Living, a U.S. Department of Health and Human Services agency that is responsible for administering the statute.
An HHS spokesperson told the Blade a final rule is expected “early next year.”
“We’ve looked at the many challenges facing LGBT older people and older people living with HIV,” said Tax, whose organization, Services and Advocacy for GLBT Elders, is the country’s largest group focused on the needs of LGBTQ seniors.
These populations experience “higher rates of social isolation” and “higher rates of poverty” and are “less likely to be partnered, less likely to have children, [and are] more culturally and socially isolated from mainstream institutions,” he said.
Therefore, they “seem to fit the definition of greatest social need quite well,” Tax said, referring to a distinction in the legislation that SAGE has sought to effectuate for LGBTQ elders and older adults with HIV, coming “quite close” in the law’s 2020 reauthorization.
Tax explained, “what we got at the end of the day is some language that requires every state unit on aging in the country and every area agency on aging in the country — which are basically state departments of aging and local departments of aging — to do three things.
“One,” he said, “engage in outreach to LGBT older people; two, to collect data on their needs; and three, to collect data on whether they are meeting their needs.”
SAGE is now working with these state and local entities to ensure “they’re, in fact, carrying out these requirements” Tax said.
Next year, the Older Americans Act will be up for reauthorization again, so “we will once again be fighting for an explicit greatest social need designation again for LGBT older people and older people living with HIV,” he said, adding, “And we recently introduced legislation with [U.S. Rep.] Suzanne Bonamici [D-Ore.] that would try to accomplish that goal in 2024.”
The legislation, Tax explained, originally “came about in 1965 under Lyndon Johnson’s Great Society as a counterpart to Medicare and Social Security,” which respectively addressed the medical and financial needs of older Americans.
“The Older Americans Act is everything else that should enable you to age in place in your community,” Tax said — and, as such, the statute covers, among other programs, “home and congregate meals and meals at senior centers, Meals on Wheels, transportation assistance, legal assistance, caregiver support, respite, all the things that have enabled people to age in place in their community.”
SAGE’s legislative efforts are coupled with advocacy around the administration and enforcement of the statute by ACL, which prior to the forthcoming rulemaking has not issued new regulations on the Older Americans Act since 1988, Tax said.
“Part of that,” he said, “is because there have been so many legislative changes since the law came about in 1988, so, their goal now is to modernize those regs and recognize the changes to the OAA and also maybe put some additional information in there or some additional guidance in there that might not be captured in the statute.”
SAGE wants the ACL “to be as explicit as possible, as proscriptive as possible, about ensuring that the aging network is meeting the needs of both LGBT older people and older people living with HIV,” Tax said, which informed the organization’s public comment to the agency.
This work is important because there are state-by-state differences in how older LGBTQ adults and seniors with HIV are treated, Tax said.
For instance, the “New York State Office for the Aging is extremely aware of the needs of LGBT older people and older people living with HIV,” he said. “They acknowledge that in the work that they do; they’re very intentional in the work that they do to meet the needs of LGBT folks and older people living with HIV.”
Tax said, “we are working hard at SAGE to make sure that other states first acknowledge that this population, or these populations, even exist, and secondly, [that they] are doing more to make sure that LGBT older people and older people living with HIV have access to the same aging services and supports other older people have access to.”
Politics, unfortunately, can play a role, Tax told the Blade.
“When anti equality forces are in control in the White House, of course, that does have an impact on the types of rules and regulations you see coming out of the administration and its agencies” he said.
By contrast, “it’s pretty clear now with the Biden administration’s focus on equity and its interest in making sure that LGBT folks are treated like everybody else, that we’re seeing regulations or proposed regulations that incorporate those important themes.”
“There are good people in state agencies across the country who want to do the right thing,” Tax said, but “Sometimes they bump up against the political realities of their states.”
“We are working hard at SAGE to make sure people who want to do the right thing regardless of what state they live in have the resources and the information and the tools that they need to take care of all of the older people in their states,” Tax said.
Federal Government
US Census Bureau testing survey on LGBTQ households
Agency proposing questions about sexual orientation and gender identity
The U.S. Census Bureau is seeking public comment on a proposed test of sexual orientation and gender identity questions on the American Community Survey. The test would begin this summer and continue into next year.
The Census Bureau published the request as a Federal Register notice. In its press release the agency noted that the ACS is an ongoing survey that collects detailed housing and socioeconomic data. It allows the Census Bureau to provide timely and relevant housing and socioeconomic statistics, even for low levels of geography.
As part of the process for adding new questions to the ACS, the Census Bureau tests potential questions to evaluate the quality of the data collected.
The Census Bureau proposes testing questions about sexual orientation and gender identity to meet the needs of other federal agencies that have expressed interest in or have identified legal uses for the information, such as enforcing civil rights and equal employment measures.
The test would follow the protocols of the actual ACS — with one person asked to respond to the survey on behalf of the entire household. These particular questions are asked about people 15 years of age or older. Households are invited to respond to the survey online, by paper questionnaire or by phone.
The current Federal Register notice gives the public a final opportunity to provide feedback before the Census Bureau submits its recommendations to the Office of Management and Budget for approval. The public may provide feedback through May 30 online.
Federal Government
Republican state AGs challenge Biden administration’s revised Title IX policies
New rules protect LGBTQ students from discrimination
Four Republicans state attorneys general have sued the Biden-Harris administration over the U.S. Department of Education’s new Title IX policies that were finalized April 19 and carry anti-discrimination protections for LGBTQ students in public schools.
The lawsuit filed on Tuesday, which is led by the attorneys general of Kentucky and Tennessee, follows a pair of legal challenges from nine Republican states on Monday — all contesting the administration’s interpretation that sex-based discrimination under the statute also covers that which is based on the victim’s sexual orientation or gender identity.
The administration also rolled back Trump-era rules governing how schools must respond to allegations of sexual harassment and sexual assault, which were widely perceived as biased in favor of the interests of those who are accused.
“The U.S. Department of Education has no authority to let boys into girls’ locker rooms,” Tennessee Attorney General Jonathan Skrmetti said in a statement. “In the decades since its adoption, Title IX has been universally understood to protect the privacy and safety of women in private spaces like locker rooms and bathrooms.”
“Florida is suing the Biden administration over its unlawful Title IX changes,” Florida Gov. Ron DeSantis wrote on social media. “Biden is abusing his constitutional authority to push an ideological agenda that harms women and girls and conflicts with the truth.”
After announcing the finalization of the department’s new rules, Education Secretary Miguel Cardona told reporters, “These regulations make it crystal clear that everyone can access schools that are safe, welcoming and that respect their rights.”
The new rule does not provide guidance on whether schools must allow transgender students to play on sports teams corresponding with their gender identity to comply with Title IX, a question that is addressed in a separate rule proposed by the agency in April.
LGBTQ and civil rights advocacy groups praised the changes. Lambda Legal issued a statement arguing the new rule “protects LGBTQ+ students from discrimination and other abuse,” adding that it “appropriately underscores that Title IX’s civil rights protections clearly cover LGBTQ+ students, as well as survivors and pregnant and parenting students across race and gender identity.”
Federal Government
4th Circuit rules gender identity is a protected characteristic
Ruling a response to N.C., W.Va. legal challenges
BY ERIN REED | The 4th U.S. Circuit Court of Appeals ruled Monday that transgender people are a protected class and that Medicaid bans on trans care are unconstitutional.
Furthermore, the court ruled that discriminating based on a diagnosis of gender dysphoria is discrimination based on gender identity and sex. The ruling is in response to lower court challenges against state laws and policies in North Carolina and West Virginia that prevent trans people on state plans or Medicaid from obtaining coverage for gender-affirming care; those lower courts found such exclusions unconstitutional.
In issuing the final ruling, the 4th Circuit declared that trans exclusions were “obviously discriminatory” and were “in violation of the equal protection clause” of the Constitution, upholding lower court rulings that barred the discriminatory exclusions.
The 4th Circuit ruling focused on two cases in states within its jurisdiction: North Carolina and West Virginia. In North Carolina, trans state employees who rely on the State Health Plan were unable to use it to obtain gender-affirming care for gender dysphoria diagnoses.
In West Virginia, a similar exclusion applied to those on the state’s Medicaid plan for surgeries related to a diagnosis of gender dysphoria. Both exclusions were overturned by lower courts, and both states appealed to the 4th Circuit.
Attorneys for the states had argued that the policies were not discriminatory because the exclusions for gender affirming care “apply to everyone, not just transgender people.” The majority of the court, however, struck down such a claim, pointing to several other cases where such arguments break down, such as same-sex marriage bans “applying to straight, gay, lesbian, and bisexual people equally,” even though straight people would be entirely unaffected by such bans.
Other cases cited included literacy tests, a tax on wearing kippot for Jewish people, and interracial marriage in Loving v. Virginia.
See this portion of the court analysis here:
Of particular note in the majority opinion was a section on Geduldig v. Aiello that seemed laser-targeted toward an eventual U.S. Supreme Court decision on discriminatory policies targeting trans people. Geduldig v. Aiello, a 1974 ruling, determined that pregnancy discrimination is not inherently sex discrimination because it does not “classify on sex,” but rather, on pregnancy status.
Using similar arguments, the states claimed that gender affirming care exclusions did not classify or discriminate based on trans status or sex, but rather, on a diagnosis of gender dysphoria and treatments to alleviate that dysphoria.
The majority was unconvinced, ruling, “gender dysphoria is so intimately related to transgender status as to be virtually indistinguishable from it. The excluded treatments aim at addressing incongruity between sex assigned at birth and gender identity, the very heart of transgender status.” In doing so, the majority cited several cases, many from after Geduldig was decided.
Notably, Geduldig was cited in both the 6th and 11th Circuit decisions upholding gender affirming care bans in a handful of states.
The court also pointed to the potentially ridiculous conclusions that strict readings of what counts as proxy discrimination could lead to, such as if legislators attempted to use “XX chromosomes” and “XY chromosomes” to get around sex discrimination policies:
Importantly, the court also rebutted recent arguments that Bostock applies only to “limited Title VII claims involving employers who fired” LGBTQ employees, and not to Title IX, which the Affordable Care Act’s anti-discrimination mandate references. The majority stated that this is not the case, and that there is “nothing in Bostock to suggest the holding was that narrow.”
Ultimately, the court ruled that the exclusions on trans care violate the Equal Protection Clause of the Constitution. The court also ruled that the West Virginia Medicaid Program violates the Medicaid Act and the anti-discrimination provisions of the Affordable Care Act.
Additionally, the court upheld the dismissal of anti-trans expert testimony for lacking relevant expertise. West Virginia and North Carolina must end trans care exclusions in line with earlier district court decisions.
The decision will likely have nationwide impacts on court cases in other districts. The case had become a major battleground for trans rights, with dozens of states filing amicus briefs in favor or against the protection of the equal process rights of trans people. Twenty-one Republican states filed an amicus brief in favor of denying trans people anti-discrimination protections in healthcare, and 17 Democratic states joined an amicus brief in support of the healthcare rights of trans individuals.
Many Republican states are defending anti-trans laws that discriminate against trans people by banning or limiting gender-affirming care. These laws could come under threat if the legal rationale used in this decision is adopted by other circuits. In the 4th Circuit’s jurisdiction, West Virginia and North Carolina already have gender-affirming care bans for trans youth in place, and South Carolina may consider a similar bill this week.
The decision could potentially be used as precedent to challenge all of those laws in the near future and to deter South Carolina’s bill from passing into law.
The decision is the latest in a web of legal battles concerning trans people. Earlier this month, the 4th Circuit also reversed a sports ban in West Virginia, ruling that Title IX protects trans student athletes. However, the Supreme Court recently narrowed a victory for trans healthcare from the 9th U.S. Circuit Court of Appeals and allowed Idaho to continue enforcing its ban on gender-affirming care for everyone except the two plaintiffs in the case.
Importantly, that decision was not about the constitutionality of gender-affirming care, but the limits of temporary injunctions in the early stages of a constitutional challenge to discriminatory state laws. It is likely that the Supreme Court will ultimately hear cases on this topic in the near future.
Celebrating the victory, Lambda Legal Counsel and Health Care Strategist Omar Gonzalez-Pagan said in a posted statement, “The court’s decision sends a clear message that gender-affirming care is critical medical care for transgender people and that denying it is harmful and unlawful … We hope this decision makes it clear to policy makers across the country that health care decisions belong to patients, their families, and their doctors, not to politicians.”
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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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