HRC Blog

Obama Administration Announces Two Important Steps Toward Equal Access to Healthcare

This post comes from HRC Legislative Counsel Robin Maril.

Today, the Obama administration published two policies that will help improve access to quality healthcare for the LGBT community.  First, the Department of Health and Human Services (HHS) issued guidance clarifying that state Medicaid agencies have authority to provide same-sex couples with equal access to the financial and asset protections available to opposite-sex couples when a partner enters a nursing home or care facility.  In a letter to state agencies, the Centers for Medicare and Medicaid Services advised that the agencies may take steps to ensure that same-sex partners can remain in shared homes and to protect same-sex partners under estate recovery and transfer of assets rules.   In a statement from HHS, Secretary Kathleen Sebelius noted that “low-income same-sex couples are too often denied equal treatment and the protections offered to other families in their greatest times of need.  This is now changing. Today’s guidance represents another important step toward ensuring that the rights and dignity of every American are respected by their government.”  The full policy is available at www.cms.gov/SMDL/SMD/list.asp.

Medicaid currently requires individuals in need of nursing care to exhaust most of their personal incomes and assets before qualifying for this long-term care benefit.  While there are protections ensuring that the spouse of a Medicaid nursing home resident may remain in the couple’s home and retain assets he or she needs to live comfortably, because of marriage discrimination in the states and the federal Defense of Marriage Act, same-sex couples do not have access to these safeguards.   This disparity results in displacement, insecurity, and even homelessness for some LGBT elders.  Today’s announcement clarifies that state agencies can voluntarily extend these protections when the same-sex spouse or domestic partner of the Medicaid enrollee continues to reside in their home.  While this is a positive step forward, the federal Defense of Marriage Act prevents today’s guidance from being a mandate, and same-sex couples in states that choose not to take these steps will remain vulnerable.

Also today, the Veterans Health Administration published a directive to ensure improved access to quality health care for transgender veterans served by the Department of Veterans Affairs (VA) healthcare system. Today’s directive establishes a policy of respectful delivery of healthcare to transgender and intersex veterans in all VA facilities.

The directive specifically requires VA staff to provide equal care to transgender patients "without discrimination in a manner consistent with care and management of all Veteran patients."   While the directive reiterates that sex reassignment surgery cannot be performed by, or paid for, by the VA, all other medically necessary healthcare for transgender veterans is covered, including sex-specific wellness care like mammograms and pap smears, as well as other transition-related care.  The directive also provides important guidance on the confidentiality of personal information pertaining to transgender status and medical care.  It is available online at www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2416.

Today’s action is an important first step to improving healthcare for transgender and intersex individuals.  It will not only help secure equal access to healthcare provided by the VA for transgender and intersex veterans, but it also provides a meaningful example for other healthcare providers as to ways to ensure equal, quality care for all transgender and intersex patients.

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