Gov. Larry Hogan may have sent a message of "tolerance and mutual respect" during his inauguration on Wednesday, but advocates for the state's lesbian, gay, bisexual and transgender community say his early actions in office have signaled something different.
In one of his first acts, Hogan held up a regulation that would have banned Medicaid providers in the state from discriminating on the basis of sexual orientation and gender identity, according to state officials. The provision was proposed in recent months under the administration of Hogan's predecessor, Martin O'Malley, at the urging of LGBT groups.
"To withdraw a regulation that prohibits discrimination in the provision of essential medical services, which also has no fiscal impact, seems contrary to the spirit of inclusiveness touted in his inauguration speech yesterday," said Carrie Evans, executive director of Equality Maryland, the state's largest LGBT advocacy organization, in a statement. "We know that trans people in Maryland face discrimination when accessing health care and we should be working to ensure this doesn't happen instead of overtly condoning it."
The regulation also would have explicitly prevented discrimination based on religious affiliation and made the current Medicaid regulatory language consistent with the state's other non-discrimination laws.
The rule-making is separate from a state effort to end exclusions for transgender patients' transition care under Medicaid, about which advocates also are concerned. The state took the step of providing similar coverage to state employees last summer.
The regulation was one of five that Hogan pulled back prior to their appearing in the Maryland Register on Friday, preventing them from taking effect as his office reviews them further.
"We just basically pulled all the regulations that were supposed to be published on Friday," Hogan said Thursday. "We didn't like the fact that [O'Malley] was trying to push these things through at the last minute. We're going to make sure our new … team throughout government reviews every one of these regulations to make sure which direction we should head."
Two other regulations he held back also relate to health care. One would have implemented mid-year adjustments to HealthChoice, the state's mandatory managed care program, and added supplemental medical payments for Hepatitis C therapy services. The other would have changed eligibility periods and premium adjustment requirements under the Employed Individuals with Disabilities Program, managed by the Department of Health and Mental Hygiene.
The last two regulations Hogan withheld were environmental regulations. One would have curbed Eastern Shore farmers' use of poultry manure on their fields. The second would have clamped down on air pollution from coal-burning power plants.
Hogan's office has said he wants to review the provisions to be sure they are warranted.
State analysts previously determined the Medicaid discrimination change would have no fiscal impact on the state budget, making Hogan's hesitation even more troubling, advocates said.
Hogan also drew criticism from the LGBT community for issuing an executive order Wednesday warning executive branch employees they must adhere to "laws and regulations that provide equal opportunity for all Marylanders," but left gender identity out of a list of protected categories even though the Fairness for All Marylanders Act of 2014 established specific protections for transgender residents in Maryland.
On Thursday, Equality Maryland and Free State Legal Project, a prominent LGBT legal advocacy group, issued a joint statement about Hogan's actions, saying the first 24 hours of his tenure were "not a good sign" for the LGBT community.
Jer Welter, Free State Legal's deputy director and managing attorney, commended the governor for issuing an executive order directing executive branch employees to adhere to equal opportunity laws in Maryland.
"However," he wrote, "those laws now include gender identity and we urge him to re-issue this Order with all of the current prohibited grounds included in state law."