Extending Medicaid Long-Term Care Impoverishment Protections to Same-Sex Couples

By Jennifer C. Pizer, Craig J. Konnoth, Christy Mallory, Brad Sears
June 2012

Overview Report

State Reports:
Colorado
Georgia
Illinois
Missouri
Pennsylvania
Utah
Virginia

When recipients of Medicaid receive long-term care benefits, Medicaid can place a lien against their homes or seek recovery from their estates after death in order to recoup the expenses of the care.  Medicaid can also penalize recipients of long-term care for giving their home or other assets away for less than full value by not covering costs of their care for a certain period of time.  State and federal law provides exceptions to these requirements when the long-term care recipient has a different-sex spouse.  These protections prevent surviving spouses from becoming impoverished by losing their homes.  Until recently, these exceptions could not include same-sex spouses or partners.

In the summer of 2011, the Center for Medicare & Medicaid Services (CMS) issued a letter informing states that federal law allows same-sex partners of recipients to be included in these impoverishment protections. However, CMS did not provide these impoverishment protections to same-sex couples directly.  States must adopt affirmative policy measures to provide them.

The Overview Report presents demographic data on same-sex couples likely to benefit if states extend these protections, explains CMS’s approach to extending impoverishment protections to same-sex couples, and provides general information about the procedures through which states may provide protections.  It also discusses two important considerations relevant to many states seeking to amend their impoverishment rules to protect same-sex couples:  (1) criteria for determining which same-sex couples will be eligible for impoverishment protections; and (2) the potential impact of state statutory or constitutional limitations on recognizing same-sex relationships.

The State Reports provide more detailed information on how to implement the policy changes in those states.