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New guidance affords gay couples equal access to Medicaid

Non-marriage equality states can refuse new policy for gay couples

Published

12 years ago

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Centers for Medicare & Medicaid Services, gay news, Washington Blade
Centers for Medicare & Medicaid Services, gay news, Washington Blade

The Centers for Medicare & Medicaid has issued new post-DOMA guidance (Image public domain).

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.

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Congress

Shaheen, Collins reintroduce bill prohibiting anti-LGBTQ discrimination in jury service

Senators note the absence of protections in federal courtrooms

Published

1 day ago

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June 18, 2025

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U.S. Sen. Jeanne Shaheen (D-N.H.) (Washington Blade photo by Michael Key)

U.S. Sens. Jeanne Shaheen (D-N.H.) and Susan Collins (R-Maine) reintroduced a bill on Wednesday that would prohibit discrimination on the basis of sexual orientation and gender identity during the federal jury selection process.

The bipartisan Jury Access for Capable Citizens and Equality in Service Selection (ACCESS) Act would enshrine protections for LGBTQ Americans who are serving or who might be selected to serve on juries, alongside rules proscribing discrimination on the basis of race, color, religion, sex, national origin, and economic status that are already enforced in federal courtrooms.

Co-sponsoring the bill with Shaheen and Collins are U.S. Sens. Sheldon Whitehouse (D-R.I.), Ed Markey (D-Mass.), Martin Heinrich (D-N.M.), Peter Welch (D-Vt.), Catherine Cortez Masto (D-Nev.), Mazie Hirono (D-Hawaii), Ben Ray Luján (D-N.M.) and Chris Coons (D-Del.)

“Serving on a jury is a civic duty that no one should be prevented from fulfilling because of who they are or who they love,” Shaheen said in a press release. “It’s preposterous that under current law there are no protections prohibiting discrimination against LGBTQ+ jurors in federal courts and Congress must take action to rectify this injustice.” 

“Serving on a jury is a fundamental right and obligation that no individual should be prohibited from fulfilling based on their sexual orientation or gender identity,” said Collins. “I have long worked to fight discrimination, and I am proud to join this effort to help eliminate bias from our judicial system.” 

Amid the absence of nationwide protections, the release notes that only 17 states “prohibit exclusion from jury service in state court based on sexual orientation” while “just 12 protect against discrimination based on gender identity.”

This spring, Democratic lawmakers from the House and the Senate, including leadership from both chambers, reintroduced the Equality Act, which would codify LGBTQ inclusive federal nondiscrimination rules in a range of contexts from employment and housing to public accommodations and education.

Shaheen and Collins were integral to the bill’s inclusion of protections applying to jury service.

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Congress

Torres: gay Venezuelan asylum seeker is ‘poster child’ for Trump’s ‘abuses against due process’

Congressman spoke with the Blade Thursday

Published

6 days ago

on

June 13, 2025

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Democratic U.S. Rep. Ritchie Torres of New York told the Washington Blade during an interview Thursday that his party erred in focusing so much attention on demands for the Trump-Vance administration to return Kilmar Abrego Garcia to the U.S. when the wrongful deportation of Andry Hernández Romero “was much more egregious.”

Hernández is a gay Venezuelan national who was deported to El Salvador in March and imprisoned in the country’s notorious Terrorism Confinement Center, a maximum-security prison known by the Spanish acronym CECOT.

“In the case of Andry, the government admits that it has no evidence of gang membership, but he was deported without due process, without a notification to his attorney, without a court hearing to contest the allegations against him, without a court order authorizing his deportation,” the congressman said.

“He had not even the slightest semblance of due process,” Torres said. “And even though he had a court hearing scheduled for March 17, the Trump administration proceeded to deport him on March 15, in violation of a court order.”

“I think we as a party should have held up Andry as the poster child for the abuses against due process, because his case is much more sympathetic,” Torres said. “There’s no one who thinks that Andry is a gang member.”

“Also,” the congressman added, “he’s not a quote-unquote illegal immigrant. He was a lawful asylum seeker. He sought asylum lawfully under the statutes of the United States, but he was deported unlawfully at the hands of the Trump administration.”

Torres was among the 49 members of Congress who joined with Democratic U.S. Sens. Alex Padilla and Adam Schiff of California in writing to Secretary of State Marco Rubio on Monday demanding information about Romero, including proof of life.

The lawmakers urged the State Department to facilitate his access to legal counsel and take steps to return him, expressing fear for his safety — concerns that Torres reiterated on Thursday.

“Jails and prisons can be dangerous places for gay men, and that is especially true of a place like CECOT,” the congressman said. “He fled Latin America to escape violent homophobia. There are a few places on earth that have as much institutionalized homophobia as jails and prisons, and so I do fear for his safety.”

“I released a video telling the story of Andry,” Torres noted, adding, “I feel like we have to do more to raise awareness and the video is only the beginning … And you know, the fact that Abrego Garcia is returning to the United States shows that the administration has the ability to bring back the migrants who were unlawfully deported.”

Torres spoke with the Blade just after Padilla was forcibly removed from a federal building in Los Angeles after attempting to question U.S. Homeland Security Secretary Kristi Noem during a press conference on immigration Thursday.

Footage of the senator being pushed out of the room, onto the floor, and handcuffed by officers wearing FBI identifying vests drew outrage from top Democrats in California and beyond.

“It’s the latest reminder that Donald Trump and his administration have no respect for anything or anyone but himself,” Torres told the Blade. “And every bit as outrageous as Donald Trump himself has been the enabling on the part of the congressional Republicans who are aiding and abetting his authoritarian abuses.”

“We have to be vigilant in resisting Donald Trump,” the congressman said. “We have to resist him on the streets through grassroots mobilization. We have to resist him in the courtrooms through litigation. We have to resist him in the halls of Congress through legislation.”

Torres added that “we have to win back the majority in 2026” and “if Republicans have no interest in holding Donald Trump accountable, then those Republicans should be fired from public office” because “we need a Congress that is able and willing to hold Donald Trump accountable, to stand up to his authoritarian assault on our democracy.”

Resisting is “a matter of free speech,” he said, noting that the president’s aim is to “create a reign of terror that intimidates people into silence,” but “we cannot remain silent. We have to unapologetically and courageously exercise our right to free speech, our right to assemble peacefully, and our right to resist an authoritarian president like Donald Trump.”

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Congress

Padilla forcibly removed from federal building for questioning DHS secretary

Prominent Democrats rushed to defend senator

Published

7 days ago

on

June 12, 2025

By

U.S. Sen. Alex Padilla (D-Calif.) (Washington Blade photo by Michael Key)

Democratic U.S. Sen. Alex Padilla of California was forcibly removed from a federal building in Los Angeles after attempting to ask questions of U.S. Homeland Security Secretary Kristi Noem during a press conference on immigration Thursday

The city has been rattled in recent days as protestors objecting to the Trump-Vance administration’s immigration crackdowns clashed with law enforcement and then the president deployed National Guard troops and U.S. Marines, which was seen as a dramatic escalation.

According to a video shared by his office, the senator, who serves as ranking member of the Senate Judiciary Immigration Subcommittee, introduced himself and said, I have questions for the secretary.” After he was pushed out of the room, officers with FBI-identifying vests told Padilla to put his hands behind his back and handcuffed him.

“Senator Padilla is currently in Los Angeles exercising his duty to perform Congressional oversight of the federal government’s operations in Los Angeles and across California,” reads a statement from his office.

“He was in the federal building to receive a briefing with General Guillot and was listening to Secretary Noem’s press conference,” the statement continued. “He tried to ask the secretary a question, and was forcibly removed by federal agents, forced to the ground and handcuffed. He is not currently detained, and we are working to get additional information.”

Democrats were furious, with many releasing strong statements online condemning the actions of law enforcement officers, including California Gov. Gavin Newsom (D), Los Angeles Mayor Karen Bass (D), and the state’s other U.S. senator, Adam Schiff (D).

Human Rights Campaign Chief of Staff Jay Brown also issued a statement: “A sitting U.S. senator should be allowed to ask a Cabinet secretary a question at a press conference — in his own state, on an issue affecting his constituents — without being violently thrown to the floor and handcuffed. Everyone who cares about our country must condemn this undemocratic act. Full stop.”



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