Politics
New guidance affords gay couples equal access to Medicaid
Non-marriage equality states can refuse new policy for gay couples
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.
Congress
House passes reconciliation with gender-affirming care funding ban
‘Big Beautiful Bill’ now heads to the Senate
The Republican-led U.S. House of Representatives on Thursday voted 215-214 for passage of the “One Big Beautiful Bill Act” reconciliation package, which includes provisions that would prohibit the use of federal funds to support gender-affirming care.
But for an 11th hour revision of the bill late Wednesday night by conservative lawmakers, Medicaid and CHIP would have been restricted only from covering treatments and interventions administered to patients younger than 18.
The legislation would also drop requirements that some health insurers must cover gender-affirming care as an “essential health benefit” and force states that currently mandate such coverage to find it independently. Plans could still offer coverage for transgender care but without the EHB classification patients will likely pay higher out of pocket costs.
To offset the cost of extending tax cuts from 2017 that disproportionately benefited the wealthiest Americans, the reconciliation bill contains significant cuts to spending for federal programs like Medicaid and the Supplemental Nutrition Assistance Program.
The Human Rights Campaign criticized House Republicans in a press release and statement by the group’s president, Kelley Robinson:
“People in this country want policies and solutions that make life better and expand access to the American Dream. Instead, anti-equality lawmakers voted to give handouts to billionaires built on the backs of hardworking people — with devastating consequences for the LGBTQ+ community.
“If the cuts to programs like Medicaid and SNAP or resources like Planned Parenthood clinics weren’t devastating enough, House Republicans added a last minute provision that expands its attacks on access to best practice health care to transgender adults.
“This cruel addition shows their priorities have never been about lowering costs or expanding health care access–but in targeting people simply for who they are. These lawmakers have abandoned their constituents, and as they head back to their districts, know this: they will hear from us.”
Senate Republicans are expected to pass the bill with the budget reconciliation process, which would allow them to bypass the filibuster and clear the spending package with a simple majority vote.
Changes are expected as the bill will be reviewed and amended by committees, particularly the Finance Committee, and then brought to the floor for debate — though modifications are expected to focus on Medicaid reductions and debate over state and local tax deductions.
Congress
Gerry Connolly dies at 75 after battle with esophageal cancer
Va. congressman fought for LGBTQ rights
Democratic U.S. Rep. Gerry Connolly of Virginia died on Wednesday, according to a statement from his family.
The 75-year-old lawmaker, who served in Congress since 2009, announced last month that he will not seek reelection and would step down from his role as the top Democrat on the powerful U.S. House Oversight Committee because his esophageal cancer had returned.
“We were fortunate to share Gerry with Northern Virginia for nearly 40 years because that was his joy, his purpose, and his passion,” his family said in their statement. “His absence will leave a hole in our hearts, but we are proud that his life’s work will endure for future generations.”
“He looked out for the disadvantaged and voiceless. He always stood up for what is right and just,” they said.
Connolly was memorialized in statements from colleagues and friends including House Democratic Leader Hakeem Jeffries (N.Y.), Republican House Speaker Mike Johnson (La.), former President Joe Biden, and U.S. Rep. Jamie Raskin (D-Md.).
Several highlighted Connolly’s fierce advocacy on behalf of federal workers, who are well represented in his northern Virginia congressional district.
The congressman also supported LGBTQ rights throughout his life and career.
When running for the Fairfax County Board of Supervisors in 1994, he fought the removal of Washington Blade newspapers from libraries. When running in 2008 for the U.S. house seat vacated by Tom Davis, a Republican, Connolly campaigned against the amendment to Virginia’s constitution banning same-sex marriage and civil unions in the state.
In Congress, he supported the repeal of “Don’t Ask, Don’t Tell,” the U.S. Supreme Court’s ruling on marriage equality, the Biden-Harris administration’s rescission of the anti-trans military ban, and the designation within the State Department of a special LGBTQ rights envoy. The congressman also was an original cosponsor of the Equality Act and co-sponsored legislation to repeal parts of the Defense of Marriage Act.
Congress
Marjorie Taylor Greene’s bill to criminalize gender affirming care advances
Judiciary Committee markup slated for Wednesday morning
U.S. Rep. Marjorie Taylor Greene (R-Ga.)’s “Protect Children’s Innocence Act,” which would criminalize guideline-directed gender affirming health care for minors, will advance to markup in the House Judiciary Committee on Wednesday morning.
Doctors and providers who administer medical treatments for gender dysphoria to patients younger than 18, including hormones and puberty blockers, would be subject to Class 3 felony charges punishable by up to 10 years in prison if the legislation is enacted.
LGBTQ advocates warn conservative lawmakers want to go after families who travel out of state to obtain medical care for their transgender kids that is banned or restricted in the places where they reside, using legislation like Greene’s to expand federal jurisdiction over these decisions. They also point to the medically inaccurate way in which the bill characterizes evidence-based interventions delineated in standards of care for trans and gender diverse youth as “mutilation” or “chemical castration.”
Days into his second term, President Donald Trump signed “Protecting Children from Chemical and Surgical Mutilation,” an executive order declaring that the U.S. would not “fund, sponsor, promote, assist, or support the so-called ‘transition’ of a child from one sex to another, and it will rigorously enforce all laws that prohibit or limit” medical treatments and interventions intended for this purpose.
Greene, who has introduced the bill in years past, noted the president’s endorsement of her bill during his address to the joint session of Congress in March when he said “I want Congress to pass a bill permanently banning and criminalizing sex changes on children and forever ending the lie that any child is trapped in the wrong body.”
PHOTOS: Helen Hayes Awards
Laverne Cox, Reneé Rapp, Deacon Maccubbin named WorldPride grand marshals
House passes reconciliation with gender-affirming care funding ban
PHOTOS: D.C. Trans Pride
Men convicted of murdering two men in NYC gay bar drugging scheme sentenced
Looking back at 50 years of Pride in D.C
WorldPride events round-up
Pope Leo XIV: Family based on ‘stable union between a man and a woman’
Wes Moore signs HIV decriminalization bill
