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
Congress passes ‘Big, Beautiful Bill’ with massive cuts to health insurance coverage
Roughly 1.8 million LGBTQ Americans rely on Medicaid
The “Big, Beautiful Bill” heads to President Donald Trump’s desk following the vote by the Republican majority in the U.S. House of Representatives Thursday, which saw two nays from GOP members and unified opposition from the entire Democratic caucus.
To partially offset the cost of tax breaks that disproportionately favor the wealthy, the bill contains massive cuts to Medicaid and social safety net programs like food assistance for the poor while adding a projected $3.3 billion to the deficit.
Policy wise, the signature legislation of Trump’s second term rolls back clean energy tax credits passed under the Biden-Harris administration while beefing up funding for defense and border security.
Roughly 13 percent of LGBTQ adults in the U.S., about 1.8 million people, rely on Medicaid as their primary health insurer, compared to seven percent of non-LGBTQ adults, according to the UCLA School of Law’s Williams Institute think tank on sexual orientation and gender identities.
In total, the Congressional Budget Office estimates the cuts will cause more than 10 million Americans to lose their coverage under Medicaid and anywhere from three to five million to lose their care under Affordable Care Act marketplace plans.
A number of Republicans in the House and Senate opposed the bill reasoning that they might face political consequences for taking away access to healthcare for, particularly, low-income Americans who rely on Medicaid. Poorer voters flocked to Trump in last year’s presidential election, exit polls show.
A provision that would have blocked the use of federal funds to reimburse medical care for transgender youth was blocked by the Senate Parliamentarian and ultimately struck from the legislation — reportedly after the first trans member of Congress, U.S. Rep. Sarah McBride (D-Del.) and the first lesbian U.S. senator, Tammy Baldwin (D-Wis.), shored up unified opposition to the proposal among Congressional Democrats.
Congress
Ritchie Torres says he is unlikely to run for NY governor
One poll showed gay Democratic congressman nearly tied with Kathy Hochul
Gay Democratic Congressman Ritchie Torres of New York is unlikely to challenge New York Gov. Kathy Hochul (D) in the state’s next gubernatorial race, he said during an appearance Wednesday on MSNBC’s “Morning Joe.”
“I’m unlikely to run for governor,” he said. ““I feel like the assault that we’ve seen on the social safety net in the Bronx is so unprecedented. It’s so overwhelming that I’m going to keep my focus on Washington, D.C.”
Torres and Hochul were nearly tied in a poll this spring of likely Democratic voters in New York City, fueling speculation that the congressman might run. A Siena College poll, however, found Hochul leading with a wider margin.
Back in D.C., the congressman and his colleagues are unified in their opposition to President Donald Trump’s signature legislation, the “Big Beautiful Bill,” which heads back to the House after passing the Senate by one vote this week.
To pay for tax cuts that disproportionately advantage the ultra-wealthy and large corporations, the president and Congressional Republicans have proposed massive cuts to Medicaid and other social programs.
A provision in the Senate version of the bill that would have blocked the use of federal funds to reimburse medical care for transgender youth was blocked by the Senate Parliamentarian and ultimately struck from the legislation, reportedly after pressure from transgender U.S. Rep. Sarah McBride (D-Del.) and lesbian U.S. Sen. Tammy Baldwin (D-Wis.).
Torres on “Morning Joe” said, “The so-called Big Beautiful Bill represents a betrayal of the working people of America and nowhere more so than in the Bronx,” adding, “It’s going to destabilize every health care provider, every hospital.”
Congress
House Democrats oppose Bessent’s removal of SOGI from discrimination complaint forms
Congressional Equality Caucus sharply criticized move
A letter issued last week by a group of House Democrats objects to Treasury Secretary Scott Bessent’s removal of sexual orientation and gender identity as bases for sex discrimination complaints in several Equal Employment Opportunity forms.
Bessent, who is gay, is the highest ranking openly LGBTQ official in American history and the second out Cabinet member next to Pete Buttigieg, who served as transportation secretary during the Biden-Harris administration.
The signatories to the letter include a few out members of Congress, Congressional Equality Caucus chair and co-chairs Mark Takano (Calif.), Ritchie Torres (N.Y.), and Becca Balint (Vt.), along with U.S. Reps. Nikema Williams (Ga.), Hank Johnson (Ga.), Raja Krishnamoorthi (Ill.), Delia Ramirez (Ill.), Joyce Beatty (Ohio), Lloyd Doggett (Texas), Eleanor Holmes Norton (D.C.), Josh Gottheimer (N.J.), and Sylvia Garcia (D-Texas).
The letter explains the “critical role” played by the EEO given the strictures and limits on how federal employees can find recourse for unlawful workplace discrimination — namely, without the ability to file complaints directly with the Employment Opportunity Commission or otherwise engage with the agency unless the complainant “appeal[s] an agency’s decision following the agency’s investigation or request[s] a hearing before an administrative judge.”
“Your attempt to remove ‘gender identity’ and ‘sexual orientation’ as bases for sex discrimination complaints in numerous Equal Employment Opportunity (EEO) forms will create unnecessary hurdles to employees filing EEO complaints and undermine enforcement of federal employee’s nondiscrimination protections,” the members wrote in their letter.
They further explain the legal basis behind LGBTQ inclusive nondiscrimination protections for federal employees in the EEOC’s decisions in Macy v. Holder (2012) and Baldwin v. Foxx (2015) and the U.S. Supreme Court’s decision in Bostock v. Clayton County (2020).
“It appears that these changes may be an attempt by the department to dissuade employees from reporting gender identity and sexual orientation discrimination,” the lawmakers wrote. “Without forms clearly enumerating gender identity and sexual orientation as forms of sex discrimination, the average employee who experiences these forms of discrimination may see these forms and not realize that the discrimination they experienced was unlawful and something that they can report and seek recourse for.”
“A more alarming view would be that the department no longer plans to fulfill its legal obligations to investigate complaints of gender identity and sexual orientation and ensure its
employees are working in an environment free from these forms of discrimination,” they added.
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