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.
2026 Midterm Elections
Markey’s primary win deemed success for LGBTQ activists
Mass. lawmaker champions transgender rights
U.S. Sen. Ed Markey (D-Mass.) clinched the Democratic seat for his reelection campaign in Massachusetts’s primary election on Tuesday.
Markey won the deep-blue state with 64.8 percent of the vote, according to NBC News, triumphing over Marine Corps combat veteran and Congressman Seth Moulton, who received 35.2 percent of the vote.
Massachusetts’s primary election, which determined which Democratic candidate will head to the polls to face off against the Republican challenger in November, is being considered a victory for LGBTQ-inclusive policy, as well as for a divisive pro-transgender rights candidate — both things Markey has become an outspoken champion of.
Markey has experience at multiple levels of government, from the state level, where he served three terms in the state House of Representatives, to his federal tenure, including 20 terms in the U.S. House of Representatives and is now serving his second term as a senator. He has become a fixture of a changing Democratic Party in one of the most consistently blue places in the U.S.
This primary — and much of the national discussion surrounding the Senate seat — focused a lot of campaigning power on fighting the growing sentiment, led mostly by Republicans, that the frustration many Americans feel lends itself to an anti-establishment and anti-incumbent attitude.
Markey ran his campaign using his past as a reflection of his commitment to constantly putting his best foot forward for Bay Staters — particularly with apprehension for issues younger and more progressive democrats have been righting for — including Green New Deal and “Medicare for All” while Moulton — who was also elected to federal office prior to this run — campaigned on being younger than Markey, arguing that he was not the same type of established politician.
Moulton also faced backlash for negative comments about trans athletes, sparking criticism for those who did want younger candidate but want for trans rights to be protected.
Markey’s track record of supporting the LGBTQ community is one of the most clear in federal politics, one that has garnered a “100 percent lifetime voting record” on the Human Rights Campaign’s PAC politician review scorecard.
That list of Markey’s actions includes being a cosponsor of the Equality Act, driving landmark legislation to ensure federal protections for LGBTQ Americans, and being one of the most vocal proponents for trans rights in the federal government — specifically in multiple appropriations bills and in the National Defense Authorization Act. He was also the lead sponsor of the Transgender Health Care Access Act and the Transgender Bill of Rights resolution.
Markey first introduced the Transgender Bill of Rights in the Senate in 2023, where it ultimately failed to be brought to law. He reintroduced the legislation this year once again. This was a direct response to the attitude pushed by many conservatives after 2021, when the push to minimize trans rights started to become a key part of their cause and has been constantly propped up by the Trump-Vance administration.
“Massachusetts needs a senator who stands up and fights back, a senator who never forgets who they are fighting for,” Markey said during his victory speech. “That has been the mission of my life, and it always will be.”
Following the calling of the primary, a slew of LGBTQ organizations rallied behind Markey, many pushing his past as an asset that puts his money where his mouth is through advocating for legislation specifically protecting the LGBTQ community.
Tyler Hack, the executive director of the Christopher Street Project, an organization dedicated to pushing for legal protections for trans americans, released a statement following Markey’s win. Hack argued that putting forward such a staunchly pro-trans candidate is a win for the community, especially after endorsing him earlier this year.
“Tonight, anti-trans politics lost. Massachusetts rejected the idea that attacking transgender people is a shortcut to political power. Voters chose a different path: one where equality is not negotiable, cruelty is not courage, and transgender people do not have to disappear for Democrats to succeed.”
The Human Rights Campaign also endorsed him as a candidate earlier this year and issued a statement via its president, Kelley Robinson.
“Ed Markey has spent decades fighting for LGBTQ+ equality, for working people, and for a more livable world,” Robinson said. “He knows why equality matters. He’s stood with us no matter what. We were proud to endorse him this year, and when a pro-equality majority takes back the Senate this fall, we will continue to count on him as a champion for our community.”
Markey is running for reelection against Republican John Deaton in November, where he is expected to win.
Congress
HRC president campaigns for Chris Pappas in NH
Gay congressman running to succeed retiring U.S. Sen. Jeanne Shaheen
Human Rights Campaign President Kelley Robinson on Sunday campaigned for U.S. Rep. Chris Pappas (D-N.H.) in New Hampshire.
Robinson traveled to Manchester, the state’s largest city, nine days before the Sept. 8 primary that will determine who will vie for retiring U.S. Sen. Jeanne Shaheen (D-N.H.)’s seat.
We’re hitting the pavement across New Hampshire to fight for a freer, fairer future for everyone.
Glad to have Human Rights Campaign President @KelleyJRobinson join us for a canvass launch in Manchester today. pic.twitter.com/XWCEaQxy4o
— Chris Pappas (@ChrisPappasNH) August 30, 2026
Former U.S. Sen. John E. Sununu, who represented New Hampshire in the U.S. Senate from 2003-2009, will face off against former U.S. Sen. Scott Brown, who represented Massachusetts in the U.S. Senate from 2010-2013, in the Republican primary.
Karishma Manzur is among the Democrats challenging Pappas.
A poll the University of New Hampshire Survey Center released on Aug. 26 shows Sununu is ahead of Brown. The same survey shows Pappas ahead of Manzur and his other Democratic challengers.
The UNH Survey Center poll shows Sununu ahead of Pappas by a 45-43 percent margin if they were to face off in the general election. The margin of error is +/-2.1 percent.
Pappas would become the first openly gay man elected to the U.S. Senate if he were to win in November.
Congress
Chris Van Hollen says the Democratic Party needs change. Is he the one to lead it?
Senator is backing anti-establishment Democrats across the country
By LEE O. SANDERLIN | The Democratic Party is having something of an identity crisis — losing to President Donald Trump twice in three elections will do that.
Should the party embrace anti-establishment figures who espouse progressive policy ideas like Medicare for all and rhetoric about unrigging the economy for the 1 percent? Or should Democrats try to appeal to moderates who want to return to semi-normalcy in a time of political upheaval?
Although he’s been in Congress since 2002, with key leadership roles throughout his tenure, Maryland Sen. Chris Van Hollen, 67, counts himself firmly in the anti-establishment camp.
The rest of this article can be found on the Baltimore Banner’s website.
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