Medicaid can be flexible on same-sex pairs

The CMS on Friday outlined options and flexibilities that state Medicaid agencies have when offering beneficiary protections related to liens, transfers of assets and estate recovery for same-sex couples.

In a three-page letter (PDF) to state Medicaid directors, Cindy Mann—director of the Center for Medicaid, CHIP and Survey & Certification at the CMS—said the direction is intended to clarify state plan flexibilities for all Medicaid recipients regardless of their sexual orientation.

According to HHS, the Medicaid program requires individuals who need care to have exhausted most of their personal income and assets before qualifying for Medicaid assistance. States may impose liens—or legal claim—on property of those individuals, but liens may not be imposed when certain people are living in the home lawfully, Mann wrote in her letter. Those individuals include a spouse, a child under age 21, children who are blind or permanently disabled, or siblings who have an equity interest in the home and resided there for a least one year before the individual was admitted to a medical institution. These beneficiary protections, however, represent only the minimum level of protection that states must implement.

“A state can have a policy or rule not to pursue liens when the same-sex spouse or domestic partner of the Medicaid beneficiary continues to lawfully reside in the home,” Mann wrote.

The letter also offered some direction on how states can address transfer-of-asset rules and estate recovery for same-sex partners.