HHS extends equal coverage to same-sex Advantage beneficiaries in skilled-nursing facilities

All beneficiaries in Medicare Advantage plans will now receive access to equal coverage when it comes to care in a skilled-nursing facility where their spouse lives, regardless of sexual orientation, HHS announced Thursday.

The guidance specifies that certified married same-sex couples would be eligible for this equal coverage and care even if they reside in a state that does not legally recognized their marriage.

This is the first HHS guidance responding to the recent U.S. Supreme Court ruling striking down the 1996 Defense of Marriage Act, which barred the federal government from recognizing same-sex marriages. But it's not likely to have wide application because Medicare coverage of skilled-nursing care is limited and the odds of both spouses being in the facility for short stays at the same time is small.

“HHS is working swiftly to implement the Supreme Court's decision and maximize federal recognition of same-sex spouses in HHS programs,” HHS Secretary Kathleen Sebelius said in a written statement. “Today's announcement is the first of many steps that we will be taking over the coming months to clarify the effect of the Supreme Court's decision and to ensure that gay and lesbian couples are treated equally under the law.”

In its guidance document, HHS' Medicare Drug and Health Plan Contract Administration Group Director Danielle Moon stated that all private companies contracted with Medicare to provide coverage as part of Medicare Advantage were required to provide the same care to a married same-sex spouse residing in a skilled-nursing facility as it would a opposite-sex spouse.

The memo explains the changes were effective immediately and were in direct response to the Supreme Court's decision that held Section 3 of DOMA unconstitutional.

“Prior to this, a beneficiary in a same-sex marriage enrolled in a Medicare Advantage plan did not have equal access to such coverage and, as a result, could have faced time away from his or her spouse or higher costs because of the way that marriage was defined for this purpose,” CMS Administrator Marilyn Tavenner wrote.

In a response to the announcement, the organization Services and Advocacy For Gay, Lesbian, Bisexual and Transgender Elders Executive Director Michael Adams said the group lauded the move as a step forward toward ensuring married lesbian, gay, bisexual and trans-sexual elders received the care they needed from care providers.

“While most Medicare beneficiaries have long been entitled to care in the nursing home where their spouse resides, same-sex couples have often been forced to choose between receiving care in a nursing home away from their spouse or paying out-of-pocket costs to stay in the same facility,” Adam said in a written statement. “Extending these benefits to legally married same-sex couples gives them the respect of equal treatment and the comfort of remaining united with their loved one when both are in long-term care.”

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