For background information regarding Medicaid’s existing spousal impoverishment rules, see CMS’ webpage on this issue.
On May 7, following the release of updated 2015 Supplemental Security Income (SSI) and Spousal Impoverishment Standards (details here; bulletin here), CMS issued a letter to State Medicaid Directors (SMDs) delineating guidance on how to apply the spousal impoverishment protections pursuant to the ACA that are applicable to married individuals seeking Medicaid coverage of certain long-term services and supports (LTSS).
CMS’ 2016 Spousal Impoverishment Standard is posted here.
On June 14, 2016, CMS issued guidance regarding the delivery of family planning services and supplies, which is a mandatory benefit in Medicaid, eligible for enhanced federal financial participation (FFP) rate of 90 percent. Specifically, the letter provides guidance and clarification on: (1) family planning services provided under both fee-for-service and managed care delivery systems; (2) the purpose of the family planning visit; (3) strategies to reduce barriers to receiving family planning services and supplies; and (4) ways to increase and ensure timely access to contraceptive methods.
On Apr. 3 2019, Congress passed H.R. 1839, the Medicaid Services Investment and Accountability Act, to extend protection against spousal impoverishment for Medicaid recipients of HCBS against spousal impoverishment through Sept. 30, 2019 (as opposed to Mar. 31, 2019 pursuant to prior Medicaid “Extenders” legislation (P.L. 116-3). See our prior summary for more information.
In August, President Trump signed into law a package of Medicaid extenders incorporated in the Sustaining Excellence in Medicaid Act of 2019 (H.R. 3253). Highlights of legislative package includes an extension of the protection allowing states to disregard a Medicaid recipient’s spousal income and assets when determining eligibility for HCBS from Sept. 30, 2019 to Dec. 31, 2019. Our summary of the legislative package is available here.
On Dec. 26, CMS issued updated 2020 SSI and Spousal Impoverishment Standards.
SEC. 2404. PROTECTION FOR RECIPIENTS OF HOME AND COMMUNITY-BASED SERVICES AGAINST SPOUSAL IMPOVERISHMENT. During the 5-year period that begins on January 1, 2014, section 1924(h)(1)(A) of the Social Security Act (42 U.S.C. 1396r– 5(h)(1)(A)) shall be applied as though ‘‘is eligible for medical assistance for home and community-based services provided under subsection (c), (d), or (i) of section 1915, under a waiver approved under section 1115, or who is eligible for such medical assistance by reason of being determined eligible under section 1902(a)(10)(C) or by reason of section 1902(f) or otherwise on the basis of a reduction of income based on costs incurred for medical or other remedial care, or who is eligible for medical assistance for home and community-based attendant services and supports under section 1915(k)’’ were substituted in such section for ‘‘(at the option of the State) is described in section 1902(a)(10)(A)(ii)(VI)’’.