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February 26, 2013

Maryland Extends Medicaid Spousal Impoverishment Protections to Same-Sex Couples

Maryland Advocate, Susan Francis
SAGE was thrilled to learn that Maryland recently extended spousal impoverishment protections for same-sex couples! Spousal impoverishment protections prevent a healthy spouse from having to spend down their savings and live in poverty, or give up a family home, in order to qualify his/her spouse for Medicaid long-term care support. Until 2011, these protections generally did not apply to same-sex couples. However in June of that year the Centers for Medicare and Medicaid Services (CMS) announced that states could extend some of these important protections to same-sex couples.

After CMS’ announcement SAGE partnered with the Williams Institute on a Spousal Impoverishment Protections Initiative, an effort that provides research and technical support for advocates nationwide to ensure that each state takes the steps necessary to extend protections for same-sex couples. California, New York and Delaware are among the states that have already implemented these protections since the announcement from CMS, while many other states have efforts underway.

SAGE Policy Associate Alli Auldridge recently spoke with Susan Francis, Esq., a Maryland advocate who was instrumental in the state’s push to extend spousal impoverishment protections, about the successful advocacy process and what this win means for same-sex older adults in Maryland.

Alli: Can you tell me about how you initially got involved in the effort to extend spousal impoverishment protections to same-sex couples in Maryland?

Susan: Last June I participated in the Williams Institute webinar about the protections and afterward I contacted Carrie Evans, the Executive Director of Equality Maryland, to see if we could work together on this important issue.  From that point on it was a very collaborative effort: we worked with other local advocates who had more familiarity and experience working with Medicaid and with the state Medicaid agency.  We made inquiries at the Department of Health and Mental Hygiene (DHMH), where they were receptive to discussions about the protections. At that point it was also close to the November election so we decided to see how voters would decide Maryland’s marriage equality referendum. Although states can enact spousal impoverishment protections without marriage equality legislation in place, we knew that our advocacy work would be easier if the marriage bill passed, so we waited. Maryland voted to pass marriage, so after the election I worked with Equality Maryland to draft a letter to DHMH urging the Department to adopt provisions to protect same-sex couples.  A few weeks later, we received a response saying that DHMH agreed that protections related to liens, estate recovery and transfer penalties should be afforded to all spouses and would take steps to implement them.

Alli: It sounds like your advocacy efforts happened fairly seamlessly. Did you encounter any roadblocks along the way either before or after DHMH approved the extension of the protections?

Susan: Certainly, the process of extending these protections was aided by the election, and also by a push from both Governor O’Malley’s office and the Attorney General’s Office in getting state agencies to extend all marriage and marriage-like benefits to same-sex couples. Before we had received DHMH’s response I was working separately with LGBT advocates like Equality Maryland in partnership with Attorney General Doug Gansler’s office to release an advisory letter offering guidance to state agencies, and with the Governor to issue a directive to all state agencies to quickly enact all policies to reflect the election results. All of these efforts established a statewide atmosphere where agencies and departments such as DHMH were receptive to enacting these protections.

We were lucky in some respect in that we did not experience specific roadblocks. Initially I was nervous about how far we could push these efforts, because neither myself nor Carrie at Equality Maryland were experts in Medicaid regulations. We were just advocates concerned about issues affecting the LGBT community and became aware of this new opportunity to protect same-sex couples. We began the work by asking lots of questions, using the resources available to us from SAGE’s Initiative, reaching out to people who were more versed in Medicaid and partnering with organizations who had ideas about how to take the next steps.

Alli: Now that the protections are being extended, what happens next in this process?

Susan: In terms of what’s next, we’re continuing to work with the ACLU, Lambda Legal and our new contacts in state government to figure out how to spread the word about this expansion of Medicaid protections. These changes are really important for low-income same-sex couples to know about so we are continuing to reach out to legal service providers to make sure that they have current information to pass on to their clients. We’ll continue to work with Equality Maryland and the Attorney General’s Office to make sure everything that can be done to protect same-sex married couples is done, until DOMA is repealed.

Finally, I’m hoping that there can also be conversations about how we protect the financial security of all LGBT older adults, regardless of whether or not they are married. There are many reasons that same-sex and heterosexual couples choose not to marry and perhaps there are frameworks we can look at to extend protections for those vulnerable couples as well.

For more information on SAGE's Spousal Impoverishment Protections Initiative, including a state advocacy guide for understanding spousal impoverishment protections, visit sageusa.org/spousalimpoverishment.  


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