Hunter of Justice by Nat Hunter
The Obama administration issued guidance last Friday delineating how same-sex couples can be financially protected if one becomes Medicaid eligible in the process of securing long-term care for a serious disability (often age-related).
As the letter explains, married heterosexual couples have a variety of legal mechanisms that allow the non-disabled spouse to retain some basic assets such as their home. Because of DoMA, same-sex marriages cannot be recognized. Thus no same-sex couples have had access to the same options for preventing spousal impoverishment.
The new guidance letter on Medicaid rules for same-sex couples suggests a variety of ways that the same kinds of considerations can apply to same-sex couples, whether married or not. This may sound like a mush of bureaucratic legalese, but it is much more than that. Aside from the smart lawyering involved in producing this analysis (kudos to the HHS legal staff), this development is important in both the short and the long term.
In the short term, along with every other baby booomer in the U.S., more and more same-sex couples are entering the final third of life. Medicaid, originally set up as a health insurance system for the poor, including the "medically indigent," now pays more than half the total costs of long-term care in the U.S. Given the expense of nursing homes even for middle-class Americans, Medicaid has been necessary for millions of elders to receive decent care. For senior same-sex couples, the new Administration position is a huge and immediate change.
But there is another, potential long-term effect of the new guidance as well. It's less obvious but, with a little investment of energy, one that could help end routinely anti-gay policies in social services agencies. Here's why -
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