MassHealth Equality law gives same-sex couples choice

Before Gov. Deval Patrick's signing of the MassHealth Equality bill last week married same-sex couples accessing services through MassHealth, the state's Medicaid program, lacked the crucial protections enjoyed by their heterosexual counterparts. If one spouse needed long-term care through MassHealth, the couple would be forced to spend down most of their joint assets and possibly lose their home. The MassHealth Equality bill puts same-sex couples on a level playing field with heterosexual couples.

"What this MassHealth Equality bill does is say we are going to treat all married couples the same here in Massachusetts," said Bruce Bell, Infoline Manager at Gay and Lesbian Advocates and Defenders (GLAD). "Initially when Goodridge passed, the state stayed with the federal definition of marriage for the purposes of Medicaid, so that meant that even though a person did legally get married here in Massachusetts if they were applying for Medicaid they were not able to be treated as a family, as a married couple."

MassHealth refused to recognize same-sex married couples as married because it receives half of its funding from the federal government, which is prohibited from recognizing same-sex marriages by the 1996 Defense of Marriage Act (DOMA).

Advocates say the MassHealth Equality law gives same-sex couples a choice as to whether they should apply for medical benefits as individuals or as a couple, the same choice given to heterosexuals. This option allows same-sex couples to weigh their options. A number of factors, including the income distribution between spouses and each spouse's financial resources, can determine whether it makes more sense to file individually or jointly.

"Right now, they only have the option of applying as individuals. Now that it's in effect they will be able to choose which arrangement benefits them both the most," explained Deborah Thompson, a lobbyist and Pass Group lawyer who worked with the coalition of organizations working to pass the bill.

Bell said the bill affects same-sex couples with the greatest financial need.
"Anybody who qualifies for MassHealth is now able to be treated as a family, as opposed to being treated as an individual. It's a huge change," said Bell. "It's a substantial number of people, both seniors and the people who are on MassHealth health insurance in general, they are the lowest income families in the state who can't afford to pay for private insurance."

The spousal protections provided by the bill are most crucial when one's spouse goes into a nursing home. Those protections ensure that the spouse who isn't placed into the home is protected by allowing them to keep their assets, particularly their home, without factoring them into the other spouse's ability to pay for the nursing home costs.

According to Bell, without this protection, an individual's assets can be dwindled down to less than $2000. Prior to the passage of the MassHealth Equality bill, heterosexual Massachusetts couples had that protection, while same-sex couples did not.

"It was this nightmarish condition where if everything was joint, potentially everything could be considered to be owned by the spouse in nursing home," said Bell.

The MassHealth Equality bill gets around DOMA by shifting the cost of treating same-sex couples as spouses to the state. Normally the state and federal government split the cost for everyone enrolled in MassHealth.

"Basically what it means is that same-sex married couples get treated with state funds as opposed to the federal government funds under this new bill," Bell explained.

"The difference I think between the federal and state program is whether federal dollars get contributed to it. If you want to, because of the [DOMA], treat [same-sex couples] you can't do it on federal dollars. You have to depend on a separate state funding program," said Thompson.

According to the state's cost estimate, it is estimated that same-sex couples will cost the state an additional $2.37 million. LGBT advocates have not yet found a same-sex married couple currently accessing MassHealth services.