DEPARTMENT OF HEALTH & HUMAN SERVICES 
Centers for Medicare & Medicaid Services 
7500 Security Boulevard, Mail Stop S2-26-12 
Baltimore, Maryland   21244-1850 
 
 
 
CMCS Informational Bulletin 
 
DATE:  May 4, 2021 
 
FROM:  Anne Marie Costello, Acting Deputy Administrator & Director 
Center for Medicaid and CHIP Services  
 
SUBJECT:    Extension of the Spousal Impoverishment Rules for Married Applicants and 
Recipients of Home and Community-Based Services  
 
The purpose of this CMCS Informational Bulletin is to advise you that the recently enacted 
Consolidated Appropriations Act, 2021 (Pub. L. No. 116-260, enacted on December 27, 2020) 
modifies section 2404 of the Patient Protection and Affordable Care Act (ACA) to require that 
state Medicaid agencies apply the spousal impoverishment rules to married applicants and 
beneficiaries eligible for home and community-based services (HCBS) through September 30, 
2023.1  
 
The Consolidated Appropriations Act, 2021 provides a temporary extension of the ACAs 
spousal impoverishment-related provision, which initially was set to expire on December 31, 
2018, but has been extended several times through subsequent legislation.2 CMS has informed 
states of prior extensions through CMCS Informational Bulletins.3 As CMS has noted with 
regard to previous extensions, states should continue to follow the guidance CMS published in 
SMDL #15-001 (Affordable Care Acts Amendments to the Spousal Impoverishment Statute, 
available at https://www.medicaid.gov/federal-policy-guidance/downloads/smd050715.pdf) relating to 
the application of the ACAs spousal impoverishment-related provision so long as section 2404 
of the ACA is in effect. 
 
Similar to previous temporary extensions of the ACAs spousal impoverishment-related 
provision, section 205(b) of the Consolidated Appropriations Act, 2021 includes a Rule of 
                                                      
1 See Division H (Departments Of Labor, Health And Human Services, and Education, and Related Agencies 
Appropriations Act, 2021), Title II (Department of Health and Human Services), Section 205(a) (Extension of 
the spousal impoverishment protections), of the Consolidated Appropriations Act, 2021. 
2 See Division A (Keeping Workers Paid and Employed, Health Care System Enhancements, and Economic 
Stabilization), Title III (Supporting Americas Health Care System in the Fight Against the Coronavirus), 
Subtitle E (Health and Human Services Extenders), Part II (Medicaid Provisions), Section 3812 (Extension of 
spousal impoverishment protections.) of the Coronavirus Aid, Relief, and Economic Security Act (the CARES 
Act); see also Division C (Health Extenders), Title III (Medicaid Extenders), Section 2302 (Extension of 
spousal impoverishment protections) of the Continuing Appropriations Act, 2021 and Other Extensions Act; see 
also Division B (Health Extenders), Title I (Medicare and Medicaid Extenders), Section 1105 (Extension of 
spousal impoverishment protections) of the Further Continuing Appropriations Act, 2021, and Other Extensions 
Act. 
3 See https://www.medicaid.gov/federal-policy-guidance/downloads/cib020819.pdf; 
https://www.medicaid.gov/federal-policy-guidance/downloads/cib050819.pdf;  
https://www.medicaid.gov/federal-policy-guidance/downloads/cib090419.pdf; and 
https://www.medicaid.gov/federal-policy-guidance/downloads/cib021020.pdf.  Page 2  CMCS Informational Bulletin 
 
Construction that addresses how states may apply income and resource disregards authorized 
under section 1902(r)(2) of the Act to certain individuals eligible for HCBS. The Rule of 
Construction enables states to target less restrictive financial methodologies at individuals 
eligible for HCBS, including married individuals whose financial eligibility is determined under 
the spousal impoverishment rules. CMS expects to provide additional guidance on this matter. 
 
CMCS is available to provide technical assistance as needed. If you have any questions, please 
contact Gene Coffey at Gene.Coffey@cms.hhs.gov.