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:  February 10, 2020 
 
FROM:  Calder Lynch, Deputy Administrator and Director 
Center for Medicaid and CHIP Services  
 
SUBJECT:        New Extension of the Affordable Care Acts Spousal Impoverishment 
Provision for Married Applicants and Recipients of Home and Community-Based Services  
 
The purpose of this CMCS Informational Bulletin is to advise State Medicaid agencies that the 
recently enacted Further Consolidated Appropriations Act, 2020 (Pub. L. No. 116-94, enacted on 
December 20, 2019) 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 
May 22, 2020.1  
 
The Further Consolidated Appropriations Act, 2020 contains the fourth temporary extension of 
the ACAs spousal impoverishment-related provision.  CMS has informed states of each 
previous extension through CMCS Informational Bulletins.2  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 Statute3) 
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 legislation providing temporary extensions of the ACAs spousal 
impoverishment-related provisions,4 the Further Consolidated Appropriations Act, 2020 made 
changes to how states may apply income and resource disregards authorized under section 
1902(r)(2) of the Act to certain individuals eligible for HCBS.5  CMS expects to provide 
guidance soon on this matter.  
 
In the event that the ACAs spousal impoverishment provision expires in the future, states can 
refer to the CMCS Informational Bulletin, Sunset of Section 2404 of the Affordable Care Act, 
                                                      
1 See Division N (Health and Human Services Extenders), Title I (Health and Human Services Extenders), 
Subtitle B - Medicaid Provisions, Section 204(a) (Extension of the spousal impoverishment protections), of the 
Appropriations Act. 
2 See https://www.medicaid.gov/federal-policy-guidance/downloads/cib020819.pdf; 
https://www.medicaid.gov/federal-policy-guidance/downloads/cib050819.pdf; and 
https://www.medicaid.gov/federal-policy-guidance/downloads/cib090419.pdf. 
3 https://www.medicaid.gov/federal-policy-guidance/downloads/smd050715.pdf 
4 Section 3(a) of the Medicaid Extenders Act of 2019 (P.L. 116-3), and section 3(b) of the Sustaining Excellence in 
Medicaid Act of 2019 (P.L. 116-39) 
5 See Division N (Health and Human Services Extenders), Title I (Health and Human Services Extenders), 
Subtitle B - Medicaid Provisions, Section 204(b) (Rule of Construction) of the Appropriations Act.  Page 2  CMCS Informational Bulletin 
 
Relating to the Spousal Impoverishment Rules for Certain Home and Community-Based 
Services Applicants and Recipient,6  published on November 9, 2018.  The bulletin provided 
instructions on how states should proceed if the ACAs provision expired.  
 
CMCS is available to provide technical assistance as needed. If you have any questions, please 
contact Gene Coffey at Gene.Coffey@cms.hhs.gov.  
 
                                                      
6 https://www.medicaid.gov/federal-policy-guidance/downloads/cib110918-2.pdf