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 8,  2019  
FROM:  Timothy  B. Hill, Deputy  Center Director  
Center for Medicaid and CHIP Services  
SUBJECT:   Temporary Extension of the Affordable Care Acts Spousal Impoverishment 
Provision for Married Recipients of Home and Community-Based Services  
The purpose of this CMCS Informational Bulletin is to advise you that the recently enacted 
Medicaid Extenders Act of 2019 (P.L. 116-3) 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 March 31, 2019.1   
 
On November 9, 2018, the Centers for Medicare & Medicaid Services (CMS) published a 
separate CMCS Informational Bulletin (the November bulletin) advising stakeholders that the 
ACAs spousal impoverishment-related provision was set to expire on December 31, 2018 
(Sunset of Section 2404 of the Affordable Care Act, Relating to the Spousal Impoverishment 
Rules for Certain Home and Community-Based Services Applicants and Recipient).2  CMS 
instructed states in the November bulletin that, if the provision were to expire, eligibility 
redeterminations and post-eligibility treatment-of-income (PETI) recalculations would be 
necessary for many married individuals receiving HCBS.  States that have completed 
redeterminations for married HCBS recipients and informed any such beneficiaries that (due to 
the expiration of the ACA provision) they are no longer eligible for Medicaid or will have their 
PETI calculation modified should revise their decisions and immediately inform  these 
individuals that they remain eligible for Medicaid or that their PETI calculation will not change.  
Unless the ACA provision is further extended, however, states will need to conduct 
redeterminations and recalculations, upon the new March 31, 2019 expiration, in accordance 
with the instructions in the November bulletin.   
 
The Medicaid Extenders Act of 2019 did not modify the terms of the ACA spousal 
impoverishment-related provision beyond the extension of its sunset date. States should therefore 
continue to follow the guidance CMS published in SMDL #15-001 through March 31, 
2019.3  Section 3(b) of the Medicaid Extenders Act of 2019, however, contains a rule of 
construction provision relating to the manner in which the spousal impoverishment rules should 
be construed pertaining to a states application of income or resource disregards for married 
individuals receiving certain HCBS.  CMS is presently reviewing this provision and will provide 
additional guidance to states after completing its review. If you have any questions, please 
contact Gene Coffey at Gene.Coffee@cms.hhs.gov. 
                                                            
1 Section  3(a) of the  law contains the extension.  
2  https://www.medicaid.gov/federal-policy-Guidance/index.html?sl=yes&fcf=49978#.XFCpGeHHUUQ.link   
3  https://www.medicaid.gov/federal-policy-guidance/downloads/smd050715.pdf