Initially, states were only required to apply spousal impoverishment rules to Medicaid nursing home enrollees, but not to recipients of HCBS. The Affordable Care Act made these protections mandatory for recipients of HCBS through the end of 2018, and that provision was extended through November 30, 2020 by the CARES Act. It was later extended through September 30, 2023 by the Consolidated Appropriations Act of 2021.
The Build Back Better Act called for it to be made permanent, but while that legislation passed the House in 2021, it stalled in the Senate. The pared-down version that was enacted in 2022 (the Inflation Reduction Act) did not include a provision to make the HCBS spousal impoverishment provisions permanent. So additional short-term solutions will continue to be necessary to protect community spouses whose spouses need Medicaid-funded LTSS via the HCBS program.