Many married couples receiving care through home- and community-based options might lose their Medicaid coverage by the end of the month. That’s because a three-month extension of the program’s “spousal impoverishment” protection is set to expire.

In late January, President Trump signed a three-month extension of the guarantee that Medicaid’s spousal impoverishment protections apply to home- and community-based services. But if another extension is not signed in the next two weeks, states no longer will be required to honor the provisions. That does not mean all states will opt to do so, however, as states are allowed to implement their own HCBS waiver programs.

In instances where the coverage evaporates, recipients could opt to continue receiving Medicaid-covered care in skilled nursing facilities. Since 1988, Medicaid rules have contained spousal impoverishment protections that let a married spouse at home keep a share of the couple’s income and assets.

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