(619) 505-7777

Medicaid, spousal impoverishment and a guide for same-sex couples

As the nation’s primary health insurance program for low-income individuals, Medicaid serves as the single largest payer of long-term care in the United States, which is often necessary for older adults and people with disabilities who rely on institutional or in-home health services.

However, this type of intensive prolonged care is costly to provide, and few resources other than Medicaid help pay for these services.

In addition, many Americans do not consider or cannot afford private long-term care insurance, and fewer have the sufficient personal means to fully cover these costs out-of-pocket when services are needed. Most Americans, including LGBT older adults, end up relying on Medicaid for long-term care.

Medicaid qualification rules include a series of “spousal impoverishment protections” that aim to prevent a healthy spouse from having to give up a family home or retirement savings, and live in poverty, in order to qualify his/her spouse for Medicaid. Unfortunately, these spousal impoverishment protections generally do not apply to same-sex couples, which can leave a same-sex partner without a home, unprotected from impoverishment.

But now, states have federal guidance on how they can extend these protections to all couples -- and you can help ensure that they take this important step to improve the well-being of all elders, including LGBT older adults.

Spousal Impoverishment Protections Initiative

SAGE has launched the Spousal Impoverishment Protections Initiative to support aging advocates around the country in ensuring that all 50 states provide spousal impoverishment protections to same-sex couples.

Through the initiative, SAGE and our partner organizations will:

  • Provide policy guidance to advocates interested in implementing these protections in their unique states;
  • Connect state advocates to each other to share best practices and exchange ideas;
  • Host a range of training sessions on these issues at upcoming conferences and events;
  • Develop a range of online activist tools that support state leaders in this advocacy; and
  • Highlight the individual stories of same-sex partners affected by this inequity, as well as stories from advocates nationwide who successfully helped to extend these protections.

Contact information

  • Interested in learning more about extending these protections in your state? Please contact Allison Auldridge at aauldridge@sageusa.org.
  • If you’re interested in learning more about our community advocacy efforts, please contact Serena Worthington at sworthington@sageusa.org.
  • If you’re interested in learning more about our national advocacy work, please contact Robert Espinoza at respinoza@sageusa.org.
  • To read the original blog or to visit SAGE, click HERE.


  • For resources on LGBT caregiving and long-term care, visit the Caregiving section of SAGE’s National Resource Center on LGBT Aging.
  • For a real-life example of how a lack of spousal impoverishment protections can affect same-sex couples, watch the video below.

    For more information on Medicaid and the Spousal Impoverishment Protections Initiative, read or download the SAGE publication, “A State Advocacy Guide for Understanding Spousal Impoverishment Protections, Medicaid and Same-Sex Couples.”

    Sage Sipi Booklet