CMSA Today - Issue 8, 2013 - (Page 25)
Case Management and the Law
U.S. Supreme Court Rules on
Federal Marriage Act
Decision impacts benefit plan
offerings & related services
BY GARRY CARNEAL, JD, MA
he U.S. Supreme Court made headlines in June 2013 when it struck down Section 3 of
the federal Defense of Marriage Act (DOMA), which prohibited the federal government
from acknowledging marriages between same-sex couples, in United States v. Windsor.
Section 3 deﬁned "marriage" as the legal union of one man and one woman, and "spouse" as a
person of the opposite sex who is a husband or wife.
This ruling impacts most types of
health and beneﬁt coverage, and it will
have ramiﬁcations for case managers and
others who help coordinate insurance
coverage and services for legally
married, same-sex couples.
In 1996, the passage of DOMA
necessitated interpretation of federal law in
a manner consistent with these deﬁnitions.
For example, in 1998 the Department of
Labor issued an opinion letter stating that
only the federal deﬁnitions of marriage and
spouse established under DOMA would
apply for purposes of leave under the Family
and Medical Leave Act (FMLA). Thus, the
invalidation of DOMA's initial deﬁnition
of marriage stands to aﬀect thousands of
federal statutes and regulations.
In situations where a legally married,
same-sex couple resides in a state that
recognizes same-sex marriage, the
decision raises several issues that plan
sponsors, beneﬁts professionals, and others
should carefully consider. For example,
FMLA beneﬁts will now extend to samesex spouses, and beneﬁts for federally
recognized spouses are not taxable.
The Consolidated Omnibus Budget
Reconciliation Act, also known as COBRA,
requires plans to provide continuation
coverage to spouses. With the invalidation
of Section 3 of DOMA, this coverage will
be available to same-sex spouses. The
same principle applies to a myriad of other
health insurance arrangements including
health savings accounts, and wellness and
CASE MANAGEMENT INSIGHTS
Regardless of a person's political,
legal, or religious beliefs, it is important
to fully understand how laws and court
decisions can impact the practice of case
management. The new DOMA ruling should
allow patients, their case managers, and
others to have access to more resources
when working with an individual who is
part of a legally married, same-sex couple.
For example, a dependent care assistance
program allows employees to reduce their
taxable income by setting aside money
from each paycheck before taxes to pay for
dependent care expenses. An employee can
now use such a program to pay a caregiver
who is the employee's same-sex spouse.
Case managers overseeing speciﬁc
populations may see more same-sex
married couples in groups they manage,
where one partner formerly did not
qualify to participate in that group. Case
managers working with these individuals
should leverage supplemental resources
and strategies in support of same-sex
couples, especially in cases where one or
both individuals are dealing with chronic
conditions or other medical challenges.
Transition of care strategies can also
be enhanced through expanded hospital
visitation rights, exchange of protected
health information (PHI), and other
opportunities that were formerly only
available to heterosexual married couples.
The Windsor decision leaves some
key questions unanswered. For instance,
the U.S. Supreme Court did not rule on
Section 2 of DOMA, which allows states to
refuse recognition of same-sex marriages
performed under other state laws. Without
such a ruling, questions linger as to the
treatment of same-sex couples who marry
in one state and then move to another state
that does not recognize same-sex marriage.
Many legal experts assert that the Equal
Protection Clause of the U.S. Constitution
would protect these couples no matter
where they live. Others argue that a state
should retain the rights to ban same-sex
marriages even with the Supreme Court's
ruling on Section 3.
Several federal agencies have stated that
they will review aﬀected federal statutes and
issue guidance to implement the Supreme
Court's decision. In the meantime, case
managers should move forward to serve
the best interest of their patients as health
policy and legal experts ﬁll in the details of
the Windsor decision. ■
Garry Carneal, JD,
MA, is president & CEO,
Services and RadSite.
This article is for
purposes only. For
specific legal advice
on any issue, please
consult a licensed attorney or other applicable
professional in your state or jurisdiction.
Issue 8 * 2013
Table of Contents for the Digital Edition of CMSA Today - Issue 8, 2013
Where Was Care Coordination?
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Preparing Patients for Their Journey Ahead
CASE MANAGEMENT AND THE LAW
CMSA CORPORATE PARTNERS
INDEX OF ADVERTISERS
CMSA Today - Issue 8, 2013