The Centers for Medicare and Medicaid Services (CMS) has published this ruling implementing the 2013 United States Supreme Court decision in United States v. Windsor declaring part of the so-called Defense of Marriage Act (DOMA) unconstitutional and requiring the federal government to recognize same-sex marriages. This comprehensive CMS ruling now applies to all CMS programs, services, contractors, appeals, and other eligibility determinations, including Part A and Part B Medicare Administrative Contractors (MACs), Qualified Independent Contractors (QICs), the Provider Reimbursement Review Board, the Medicare Geographic Classification Review Board, and the Medicare Appeals Council and Administrative Law Judges (ALJs) who hear Medicare appeals. Prior CMS directives had applied the Windsor decision to specific eligibility decisions but this ruling now applies the decision to all CMS eligibility decisions. This CMS ruling is applies to all appeals pending on, initiated, or reopened in accordance with applicable rules after February 9, 2015, for entitlement and enrollment determinations made on or after June 26, 2013.
Consistent with prior interpretation and application of the Windsor decision by the Obama Administration, this ruling adopts a “celebration rule’’, which means that a same- sex marriage is recognized and treated as a lawful marriage (where marital status is relevant to a determination of entitlement) if the same-sex marriage was lawful where and when it occurred. However, individuals in non-marital same-sex relationships (such as domestic partnerships or civil unions that are not marriages) are not considered married.