GN 00210: Same-Sex Marriage Claims
TN 28 (01-17)
A. Process cases that were previously on hold
The previous version of this section directed you to hold claims, appeals, post-eligibility and post-entitlement (PE) actions involving same-sex marital status determinations if we had not yet issued processing instructions in subchapter GN 00210.000. Other sections in GN 00210.000 directed you to hold some cases to protect against potential loss of benefits until we published instructions for processing those cases.
Review all same-sex marriage-related claims, appeals, and post-eligibility and post-entitlement actions that have been on hold. Process all of these cases now.
Instructions in GN 00210.000 contain policies, procedures, and processing instructions for claims, appeals, post-eligibility and post-entitlement actions involving a determination of a same-sex couple’s marital status. Except for the instructions in GN 00210.000, you should apply all other current and relevant instructions in the same manner for same-sex couples and opposite-sex couples.
If you determine that a legal opinion is necessary, request a legal opinion per GN 01010.815.
B. How to identify claims previously on hold, appeals, and post-eligibility and post-entitlement actions involving same-sex marriages or non-marital legal relationships (NMLR)
Examine all systems-generated listings and manual controls maintained in the field office (FO), workload support unit (WSU), processing center (PC), Office of Hearings Operations (OHO), or Office of Medicare Hearings and Appeals (OMHA) to locate all same-sex marriage cases previously on hold.
1. Identifying claims previously on hold and appeals for processing
First, review manual listings, if any, your office may have independently maintained to control previously on hold initial claims and appeals involving same-sex marriages or NMLRs.
Then follow the instructions for your office:
a. FOs, WSUs, and PCs
Locate all cases pending in the Modernized Claims System (MCS) and the Modernized SSI Claims System (MSSICS), where 626 appears in the first three positions of the unit code on the development worksheet (DW01).
b. OHO
Locate all cases pending at OHO with a 501 Case Flag annotated, “Special Case Processing - United States v. Windsor,” as well as all same-sex marriage-related cases previously on hold at OHO according to instructions in the Hearings, Appeals, and Litigation Law manual (HALLEX).
c. OMHA
Locate all cases forwarded to OMHA according to instructions in GN 03108.210.
2. Identifying claims previously on hold - post-eligibility and post-entitlement (PE) actions
First, review manual listings, if any, your office may have independently maintained to control claims previously on hold for PE actions involving same-sex marriages or NMLRs.
Then follow the instructions for your office:
a. FOs
Locate all cases pending:
where 626 appears in the first three positions of the unit code on the modernized development worksheet (MDW).
where 626 appears in the first three positions of the unit code on the modernized development worksheet (MDW) and information was recorded about the PE action in the MISC field; “WINDSOR” is entered in the Issue field; and “626PE” is entered in the Category field. Check the remarks screen for any pertinent information.
with this remark on the Supplemental Security Record (SSR): “HOLD 626 WINDSOR PE ACTION per EM-15016.”
where 626 appears in the first three positions of the unit code on the MAPS Development Worksheet (DWMP) for Medicare Part D subsidy events previously on hold.
b. PCs
Locate all cases pending, according to the local procedure you originally followed to hold the post-entitlement action.
C. Chart for processing all current and same-sex marriage cases previously on hold
Consult this chart to process previously on hold claims, appeals, or PE actions involving a same-sex marriage. Follow the referenced instructions:
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Same-Sex Marriage Subject |
Refer to |
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Alternatives to Duration Requirement for Surviving Spouse Benefits: A claimant files for same-sex surviving spouse benefits and meets one of the conditions in RS 00207.001A.1.a.3. – RS 00207.001A.1.a.7. as an alternative to the 9-month duration of marriage requirement. |
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Divorced Spouse Claim: A claimant files a Title II or Medicare claim or appeal as the same-sex divorced spouse of the number holder (NH). |
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Surviving Divorced Spouse Claim: A claimant files a Title II or Medicare claim or appeal as the same-sex surviving divorced spouse of the NH. |
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Surviving Divorced Mother or Father Claim: A claimant files a Title II or Medicare claim or appeal as the NH’s same-sex surviving divorced spouse with an entitled child of the deceased NH in his or her care. |
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Lump Sum Death Payment (LSDP) Claim, Late Filing: A claimant alleges that he or she failed to file for the LSDP payment within the prescribed two-year limit due to same-sex marriage laws in effect prior to the Windsor or Obergefell decisions. |
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Underpayment: A same-sex surviving spouse claims a Title II underpayment. |
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Marriage or Remarriage, Effect on Title II Entitlement: A claimant is married, or a beneficiary marries, someone of the same sex, when the Title II benefit type requires (with certain exceptions) that he or she be unmarried. |
EM-17004 |
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Marriage Adversely Affects Title II Benefits Subject to the Family Maximum: A claimant files a Title II claim as a same-sex spouse, adversely affecting the benefit amount(s) of auxiliaries on the same record. |
EM-17004 |
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PE Action Would Result in a Title XVI Overpayment: An action would result in a Title XVI overpayment due to deeming of income or resources based on recognition of a same-sex marriage or applying the couple’s payment rate or couple’s resource limit to a member of a same-sex couple. |
EM-16013 REV2 |