On Nov. 9, the Centers for Medicare & Medicaid Services (CMS) released an informational bulletin on adding sexual orientation and gender identity (SOGI) questions to state Medicaid and Children’s Health Insurance Program (CHIP) applications.
CMS on Nov. 1 added three optional SOGI questions on the model streamlined application. CMS aims to improve demographic data collection to identify disparities in access to care and support equitable health care. For states opting to collect SOGI data, the bulletin includes guidance on the process to modify state Medicaid applications and requirements for CMS approval.
The model application currently requires an applicant to answer the ‘Sex’ question with “male” or “female.” The new optional questions ask about sex assigned at birth, the applicant’s gender identity, and the applicant’s sexual orientation.
For the sex assigned at birth question, applicants may respond:
- Female.
- Male.
- A sex not listed, with a free text option.
- Not sure.
- Prefer not to answer.
Respondents have the same answer options for the gender identity question, along with the answers “transgender female” and “transgender male.”
For the sexual orientation question, answer options include:
- Lesbian or gay.
- Straight.
- Bisexual.
- A sexual orientation not listed, with a free text option.
- Not sure.
- Prefer not to answer.
States that use the model application will not need CMS approval to add these questions. States that develop their own alternative application may add these questions exactly how they are worded in this guidance without CMS approval. States have flexibility in where they place the questions, as long as the SOGI questions are asked only of household members ages 12 and older. To use different wording, a state must submit a state plan amendment (SPA).
The bulletin further reminds states that they must provide safeguards to restrict the use or disclosure of information concerning Medicaid applicants and beneficiaries to uses strictly connected with Medicaid program administration. These include establishing eligibility, determining the amount of medical or child health assistance, providing services for beneficiaries, and conducting or assisting an investigation or prosecution related to the Medicaid program.
Sharing applicants’ or beneficiaries’ SOGI data for any other purpose, including in child welfare investigations or to pursue criminal charges or civil penalties that are not directly related to program administration, is prohibited. Further, states must obtain permission from applicants and beneficiaries before disclosing their data to an outside source.
CMS aims to receive and accept SOGI data in the Transformed Medicaid Statistical Information System (T-MSIS) in 2025, and the agency will provide more information on requirements as they are finalized.
Contact Director of Policy Rob Nelb, MPH, at rnelb@essentialhospitals.org or 202.585.0127 with questions.
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