Medicaid is a collaboration of the states and the federal government. So although the Department of Health and Human Services is encouraging states to use the “Place of Celebration (POC)” to determine whether a couple is married, states that do not recognize the marriages of same-sex couples may use the “Place of Domicile (POD)” if they so choose. To further complicate this, in some cases Medicaid eligibility is determined by using the rules for Social Security Supplemental Security Income (SSI) eligibility, and so in these cases the marriage recognition rule that the Social Security Administration (SSA) determines for SSI eligibility will determine Medicaid eligibility. We are still waiting for the Social Security Administration to issue its guidance.
HHS issued a final rule regarding the Basic Health Program (BHP). BHP is an optional program for states that choose to provide Medicaid-like coverage to individuals with household incomes of 133% to 200% of the federal poverty level. In return, the Federal Government gives the state 95% of what the Federal Government would have spent on premium tax credits and cost-sharing subsidies. BHP is required to use the same definitions as the IRS, and so must use the "Place of Celebration" rule for recognizing the marriages of same-sex couples, which means those marriages will be recognized regardless of where the couple resides.