Universities, charities and hospitals affiliated with churches that oppose same-sex marriage are facing the thorny question of whether they have an obligation - morally or legally - to extend health care benefits to spouses of gay and lesbian employees in states where they now are allowed to marry.
Many religious-based institutions are making no changes or sitting on the sideline, perhaps waiting to see if the U.S. Supreme Court will settle whether gay couples should be able to marry in every state. But they now face greater pressure to make a choice amid the dramatic expansion of same-sex marriage.
A few have extended benefits to the dismay of their church hierarchy and conservatives on campuses.
The University of Notre Dame almost immediately decided to offer benefits to same-sex spouses after a court ruling in October cleared the way for gay marriage in Indiana. Another Roman Catholic school, the University of St. Thomas in Minnesota, did the same this year, saying it was doing so to comply with state and federal laws.
The explanation offered by Notre Dame's president, the Rev. John Jenkins, illustrated the fine line administrators are facing at religious-based institutions.
Court decisions, he said, have altered "centuries of thought on the nature of marriage rooted not only in the Christian tradition but also in other religious traditions." But he went on to say there was "an urgent call to welcome, support and cherish gay and lesbian brothers and sisters, who have been too often marginalized and even ostracized."
The United Methodist Church, which opposes same-sex marriage, extended benefits last April to same-sex spouses working for national church agencies in states that recognize gay marriage. The change was made despite some complaints that it sends a confusing message on church teaching.
Some church-affiliated institutions are considering a "plus-one" plan that has been adopted in recent years by several Catholic Charities organizations and hospitals around the nation. Those benefits plans offer health care to an employee and any adult living with an employee.
The president of Creighton University, a Jesuit-affiliated school in Nebraska, said in October that the need to take care of its workers and stay competitive with other colleges and medical centers was behind his decision to offer health benefits to spouses of gay employees who were married in other states where same-sex marriage is legal.
The move was not, said Rev. Timothy Lannon, a declaration approving gay marriage.
But Archbishop George Lucas of Omaha disagreed. "This is precisely the message that the university is giving," Lucas said in a statement.
Notre Dame's move surprised even those who were urging it to follow the lead of other Catholic schools such as Georgetown University and Boston College, which have offered same-sex health benefits for several years.
Sociology professor Richard Williams, who wrote a letter urging Jenkins to extend benefits to same-sex spouses, said he thinks the court ruling may have forced Notre Dame's decision.
"Maybe it was the only thing they could do," he said. "One way or another, they did the right thing."
Bishop Kevin Rhoades of the northern Indiana diocese that includes the university said Notre Dame's leaders need to "defend the religious liberty of our religious institutions that is threatened in potentially numerous ways by the legal redefinition of marriage."
More needs to be known about what legal obligations Catholic institutions have and whether constitutional rights to religious freedom could stop them from being forced to extend same-sex benefits, Rhoades said.
Whether the Constitution or state laws offer such protection isn't clear and could end up in the courts too, said Matthew Franck, director of the Witherspoon Institute's Simon Center on Religion and the Constitution in Princeton, New Jersey.
The answer, Franck said, might be rooted in a 2012 U.S. Supreme Court decision that said religious workers can't sue for job discrimination and that churches are the best judges of whether clergy and other religious employees should be fired or hired.
That narrow ruling acknowledged a "ministerial exception" to anti-discrimination laws, which says the First Amendment's guarantee of freedom of religion shields churches and their operations from protective laws when the issue involves religious employees of those institutions.
Despite the flurry of federal court decisions that have overturned state bans on gay marriage this year, changes among religious-based colleges and institutions are likely to come at a slow pace, said Fred Sainz, a vice president of the Human Rights Campaign.
"It will take people a bit to wrap their minds around these changes and move forward," he said. "Every state is not California."
Many are taking a wait-and-see approach as it's likely the U.S. Supreme Court will take up the question of gay marriage after the 6th U.S. Circuit Court of Appeals in Cincinnati upheld laws against the practice in Ohio, Michigan, Tennessee and Kentucky, following a string of favorable rulings for same-sex marriage.
Xavier University, a Jesuit school in Cincinnati, doesn't offer same sex benefits, but "thoughtful discussions are being had on campus over the issue," said Kelly Leon, a school spokeswoman. Ultimately, the school is waiting to see what happens with Ohio's law, she said.