Count income of aged, blind, or disabled people who fail SSI's noncitizen test

changelog.d/medicaid-abd-noncitizen-countable-income.fixed.md

@@ -0,0 +1 @@
+Count the own income of aged, blind, or disabled people who fail SSI's noncitizen test in SSI-methodology countable income, so Medicaid's optional aged, blind, and disabled and medically needy income tests, CAPI, and other programs no longer treat it as zero; the California state supplement no longer counts the income of a member who fails SSI's noncitizen test unless that member is in an SSI couple computation, and Maryland PAA no longer deems spouse income to people SSI bars by alien status and imputes to them only the SSI that SSA pays when they report SSI receipt, with the one-third reduction on the couple rate under deeming.

policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_for_medicaid.yaml

@@ -61,8 +61,9 @@
 # Emergency Medicaid covers noncitizens who meet the state plan's requirements
 # other than the receipt of SSI (42 U.S.C. 1396b(v)(2)(B); 42 CFR 435.406(b)).
 # In Alabama that leaves SSI's income test. Wages of $800 a month ($9,600 a
-# year) are under the SSI rate ($11,928) before any disregard. Until #10240
-# merges, the pathway counts no income for this person; Cases 7 and 8 test it.
+# year) are under the SSI rate ($11,928) before any disregard; the pathway
+# counts that income (at most 4,290 a year after exclusions). Cases 7 and 8
+# test the income limit.
 - name: Case 6, undocumented aged Alabaman keeps the pathway, unlike the citizen in Case 3, and qualifies for emergency Medicaid.
   period: 2026
   input:

policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/is_medically_needy_for_medicaid.yaml

@@ -332,3 +332,79 @@
     # 12,000 - 6,000 = 6,000 <= 6,264; resources 1,000 <= 2,000.
     is_in_medicaid_medically_needy_category: true
     is_medically_needy_for_medicaid: true
+
+- name: Case 11, aged permanent resident without 40 SSI quarters has pension counted.
+  period: 2026
+  input:
+    age: 70
+    immigration_status: LEGAL_PERMANENT_RESIDENT
+    years_since_us_entry: 10
+    ssi_qualifying_quarters_earnings: 20
+    pension_income: 60_000
+    is_in_medicaid_medically_needy_category: true
+    is_adult_for_medicaid: false
+    is_optional_senior_or_disabled_for_medicaid: false
+    medicaid_medically_needy_medical_expenses: 6_000
+    ssi_countable_resources: 1_000
+    state_code: MA
+  output:
+    # 60,000 - 20 x 12 = 59,760; 59,760 - 6,000 = 53,760 > 522 x 12 = 6,264.
+    is_medically_needy_for_medicaid: false
+
+- name: Case 12, aged permanent resident without 40 SSI quarters qualifies after medical spenddown.
+  period: 2026
+  input:
+    age: 70
+    immigration_status: LEGAL_PERMANENT_RESIDENT
+    years_since_us_entry: 10
+    ssi_qualifying_quarters_earnings: 20
+    pension_income: 18_000
+    is_in_medicaid_medically_needy_category: true
+    is_adult_for_medicaid: false
+    is_optional_senior_or_disabled_for_medicaid: false
+    medicaid_medically_needy_medical_expenses: 12_000
+    ssi_countable_resources: 1_000
+    state_code: MA
+  output:
+    # 18,000 - 20 x 12 = 17,760; 17,760 - 12,000 = 5,760 <= 522 x 12 = 6,264.
+    is_medically_needy_for_medicaid: true
+
+- name: Case 13, an aged noncitizen dependent parent's pension does not count against the head.
+  period: 2026
+  input:
+    people:
+      head:
+        age: 70
+        immigration_status: CITIZEN
+        pension_income: 20_000
+        medicaid_medically_needy_medical_expenses: 15_000
+        ssi_countable_resources: 1_000
+        is_in_medicaid_medically_needy_category: true
+        is_optional_senior_or_disabled_for_medicaid: false
+      parent:
+        age: 90
+        is_tax_unit_dependent: true
+        immigration_status: LEGAL_PERMANENT_RESIDENT
+        years_since_us_entry: 10
+        ssi_qualifying_quarters_earnings: 20
+        pension_income: 30_000
+        ssi_countable_resources: 0
+    tax_units:
+      tax_unit:
+        members: [head, parent]
+    marital_units:
+      head_unit:
+        members: [head]
+      parent_unit:
+        members: [parent]
+    households:
+      household:
+        members: [head, parent]
+        state_code: MA
+  output:
+    # The parent's 30,000 - 240 = 29,760 now counts (this PR), but a parent's
+    # income is never deemed to an adult child aged 70 (42 CFR
+    # 435.602(a)(2)(i)). The head: 20,000 - 240 - 15,000 = 4,760 <= 522 x 12
+    # = 6,264.
+    ssi_countable_income: [19_760, 29_760]
+    is_medically_needy_for_medicaid: [true, false]

policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/is_medicaid_eligible.yaml

@@ -439,3 +439,48 @@
   output:
     is_pregnant_for_medicaid: true
     is_medicaid_eligible: true
+
+- name: Case 21, aged permanent resident without 40 SSI quarters is over the Massachusetts income limit.
+  period: 2025
+  input:
+    age: 70
+    immigration_status: LEGAL_PERMANENT_RESIDENT
+    years_since_us_entry: 10
+    ssi_qualifying_quarters_earnings: 20
+    pension_income: 60_000
+    state_code: MA
+  output:
+    # The optional aged, blind, and disabled pathway counts 59,760 of
+    # income, above 100% of the poverty guideline, even though the person
+    # fails SSI's 40-quarter test.
+    is_medicaid_immigration_status_eligible: true
+    is_optional_senior_or_disabled_for_medicaid: false
+    is_medicaid_eligible: false
+
+- name: Case 22, aged permanent resident without 40 SSI quarters with a small pension is eligible.
+  period: 2025
+  input:
+    age: 70
+    immigration_status: LEGAL_PERMANENT_RESIDENT
+    years_since_us_entry: 10
+    ssi_qualifying_quarters_earnings: 20
+    pension_income: 12_000
+    state_code: MA
+  output:
+    # 12,000 - 20 x 12 = 11,760, under 100% of the poverty guideline.
+    is_optional_senior_or_disabled_for_medicaid: true
+    is_medicaid_eligible: true
+
+- name: Case 23, aged undocumented resident of the District of Columbia is over the income limit.
+  period: 2025
+  input:
+    age: 70
+    immigration_status: UNDOCUMENTED
+    pension_income: 60_000
+    state_code: DC
+  output:
+    # The District covers undocumented residents, but the optional aged,
+    # blind, and disabled pathway still counts 59,760 of income.
+    is_medicaid_immigration_status_eligible: true
+    is_optional_senior_or_disabled_for_medicaid: false
+    is_medicaid_eligible: false

policyengine_us/tests/policy/baseline/gov/hhs/medicaid/income/deemed/from_ineligible_spouse/medicaid_optional_senior_or_disabled_income_deemed_from_ineligible_spouse.yaml

@@ -120,3 +120,36 @@
     # (17,004 - 20 * 12 - 65 * 12) / 2 = 7,992 deemed and countable.
     medicaid_optional_senior_or_disabled_income_deemed_from_ineligible_spouse: [7_992, 0, 0]
     medicaid_optional_senior_or_disabled_countable_income: [7_992, 0, 0]
+
+- name: Spouse income is deemed to an aged permanent resident without 40 SSI quarters.
+  period: 2025
+  absolute_error_margin: 0.01
+  input:
+    people:
+      person1:
+        age: 70
+        is_tax_unit_head: true
+        immigration_status: LEGAL_PERMANENT_RESIDENT
+        years_since_us_entry: 10
+        ssi_qualifying_quarters_earnings: 20
+        pension_income: 6_000
+      person2:
+        age: 55
+        is_tax_unit_spouse: true
+        employment_income: 40_000
+    tax_units:
+      tax_unit:
+        members: [person1, person2]
+    marital_units:
+      marital_unit:
+        members: [person1, person2]
+    households:
+      household:
+        members: [person1, person2]
+        state_code: MA
+  output:
+    # SSI's noncitizen test does not stop deeming (42 CFR 435.601).
+    # Spouse wages 40,000 > (1,450 - 967) x 12 = 5,796.
+    # Couple: (500 - 20) x 12 + (40,000 - 65 x 12) / 2 = 25,370.
+    # Alone: (500 - 20) x 12 = 5,760. Deemed: 25,370 - 5,760 = 19,610.
+    medicaid_optional_senior_or_disabled_income_deemed_from_ineligible_spouse: [19_610, 0]

policyengine_us/tests/policy/baseline/gov/hhs/medicaid/income/medicaid_optional_senior_or_disabled_countable_income.yaml

@@ -727,3 +727,54 @@
     # 21,480 is under the 2026 guideline for two (21,640). A 75-dollar
     # disregard would leave 21,780, over the guideline.
     is_optional_senior_or_disabled_income_eligible: [true, true]
+
+- name: An aged permanent resident without 40 SSI quarters has their pension counted.
+  period: 2025
+  absolute_error_margin: 0.01
+  input:
+    age: 70
+    immigration_status: LEGAL_PERMANENT_RESIDENT
+    years_since_us_entry: 10
+    ssi_qualifying_quarters_earnings: 20
+    pension_income: 60_000
+    state_code: MA
+  output:
+    # Failing SSI's noncitizen test does not zero income under SSI
+    # methodology (42 CFR 435.601): 60,000 - 20 x 12 = 59,760.
+    medicaid_optional_senior_or_disabled_countable_income: 59_760
+    is_optional_senior_or_disabled_income_eligible: false
+
+- name: Spouse income is deemed to an aged permanent resident without 40 SSI quarters.
+  period: 2025
+  absolute_error_margin: 0.01
+  input:
+    people:
+      person1:
+        age: 70
+        is_tax_unit_head: true
+        immigration_status: LEGAL_PERMANENT_RESIDENT
+        years_since_us_entry: 10
+        ssi_qualifying_quarters_earnings: 20
+        pension_income: 6_000
+      person2:
+        age: 55
+        is_tax_unit_spouse: true
+        employment_income: 40_000
+    tax_units:
+      tax_unit:
+        members: [person1, person2]
+    marital_units:
+      marital_unit:
+        members: [person1, person2]
+    households:
+      household:
+        members: [person1, person2]
+        state_code: MA
+  output:
+    # Own income: 6,000 - 20 x 12 = 5,760.
+    # Deemed from the spouse who is not aged, blind, or disabled:
+    # 40,000 > (1,450 - 967) x 12 = 5,796, so the couple total is
+    # 5,760 + (40,000 - 65 x 12) / 2 = 25,370, and 25,370 - 5,760 = 19,610.
+    # The spouse's own countable income stays 0 to avoid counting it twice.
+    medicaid_optional_senior_or_disabled_countable_income: [25_370, 0]
+    is_optional_senior_or_disabled_income_eligible: [false, false]

policyengine_us/tests/policy/baseline/gov/hhs/medicare/savings_programs/income/msp_countable_income.yaml

@@ -427,3 +427,32 @@
     # Rule 4.2(C)(5) withholds the exclusion only from income based on need:
     # 12,000 / 12 - 50 = 950.
     msp_countable_income: 950
+
+- name: Case 20, spouse income is deemed to an aged permanent resident without 40 SSI quarters.
+  period: 2025-01
+  absolute_error_margin: 0.01
+  input:
+    people:
+      person1:
+        age: 70
+        is_tax_unit_head: true
+        immigration_status: LEGAL_PERMANENT_RESIDENT
+        years_since_us_entry: 10
+        ssi_qualifying_quarters_earnings: 20
+        ssi_unearned_income: 12_000
+      person2:
+        age: 55
+        is_tax_unit_spouse: true
+        ssi_earned_income: 20_000
+    tax_units:
+      tax_unit:
+        members: [person1, person2]
+    marital_units:
+      marital_unit:
+        members: [person1, person2]
+  output:
+    # SSI methodology deems the spouse's wages whether or not the person
+    # meets SSI's noncitizen test: 20,000 > (1,450 - 967) x 12 = 5,796.
+    # (1,000 - 20) + (1,666.67 - 65) / 2 = 980 + 800.83 = 1,780.83.
+    is_ssi_spousal_deeming_applies: [true, false]
+    msp_countable_income: [1_780.83, 790.83]

policyengine_us/tests/policy/baseline/gov/local/ca/sf/caap/ca_sf_caap.yaml

@@ -316,8 +316,8 @@
     # size-1 grant ($714) is paid through the top-level benefit, not the GA $578.
     ca_sf_caap: 714
 
-- name: Case 15, aged TPS member with a CAPI payment is excluded from the
-    budget unit along with her income.
+- name: Case 15, aged TPS member whose pension rules out CAPI stays in the
+    budget unit with her income.
   period: 2026-01
   absolute_error_margin: 0.01
   input:
@@ -339,22 +339,14 @@
         spm_unit_cash_assets: 0
   output:
     # person2 is categorically CAPI-eligible (aged 68 + noncitizen + TPS is not
-    # an SSI-qualified status) and the model pays her unit CAPI, so the
-    # receipt-based bar (ca_capi > 0) drops her from the budget unit and her
-    # pension is masked out of countable income; the remaining member collects
-    # the size-1 grant.
-    # NOTE: in real life her 2,000/month pension is roughly double the CAPI
-    # payment standard, so she would receive no CAPI and would stay in the
-    # CAAP budget unit (size 2, max grant 1,036), where her income fails the
-    # strict income test: ca_sf_caap = 0. The model currently pays her CAPI
-    # regardless of income because ca_capi's income test reads
-    # ssi_countable_income, which is zeroed for anyone failing the SSI
-    # immigration test (CAPI's entire target population) -- an upstream CAPI
-    # limitation. When that is fixed upstream, this case's expectations flip
-    # to budget_unit_size 2, countable_income 2_000, ca_sf_caap 0.
-    ca_sf_caap_budget_unit_size: 1
-    ca_sf_caap_countable_income: 0
-    ca_sf_caap: 578
+    # an SSI-qualified status), but CAPI counts her pension: her countable
+    # pension (2,000 - 20 = 1,980/month) exceeds CAPI's payment standard, so
+    # ca_capi = 0. The receipt-based bar (ca_capi > 0) does not apply, and she
+    # stays in the CAAP budget unit (size 2, max grant 1,036), where her
+    # income fails the strict income test.
+    ca_sf_caap_budget_unit_size: 2
+    ca_sf_caap_countable_income: 2_000
+    ca_sf_caap: 0
 
 - name: Case 16, one spouse receiving SSI and only one spouse applying yields
     the full one-person grant against the applicant's own income.

policyengine_us/tests/policy/baseline/gov/ssa/ssi/eligibility/income/deemed/from_ineligible_spouse/ssi_income_deemed_from_ineligible_spouse.yaml

@@ -224,3 +224,33 @@
         members: [person1, person2]
   output:
     ssi_income_deemed_from_ineligible_spouse: [0, 0]
+
+- name: Spouse income is deemed to an aged permanent resident without 40 SSI quarters (2025)
+  period: 2025
+  absolute_error_margin: 0.01
+  input:
+    people:
+      person1:
+        age: 70
+        is_tax_unit_head: true
+        immigration_status: LEGAL_PERMANENT_RESIDENT
+        years_since_us_entry: 10
+        ssi_qualifying_quarters_earnings: 20
+        pension_income: 6_000
+      person2:
+        age: 55
+        is_tax_unit_spouse: true
+        employment_income: 40_000
+    tax_units:
+      tax_unit:
+        members: [person1, person2]
+    marital_units:
+      marital_unit:
+        members: [person1, person2]
+  output:
+    # Deeming turns on aged, blind, or disabled status, not on SSI's
+    # noncitizen test: spouse wages 40,000 > (1,450 - 967) x 12 = 5,796.
+    # Couple: (500 - 20) x 12 + (40,000 - 65 x 12) / 2 = 25,370.
+    # Alone: (500 - 20) x 12 = 5,760. Deemed: 25,370 - 5,760 = 19,610.
+    is_ssi_spousal_deeming_applies: [true, false]
+    ssi_income_deemed_from_ineligible_spouse: [19_610, 0]

policyengine_us/tests/policy/baseline/gov/ssa/ssi/ssi_countable_income.yaml

@@ -147,3 +147,47 @@
     # No earned income, so earned exclusions don't apply
     # Countable = 3_868
     ssi_countable_income: 3_868
+
+- name: An aged permanent resident without 40 SSI quarters has their pension counted.
+  period: 2025
+  absolute_error_margin: 0.01
+  input:
+    age: 70
+    immigration_status: LEGAL_PERMANENT_RESIDENT
+    years_since_us_entry: 10
+    ssi_qualifying_quarters_earnings: 20
+    pension_income: 60_000
+  output:
+    # The noncitizen test bars SSI itself but does not zero the income
+    # that Medicaid and state programs count: 60,000 - 20 x 12 = 59,760.
+    ssi_countable_income: 59_760
+    ssi: 0
+
+- name: Spouse income is deemed to an aged permanent resident without 40 SSI quarters.
+  period: 2025
+  absolute_error_margin: 0.01
+  input:
+    people:
+      person1:
+        age: 70
+        is_tax_unit_head: true
+        immigration_status: LEGAL_PERMANENT_RESIDENT
+        years_since_us_entry: 10
+        ssi_qualifying_quarters_earnings: 20
+        pension_income: 6_000
+      person2:
+        age: 55
+        is_tax_unit_spouse: true
+        employment_income: 40_000
+    tax_units:
+      tax_unit:
+        members: [person1, person2]
+    marital_units:
+      marital_unit:
+        members: [person1, person2]
+  output:
+    # Own: (500 - 20) x 12 = 5,760. Deemed from the spouse who is not aged,
+    # blind, or disabled: 19,610 (20 CFR 416.1163). The spouse's own
+    # countable income stays 0.
+    ssi_countable_income: [25_370, 0]
+    ssi: [0, 0]