From 0efbb18d900b726f28904d3159761e012be01308 Mon Sep 17 00:00:00 2001
From: Ziming <ziming@policyengine.org>
Date: Wed, 21 Oct 2026 16:57:11 -0400
Subject: [PATCH 01/10] Turn off the Medicaid optional ABD pathway in states
 that cover only SSI recipients

Add gov.hhs.medicaid.eligibility.categories.senior_or_disabled.covers_non_ssi_recipients,
false for AL, DE, GA, KS, KY, MD, MS, NV, NM, SD, TN, TX and WY, and require it in
is_optional_senior_or_disabled_for_medicaid. The 209(b) SSI-recipient path is unchanged.

Co-Authored-By: Claude Opus 5.5 <noreply@anthropic.com>
---
 .../medicaid-abd-ssi-only-states.fixed.md     |   1 +
 .../covers_non_ssi_recipients.yaml            | 157 ++++++++++++++++++
 ...ional_senior_or_disabled_for_medicaid.yaml |  29 ++++
 .../categories/medicaid_category.yaml         |  32 ++++
 .../gov/states/ms/dom/hmw/integration.yaml    |   3 +-
 ...ptional_senior_or_disabled_for_medicaid.py |   9 +-
 6 files changed, 229 insertions(+), 2 deletions(-)
 create mode 100644 changelog.d/medicaid-abd-ssi-only-states.fixed.md
 create mode 100644 policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/covers_non_ssi_recipients.yaml

diff --git a/changelog.d/medicaid-abd-ssi-only-states.fixed.md b/changelog.d/medicaid-abd-ssi-only-states.fixed.md
new file mode 100644
index 00000000000..0ae5ff26c28
--- /dev/null
+++ b/changelog.d/medicaid-abd-ssi-only-states.fixed.md
@@ -0,0 +1 @@
+Limit the Medicaid optional aged, blind and disabled pathway to states that cover people who do not receive SSI, turning it off in the 13 states that cover only SSI recipients (AL, DE, GA, KS, KY, MD, MS, NV, NM, SD, TN, TX and WY).
diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/covers_non_ssi_recipients.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/covers_non_ssi_recipients.yaml
new file mode 100644
index 00000000000..9a6f9af8597
--- /dev/null
+++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/covers_non_ssi_recipients.yaml
@@ -0,0 +1,157 @@
+description: The state covers aged, blind, or disabled people who do not receive SSI as categorically needy under the Medicaid optional senior or disabled pathway, if this is true.
+metadata:
+  unit: bool
+  period: year
+  label: Medicaid senior or disabled pathway covers people who do not receive SSI
+  breakdown:
+  - state_code
+  reference:
+    - title: 42 CFR 435.210 - Optional eligibility for individuals who meet the income and resource requirements of the cash assistance programs
+      href: https://www.ecfr.gov/current/title-42/section-435.210
+    - title: 42 U.S. Code § 1396a(m) - Poverty-level aged and disabled group
+      href: https://www.law.cornell.edu/uscode/text/42/1396a#m
+    - title: KFF, Medicaid Eligibility and Enrollment Policies for Seniors and People with Disabilities (Non-MAGI) During the Unwinding (June 2024), Appendix Table 1
+      href: https://www.kff.org/report-section/medicaid-eligibility-and-enrollment-policies-for-seniors-and-people-with-disabilities-non-magi-during-the-unwinding-appendix/
+    - title: Ala. Admin. Code r. 560-X-25-.03(1) - Coverage Groups
+      href: https://www.law.cornell.edu/regulations/alabama/Ala-Admin-Code-r-560-X-25-.03
+    - title: Delaware Social Services Manual 17100 - SSI Beneficiaries
+      href: https://archive.regulations.delaware.gov/AdminCode/title16/Department%20of%20Health%20and%20Social%20Services/Division%20of%20Social%20Services/Delaware%20Social%20Services%20Manual/17000.shtml
+    - title: Georgia Medicaid Policy Manual 2101 - ABD Medicaid Classes of Assistance Overview
+      href: https://pamms.dhs.ga.gov/dfcs/medicaid/2101/
+    - title: Georgia Medicaid Policy Manual 2111 - Supplemental Security Income (SSI) Medicaid
+      href: https://pamms.dhs.ga.gov/dfcs/medicaid/2111/
+    - title: "Kansas Medicaid State Plan Amendment KS-25-0019 (effective July 1, 2025), Aged, Blind and Disabled eligibility groups #page 22-23"
+      href: https://www.medicaid.gov/medicaid/spa/downloads/KS-25-0019.pdf#page=22
+    - title: 907 KAR 20:005 Sections 1(1) and 9(3) - Medicaid technical eligibility requirements not related to a modified adjusted gross income standard or former foster care individuals
+      href: https://apps.legislature.ky.gov/law/kar/titles/907/020/005/
+    - title: "Maryland Department of Health, Guide to Maryland Medical Assistance Coverage Groups (April 2025), S02 and S98 #page 12,14-15"
+      href: https://health.maryland.gov/mmcp/Coverage%20Groups/coverage-group-guide.pdf#page=12
+    - title: Miss. Code Ann. § 43-13-115(11), as reprinted in 2024 House Bill 464 (introduced)
+      href: https://billstatus.ls.state.ms.us/documents/2024/pdf/HB/0400-0499/HB0464IN.pdf#page=5
+    - title: Mississippi Division of Medicaid Eligibility Policy and Procedures Manual, Appendix A-4-c - Inactive Categories of Eligibility
+      href: https://medicaid.ms.gov/wp-content/uploads/2016/12/Appendix-A-4.pdf#page=3
+    - title: "Mississippi Division of Medicaid Eligibility Policy and Procedures Manual, Section 101.02 (December 2016) #page 5,11"
+      href: https://medicaid.ms.gov/wp-content/uploads/2016/12/Section-101.02.pdf#page=5
+    - title: "Nevada Medicaid Assistance Manual B-300 - MAABD Medical Categories (March 2025), B-315, B-320 and B-340 #page 6-7,14"
+      href: https://dwss.nv.gov/uploadedFiles/dwssnvgov/content/Medical/B-300%20MAABD%20MEDICAL%20CATEGORIES%20Mar%2017.pdf#page=6
+    - title: 8.200.400.10(C)(1) NMAC - Supplemental security income (SSI) related medicaid
+      href: https://www.srca.nm.gov/parts/title08/08.200.0400.html
+    - title: S.D. Admin. R. 67:46:01:02(2) - Eligibility requirements
+      href: https://sdlegislature.gov/Rules/Administrative/67:46:01:02
+    - title: Tenn. Comp. R. & Regs. 1200-13-20-.08(1) - Supplementary Security Income (SSI) cash recipients
+      href: https://publications.tnsosfiles.com/rules/1200/1200-13/1200-13-20.20260423.pdf#page=73
+    - title: Texas Medicaid for the Elderly and People with Disabilities Handbook A-2000 - Mandatory Coverage Groups
+      href: https://fhb.hhs.texas.gov/handbooks/medicaid-elderly-people-disabilities-handbook/a-2000-mandatory-coverage-groups
+    - title: Texas Medicaid for the Elderly and People with Disabilities Handbook A-3000 - Optional Coverage Groups
+      href: https://fhb.hhs.texas.gov/handbooks/medicaid-elderly-people-disabilities-handbook/a-3000-optional-coverage-groups
+    - title: Wyo. Admin. Rules 048.0037.18 § 8(a) - Aged, Blind or Disabled Eligibility (effective May 23, 2025)
+      href: https://health.wyo.gov/wp-content/uploads/2025/12/Chapter-18-1.pdf#page=8
+    - title: Wyoming Medicaid Eligibility Online Manual M1005 - SSI and SSI Related
+      href: https://ecom.wyo.gov/m1000-aged-blind-or-disabled-program/m1005-ssi-and-ssi-related
+    - title: West Virginia Income Maintenance Manual 23.11.4 - SSI-Related/Non-Cash Assistance
+      href: https://bfa.wv.gov/media/40005/download?inline#page=1889
+
+AK:
+  2018-01-01: true
+AL:
+  2018-01-01: false
+AR:
+  2018-01-01: true
+AZ:
+  2018-01-01: true
+CA:
+  2018-01-01: true
+CO:
+  2018-01-01: true
+CT:
+  2018-01-01: true
+DC:
+  2018-01-01: true
+DE:
+  2018-01-01: false
+FL:
+  2018-01-01: true
+GA:
+  2018-01-01: false
+HI:
+  2018-01-01: true
+IA:
+  2018-01-01: true
+ID:
+  2018-01-01: true
+IL:
+  2018-01-01: true
+IN:
+  2018-01-01: true
+KS:
+  2018-01-01: false
+KY:
+  2018-01-01: false
+LA:
+  2018-01-01: true
+MA:
+  2018-01-01: true
+MD:
+  2018-01-01: false
+ME:
+  2018-01-01: true
+MI:
+  2018-01-01: true
+MN:
+  2018-01-01: true
+MO:
+  2018-01-01: true
+MS:
+  # The poverty-level aged and disabled group ended December 31, 2005.
+  2006-01-01: false
+MT:
+  2018-01-01: true
+NC:
+  2018-01-01: true
+ND:
+  2018-01-01: true
+NE:
+  2018-01-01: true
+NH:
+  2018-01-01: true
+NJ:
+  2018-01-01: true
+NM:
+  2018-01-01: false
+NV:
+  2018-01-01: false
+NY:
+  2018-01-01: true
+OH:
+  2018-01-01: true
+OK:
+  2018-01-01: true
+OR:
+  2018-01-01: true
+PA:
+  2018-01-01: true
+RI:
+  2018-01-01: true
+SC:
+  2018-01-01: true
+SD:
+  2018-01-01: false
+TN:
+  2018-01-01: false
+TX:
+  2018-01-01: false
+UT:
+  2018-01-01: true
+VA:
+  2018-01-01: true
+VT:
+  2018-01-01: true
+WA:
+  2018-01-01: true
+WI:
+  2018-01-01: true
+WV:
+  # SSI-Related/Non-Cash Assistance covers people under the SSI payment level.
+  2018-01-01: true
+WY:
+  2018-01-01: false
diff --git a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_for_medicaid.yaml b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_for_medicaid.yaml
index 5cd7b9fe4c7..3c2f6458859 100644
--- a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_for_medicaid.yaml
+++ b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_for_medicaid.yaml
@@ -15,3 +15,32 @@
     is_optional_senior_or_disabled_asset_eligible: false
   output:
     is_optional_senior_or_disabled_for_medicaid: false
+
+# 2026: Social Security of $900 a month leaves countable income of $10,560 a
+# year after the $20 a month disregard, under both the SSI rate ($11,928) and
+# 75% of the poverty guideline ($11,970).
+- name: Case 3, aged Alabaman who does not take up SSI is not covered, since Alabama covers only SSI recipients.
+  period: 2026
+  input:
+    age: 70
+    state_code: AL
+    social_security_retirement: 10_800
+    takes_up_ssi_if_eligible: false
+  output:
+    ssi: 0
+    is_optional_senior_or_disabled_income_eligible: true
+    is_optional_senior_or_disabled_for_medicaid: false
+    medicaid_category: NONE
+    is_medicaid_eligible: false
+
+- name: Case 4, the same person in Pennsylvania, which covers aged people who do not receive SSI, is covered.
+  period: 2026
+  input:
+    age: 70
+    state_code: PA
+    social_security_retirement: 10_800
+    takes_up_ssi_if_eligible: false
+  output:
+    is_optional_senior_or_disabled_for_medicaid: true
+    medicaid_category: SENIOR_OR_DISABLED
+    is_medicaid_eligible: true
diff --git a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medicaid_category.yaml b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medicaid_category.yaml
index 6489f6b6a1f..23338548149 100644
--- a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medicaid_category.yaml
+++ b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medicaid_category.yaml
@@ -161,3 +161,35 @@
     is_optional_senior_or_disabled_for_medicaid: [true, true]
     medicaid_category: [SENIOR_OR_DISABLED, SENIOR_OR_DISABLED]
     is_medicaid_eligible: [true, true]
+
+# 2026: an aged person with $900 a month of Social Security receives SSI of
+# $994 - ($900 - $20) = $114 a month.
+- name: Case 13, aged Alabaman who receives SSI is an SSI recipient.
+  period: 2026
+  input:
+    age: 70
+    state_code: AL
+    social_security_retirement: 10_800
+  output:
+    ssi: 1_368
+    medicaid_category: SSI_RECIPIENT
+    is_medicaid_eligible: true
+
+# Maryland covers aged, blind, or disabled people who do not receive SSI as
+# medically needy, not as categorically needy. Countable income of $10,560 a
+# year less $7,200 of other medical expenses (and any modeled Medicare Part B
+# premium) is at most $3,360, under the medically needy limit of $350 a month
+# ($4,200 a year).
+- name: Case 14, aged Marylander who does not take up SSI spends down to medically needy coverage.
+  period: 2026
+  input:
+    age: 70
+    state_code: MD
+    social_security_retirement: 10_800
+    takes_up_ssi_if_eligible: false
+    other_medical_expenses: 7_200
+  output:
+    is_optional_senior_or_disabled_for_medicaid: false
+    is_medically_needy_for_medicaid: true
+    medicaid_category: MEDICALLY_NEEDY
+    is_medicaid_eligible: true
diff --git a/policyengine_us/tests/policy/baseline/gov/states/ms/dom/hmw/integration.yaml b/policyengine_us/tests/policy/baseline/gov/states/ms/dom/hmw/integration.yaml
index f7fb8b4e1fc..43bbbc97e63 100644
--- a/policyengine_us/tests/policy/baseline/gov/states/ms/dom/hmw/integration.yaml
+++ b/policyengine_us/tests/policy/baseline/gov/states/ms/dom/hmw/integration.yaml
@@ -79,7 +79,7 @@
   output:
     ms_hmw_eligible: false
 
-- name: Case 7, person eligible under standard optional ABD Medicaid does not use HMW.
+- name: Case 7, disabled person who receives SSI gets SSI-recipient Medicaid, not HMW.
   period: 2026
   input:
     age: 45
@@ -90,6 +90,7 @@
     medicaid_optional_senior_or_disabled_countable_income: 5_000
     ssi_countable_resources: 1_500
   output:
+    is_ssi_recipient_for_medicaid: true
     ms_hmw_eligible: false
     ms_hmw_other_coverage_ineligible: false
 
diff --git a/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_for_medicaid.py b/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_for_medicaid.py
index 51886d8c2b6..3fcc24bb99e 100644
--- a/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_for_medicaid.py
+++ b/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_for_medicaid.py
@@ -10,9 +10,16 @@ class is_optional_senior_or_disabled_for_medicaid(Variable):
     reference = "https://www.law.cornell.edu/uscode/text/42/1396a#m"
 
     def formula(person, period, parameters):
+        # Some states cover aged, blind, or disabled people as categorically
+        # needy only if they receive SSI, and have no group for those who do not.
+        state = person.household("state_code_str", period)
+        p = parameters(
+            period
+        ).gov.hhs.medicaid.eligibility.categories.senior_or_disabled
+        covers_group = p.covers_non_ssi_recipients[state].astype(bool)
         is_senior_or_disabled = person("is_ssi_aged_blind_disabled", period)
         income_eligible = person(
             "is_optional_senior_or_disabled_income_eligible", period
         )
         asset_eligible = person("is_optional_senior_or_disabled_asset_eligible", period)
-        return is_senior_or_disabled & income_eligible & asset_eligible
+        return covers_group & is_senior_or_disabled & income_eligible & asset_eligible

From 4dd414057e20291fce03c27770241302f122dcc9 Mon Sep 17 00:00:00 2001
From: Ziming <ziming@policyengine.org>
Date: Wed, 21 Oct 2026 16:58:12 -0400
Subject: [PATCH 02/10] Name Nevada's Medical Assistance Manual correctly

Co-Authored-By: Claude Opus 5.5 <noreply@anthropic.com>
---
 .../senior_or_disabled/covers_non_ssi_recipients.yaml           | 2 +-
 1 file changed, 1 insertion(+), 1 deletion(-)

diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/covers_non_ssi_recipients.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/covers_non_ssi_recipients.yaml
index 9a6f9af8597..35b179925ce 100644
--- a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/covers_non_ssi_recipients.yaml
+++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/covers_non_ssi_recipients.yaml
@@ -32,7 +32,7 @@ metadata:
       href: https://medicaid.ms.gov/wp-content/uploads/2016/12/Appendix-A-4.pdf#page=3
     - title: "Mississippi Division of Medicaid Eligibility Policy and Procedures Manual, Section 101.02 (December 2016) #page 5,11"
       href: https://medicaid.ms.gov/wp-content/uploads/2016/12/Section-101.02.pdf#page=5
-    - title: "Nevada Medicaid Assistance Manual B-300 - MAABD Medical Categories (March 2025), B-315, B-320 and B-340 #page 6-7,14"
+    - title: "Nevada Medical Assistance Manual B-300 - MAABD Medical Categories (March 2025), B-315, B-320 and B-340 #page 6-7,14"
       href: https://dwss.nv.gov/uploadedFiles/dwssnvgov/content/Medical/B-300%20MAABD%20MEDICAL%20CATEGORIES%20Mar%2017.pdf#page=6
     - title: 8.200.400.10(C)(1) NMAC - Supplemental security income (SSI) related medicaid
       href: https://www.srca.nm.gov/parts/title08/08.200.0400.html

From 30f37531e095afe84f1b2811c44e1bd774ef6995 Mon Sep 17 00:00:00 2001
From: Ziming <ziming@policyengine.org>
Date: Thu, 22 Oct 2026 11:43:29 -0400
Subject: [PATCH 03/10] Add North Dakota to the states that cover only SSI
 recipients

N.D. Admin. Code 75-02-02.1-05 covers aged, blind and disabled people as
categorically needy only if they receive SSI; those who do not are medically
needy under (3)(e). The 209(b) SSI-recipient path does not read the gated
variable, so North Dakota's SSI recipients are unaffected.

Co-Authored-By: Claude Opus 5.5 <noreply@anthropic.com>
---
 changelog.d/medicaid-abd-ssi-only-states.fixed.md  |  2 +-
 .../covers_non_ssi_recipients.yaml                 |  4 +++-
 ...s_optional_senior_or_disabled_for_medicaid.yaml | 14 ++++++++++++++
 3 files changed, 18 insertions(+), 2 deletions(-)

diff --git a/changelog.d/medicaid-abd-ssi-only-states.fixed.md b/changelog.d/medicaid-abd-ssi-only-states.fixed.md
index 0ae5ff26c28..d188a153fc5 100644
--- a/changelog.d/medicaid-abd-ssi-only-states.fixed.md
+++ b/changelog.d/medicaid-abd-ssi-only-states.fixed.md
@@ -1 +1 @@
-Limit the Medicaid optional aged, blind and disabled pathway to states that cover people who do not receive SSI, turning it off in the 13 states that cover only SSI recipients (AL, DE, GA, KS, KY, MD, MS, NV, NM, SD, TN, TX and WY).
+Limit the Medicaid optional aged, blind and disabled pathway to states that cover people who do not receive SSI, turning it off in the 14 states that cover them only if they receive SSI (AL, DE, GA, KS, KY, MD, MS, NV, NM, ND, SD, TN, TX and WY).
diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/covers_non_ssi_recipients.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/covers_non_ssi_recipients.yaml
index 35b179925ce..9d1cd02c1d6 100644
--- a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/covers_non_ssi_recipients.yaml
+++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/covers_non_ssi_recipients.yaml
@@ -36,6 +36,8 @@ metadata:
       href: https://dwss.nv.gov/uploadedFiles/dwssnvgov/content/Medical/B-300%20MAABD%20MEDICAL%20CATEGORIES%20Mar%2017.pdf#page=6
     - title: 8.200.400.10(C)(1) NMAC - Supplemental security income (SSI) related medicaid
       href: https://www.srca.nm.gov/parts/title08/08.200.0400.html
+    - title: "N.D. Admin. Code 75-02-02.1-05(1)(n), (2) and (3)(e) - Coverage groups #page 10-11"
+      href: https://www.ndlegis.gov/information/acdata/pdf/75-02-02.1.pdf#page=10
     - title: S.D. Admin. R. 67:46:01:02(2) - Eligibility requirements
       href: https://sdlegislature.gov/Rules/Administrative/67:46:01:02
     - title: Tenn. Comp. R. & Regs. 1200-13-20-.08(1) - Supplementary Security Income (SSI) cash recipients
@@ -109,7 +111,7 @@ MT:
 NC:
   2018-01-01: true
 ND:
-  2018-01-01: true
+  2018-01-01: false
 NE:
   2018-01-01: true
 NH:
diff --git a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_for_medicaid.yaml b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_for_medicaid.yaml
index 3c2f6458859..09b345e7ddf 100644
--- a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_for_medicaid.yaml
+++ b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_for_medicaid.yaml
@@ -44,3 +44,17 @@
     is_optional_senior_or_disabled_for_medicaid: true
     medicaid_category: SENIOR_OR_DISABLED
     is_medicaid_eligible: true
+
+# North Dakota covers aged, blind, or disabled people who do not receive SSI
+# only as medically needy (N.D. Admin. Code 75-02-02.1-05(3)(e)).
+- name: Case 5, disabled North Dakotan who does not take up SSI is not covered by the pathway.
+  period: 2026
+  input:
+    age: 50
+    state_code: ND
+    meets_ssi_disability_criteria: true
+    social_security_disability: 10_800
+    takes_up_ssi_if_eligible: false
+  output:
+    is_optional_senior_or_disabled_income_eligible: true
+    is_optional_senior_or_disabled_for_medicaid: false

From 707e042771bef50e69a15c0fd88c9a10372b45e2 Mon Sep 17 00:00:00 2001
From: Ziming <ziming@policyengine.org>
Date: Thu, 22 Oct 2026 15:11:41 -0400
Subject: [PATCH 04/10] Keep noncitizens who fail the Medicaid immigration test
 in the ABD pathway

Medicaid categories ignore immigration status, and emergency Medicaid needs
a category. In the states that cover only SSI recipients, noncitizens cannot
receive SSI, so the gate would have removed their emergency Medicaid. Texas
MEPD A-2200 covers aliens who meet all SSI criteria except citizenship.

Co-Authored-By: Claude Opus 5.5 <noreply@anthropic.com>
---
 .../is_optional_senior_or_disabled_for_medicaid.py        | 8 +++++++-
 1 file changed, 7 insertions(+), 1 deletion(-)

diff --git a/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_for_medicaid.py b/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_for_medicaid.py
index 3fcc24bb99e..d608c855b27 100644
--- a/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_for_medicaid.py
+++ b/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_for_medicaid.py
@@ -12,11 +12,17 @@ class is_optional_senior_or_disabled_for_medicaid(Variable):
     def formula(person, period, parameters):
         # Some states cover aged, blind, or disabled people as categorically
         # needy only if they receive SSI, and have no group for those who do not.
+        # Noncitizens who fail the Medicaid immigration test cannot receive
+        # SSI either, so they stay in this group: emergency Medicaid covers
+        # them if they meet the other requirements (42 CFR 440.255(c)).
         state = person.household("state_code_str", period)
         p = parameters(
             period
         ).gov.hhs.medicaid.eligibility.categories.senior_or_disabled
-        covers_group = p.covers_non_ssi_recipients[state].astype(bool)
+        immigration_eligible = person("is_medicaid_immigration_status_eligible", period)
+        covers_group = (
+            p.covers_non_ssi_recipients[state].astype(bool) | ~immigration_eligible
+        )
         is_senior_or_disabled = person("is_ssi_aged_blind_disabled", period)
         income_eligible = person(
             "is_optional_senior_or_disabled_income_eligible", period

From ef090468a9f6a16aaf9d140d714f65b9c160df62 Mon Sep 17 00:00:00 2001
From: Ziming <ziming@policyengine.org>
Date: Mon, 26 Oct 2026 16:34:57 -0400
Subject: [PATCH 05/10] Test the immigration exception and date Mississippi's
 earlier coverage

- Add a case for an undocumented aged Alabaman who keeps the pathway and
  qualifies for emergency Medicaid.
- Cite 42 U.S.C. 1396b(v)(2)(B) and 42 CFR 435.406(b) for the exception.
- Mississippi covered people who do not receive SSI before 2006; date the
  earlier true value from the fiscal year 1997 annual report.

Co-Authored-By: Claude Opus 5.5 <noreply@anthropic.com>
---
 .../covers_non_ssi_recipients.yaml            |  7 ++++++-
 ...ional_senior_or_disabled_for_medicaid.yaml | 21 +++++++++++++++++++
 ...ptional_senior_or_disabled_for_medicaid.py |  6 +++---
 3 files changed, 30 insertions(+), 4 deletions(-)

diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/covers_non_ssi_recipients.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/covers_non_ssi_recipients.yaml
index 9d1cd02c1d6..38a24c2c7b6 100644
--- a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/covers_non_ssi_recipients.yaml
+++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/covers_non_ssi_recipients.yaml
@@ -32,6 +32,8 @@ metadata:
       href: https://medicaid.ms.gov/wp-content/uploads/2016/12/Appendix-A-4.pdf#page=3
     - title: "Mississippi Division of Medicaid Eligibility Policy and Procedures Manual, Section 101.02 (December 2016) #page 5,11"
       href: https://medicaid.ms.gov/wp-content/uploads/2016/12/Section-101.02.pdf#page=5
+    - title: Mississippi Division of Medicaid Annual Report, Fiscal Year 1997 - Eligibility
+      href: https://medicaid.ms.gov/wp-content/uploads/2020/11/1997.pdf#page=8
     - title: "Nevada Medical Assistance Manual B-300 - MAABD Medical Categories (March 2025), B-315, B-320 and B-340 #page 6-7,14"
       href: https://dwss.nv.gov/uploadedFiles/dwssnvgov/content/Medical/B-300%20MAABD%20MEDICAL%20CATEGORIES%20Mar%2017.pdf#page=6
     - title: 8.200.400.10(C)(1) NMAC - Supplemental security income (SSI) related medicaid
@@ -104,7 +106,10 @@ MN:
 MO:
   2018-01-01: true
 MS:
-  # The poverty-level aged and disabled group ended December 31, 2005.
+  # The poverty-level aged and disabled group was in force by fiscal year 1997,
+  # which began July 1, 1996; its start date is not sourced. It ended
+  # December 31, 2005.
+  1996-07-01: true
   2006-01-01: false
 MT:
   2018-01-01: true
diff --git a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_for_medicaid.yaml b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_for_medicaid.yaml
index 09b345e7ddf..724fa71ab18 100644
--- a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_for_medicaid.yaml
+++ b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_for_medicaid.yaml
@@ -58,3 +58,24 @@
   output:
     is_optional_senior_or_disabled_income_eligible: true
     is_optional_senior_or_disabled_for_medicaid: false
+
+# 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)).
+# Wages of $800 a month ($9,600 a year) are under 75% of the poverty guideline
+# ($11,970) before any disregard.
+- name: Case 6, undocumented aged Alabaman keeps the pathway, unlike the citizen in Case 3, and qualifies for emergency Medicaid.
+  period: 2026
+  input:
+    age: 70
+    state_code: AL
+    immigration_status: UNDOCUMENTED
+    employment_income_before_lsr: 9_600
+    has_emergency_medical_condition: true
+  output:
+    is_medicaid_immigration_status_eligible: false
+    ssi: 0
+    is_optional_senior_or_disabled_income_eligible: true
+    is_optional_senior_or_disabled_for_medicaid: true
+    medicaid_category: SENIOR_OR_DISABLED
+    is_medicaid_eligible: false
+    is_emergency_medicaid_eligible: true
diff --git a/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_for_medicaid.py b/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_for_medicaid.py
index d608c855b27..2931055ee42 100644
--- a/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_for_medicaid.py
+++ b/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_for_medicaid.py
@@ -12,9 +12,9 @@ class is_optional_senior_or_disabled_for_medicaid(Variable):
     def formula(person, period, parameters):
         # Some states cover aged, blind, or disabled people as categorically
         # needy only if they receive SSI, and have no group for those who do not.
-        # Noncitizens who fail the Medicaid immigration test cannot receive
-        # SSI either, so they stay in this group: emergency Medicaid covers
-        # them if they meet the other requirements (42 CFR 440.255(c)).
+        # Emergency Medicaid waives the SSI receipt requirement for noncitizens
+        # who fail the Medicaid immigration test (42 U.S.C. 1396b(v)(2)(B);
+        # 42 CFR 435.406(b) and 440.255(c)), so they stay in this group.
         state = person.household("state_code_str", period)
         p = parameters(
             period

From ed383e9caab309ac9446fae6902198718bb56d51 Mon Sep 17 00:00:00 2001
From: Ziming <ziming@policyengine.org>
Date: Mon, 26 Oct 2026 16:47:11 -0400
Subject: [PATCH 06/10] Fix issues from review: cite the emergency Medicaid
 authority

Add 42 U.S.C. 1396b(v) and 42 CFR 435.406(b) to the pathway variable's
references, since the immigration exception rests on them.

Co-Authored-By: Claude Opus 5.5 <noreply@anthropic.com>
---
 .../is_optional_senior_or_disabled_for_medicaid.py          | 6 +++++-
 1 file changed, 5 insertions(+), 1 deletion(-)

diff --git a/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_for_medicaid.py b/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_for_medicaid.py
index 2931055ee42..ca1ab1f51fd 100644
--- a/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_for_medicaid.py
+++ b/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_for_medicaid.py
@@ -7,7 +7,11 @@ class is_optional_senior_or_disabled_for_medicaid(Variable):
     label = "Seniors or disabled people not meeting SSI rules"
     documentation = "Whether this person qualifies for Medicaid through the State's optional aged, blind, or disabled pathway (not otherwise SSI-eligible)"
     definition_period = YEAR
-    reference = "https://www.law.cornell.edu/uscode/text/42/1396a#m"
+    reference = (
+        "https://www.law.cornell.edu/uscode/text/42/1396a#m",
+        "https://www.law.cornell.edu/uscode/text/42/1396b#v",
+        "https://www.ecfr.gov/current/title-42/section-435.406#p-435.406(b)",
+    )
 
     def formula(person, period, parameters):
         # Some states cover aged, blind, or disabled people as categorically

From ec7f9f707f7fa05e40041311b5f33f309773204b Mon Sep 17 00:00:00 2001
From: Ziming <ziming@policyengine.org>
Date: Mon, 26 Oct 2026 17:24:51 -0400
Subject: [PATCH 07/10] Test noncitizens kept for emergency Medicaid against
 the SSI rate

In states that cover aged, blind or disabled people only if they receive
SSI, the pathway now reaches only noncitizens who fail the Medicaid
immigration test. 42 U.S.C. 1396b(v)(2)(B) waives SSI receipt alone, so
their income limit is the SSI federal benefit rate, at or below it.

- Add Case 7 (permanent resident in the five-year bar, $12 over the SSI
  rate) and Case 8 (a couple exactly at the SSI couple rate).
- Make the SSI-rate property tests aware of covers_non_ssi_recipients.
- Cite 1396b(v), 1382(a) and 42 CFR 440.255(c).

Co-Authored-By: Claude Opus 5.5 <noreply@anthropic.com>
---
 .../medicaid-abd-ssi-only-states.fixed.md     |  2 +-
 ...ional_senior_or_disabled_for_medicaid.yaml | 69 +++++++++++++++++--
 ...dicaid_abd_ssi_rate_standard_properties.py | 27 ++++++--
 ...ptional_senior_or_disabled_for_medicaid.py |  1 +
 ...ptional_senior_or_disabled_income_limit.py | 12 +++-
 5 files changed, 100 insertions(+), 11 deletions(-)

diff --git a/changelog.d/medicaid-abd-ssi-only-states.fixed.md b/changelog.d/medicaid-abd-ssi-only-states.fixed.md
index d188a153fc5..70f6c83b549 100644
--- a/changelog.d/medicaid-abd-ssi-only-states.fixed.md
+++ b/changelog.d/medicaid-abd-ssi-only-states.fixed.md
@@ -1 +1 @@
-Limit the Medicaid optional aged, blind and disabled pathway to states that cover people who do not receive SSI, turning it off in the 14 states that cover them only if they receive SSI (AL, DE, GA, KS, KY, MD, MS, NV, NM, ND, SD, TN, TX and WY).
+Limit the Medicaid optional aged, blind and disabled pathway to states that cover people who do not receive SSI, turning it off in the 14 states that cover them only if they receive SSI (AL, DE, GA, KS, KY, MD, MS, NV, NM, ND, SD, TN, TX and WY). Noncitizens who fail the Medicaid immigration test keep the pathway there for emergency Medicaid and are tested against the SSI rate.
diff --git a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_for_medicaid.yaml b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_for_medicaid.yaml
index 724fa71ab18..210a9f9f27f 100644
--- a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_for_medicaid.yaml
+++ b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_for_medicaid.yaml
@@ -17,8 +17,7 @@
     is_optional_senior_or_disabled_for_medicaid: false
 
 # 2026: Social Security of $900 a month leaves countable income of $10,560 a
-# year after the $20 a month disregard, under both the SSI rate ($11,928) and
-# 75% of the poverty guideline ($11,970).
+# year after the $20 a month disregard, under the SSI rate ($11,928).
 - name: Case 3, aged Alabaman who does not take up SSI is not covered, since Alabama covers only SSI recipients.
   period: 2026
   input:
@@ -61,8 +60,8 @@
 
 # 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)).
-# Wages of $800 a month ($9,600 a year) are under 75% of the poverty guideline
-# ($11,970) before any disregard.
+# 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.
 - name: Case 6, undocumented aged Alabaman keeps the pathway, unlike the citizen in Case 3, and qualifies for emergency Medicaid.
   period: 2026
   input:
@@ -79,3 +78,65 @@
     medicaid_category: SENIOR_OR_DISABLED
     is_medicaid_eligible: false
     is_emergency_medicaid_eligible: true
+
+# A permanent resident two years after entry is in the five-year bar (8 U.S.C.
+# 1613) and fails the Medicaid immigration test. The pathway then tests income
+# against the 2026 SSI rate, 12 x $994 = $11,928, at or below it (42 U.S.C.
+# 1382(a)(1)(A)). Countable income is an input.
+- name: Case 7, Alabaman permanent resident in the five-year bar with income over the SSI rate gets neither the pathway nor emergency Medicaid.
+  period: 2026
+  input:
+    age: 70
+    state_code: AL
+    immigration_status: LEGAL_PERMANENT_RESIDENT
+    years_since_us_entry: 2
+    medicaid_optional_senior_or_disabled_countable_income: 11_940
+    has_emergency_medical_condition: true
+  output:
+    is_medicaid_immigration_status_eligible: false
+    medicaid_optional_senior_or_disabled_income_limit: 11_928
+    is_optional_senior_or_disabled_income_eligible: false
+    is_optional_senior_or_disabled_for_medicaid: false
+    medicaid_category: NONE
+    is_emergency_medicaid_eligible: false
+
+# The SSI couple rate in 2026 is 12 x $1,491 = $17,892; the couple's countable
+# income, $8,946 each, is exactly at it. Only the first spouse has an
+# emergency medical condition.
+- name: Case 8, Alabaman permanent-resident couple in the five-year bar at the SSI couple rate keeps the pathway.
+  period: 2026
+  input:
+    people:
+      person1:
+        age: 70
+        immigration_status: LEGAL_PERMANENT_RESIDENT
+        years_since_us_entry: 2
+        medicaid_optional_senior_or_disabled_countable_income: 8_946
+        has_emergency_medical_condition: true
+      person2:
+        age: 68
+        immigration_status: LEGAL_PERMANENT_RESIDENT
+        years_since_us_entry: 2
+        medicaid_optional_senior_or_disabled_countable_income: 8_946
+        has_emergency_medical_condition: false
+    marital_units:
+      marital_unit:
+        members: [person1, person2]
+    tax_units:
+      tax_unit:
+        members: [person1, person2]
+    spm_units:
+      spm_unit:
+        members: [person1, person2]
+    households:
+      household:
+        members: [person1, person2]
+        state_code: AL
+  output:
+    is_medicaid_immigration_status_eligible: [false, false]
+    medicaid_optional_senior_or_disabled_income_limit: [17_892, 17_892]
+    is_optional_senior_or_disabled_income_eligible: [true, true]
+    is_optional_senior_or_disabled_for_medicaid: [true, true]
+    medicaid_category: [SENIOR_OR_DISABLED, SENIOR_OR_DISABLED]
+    is_medicaid_eligible: [false, false]
+    is_emergency_medicaid_eligible: [true, false]
diff --git a/policyengine_us/tests/unit/test_medicaid_abd_ssi_rate_standard_properties.py b/policyengine_us/tests/unit/test_medicaid_abd_ssi_rate_standard_properties.py
index f9f38924c16..847b148c802 100644
--- a/policyengine_us/tests/unit/test_medicaid_abd_ssi_rate_standard_properties.py
+++ b/policyengine_us/tests/unit/test_medicaid_abd_ssi_rate_standard_properties.py
@@ -189,10 +189,19 @@ def test_no_medicaid_without_ssi_above_the_ssi_rate(year):
     standard = 12 * individual
     # Section 209(b) states test SSI recipients against their own criteria,
     # so the SSI-receipt half of this property is stated for the others.
-    classification = SYSTEM.parameters(
+    categories = SYSTEM.parameters(
         f"{year}-01-01"
-    ).gov.hhs.medicaid.eligibility.categories.ssi_recipient.classification
+    ).gov.hhs.medicaid.eligibility.categories
+    classification = categories.ssi_recipient.classification
     states = [state for state in SSI_RATE_STATES for _ in OFFSETS]
+    # States without a group for people who do not receive SSI give the
+    # pathway to nobody in this citizen grid.
+    covers = np.array(
+        [
+            bool(categories.senior_or_disabled.covers_non_ssi_recipients[state])
+            for state in states
+        ]
+    )
     countable = np.array(
         [standard + offset for _ in SSI_RATE_STATES for offset in OFFSETS]
     )
@@ -219,12 +228,14 @@ def test_no_medicaid_without_ssi_above_the_ssi_rate(year):
     # Under the rate the pathway's own tests pass, and at it they pass
     # except where the state requires income below the standard.
     covered = (countable < standard) | (at_rate & ~below_only)
-    assert optional[covered].all()
-    assert not optional[~covered].any()
+    assert optional[covered & covers].all()
+    assert not optional[~covered | ~covers].any()
     not_209b = np.array([not classification.section_209b[state] for state in states])
     receives = (countable < standard) & not_209b
     assert (category[receives] == "SSI_RECIPIENT").all()
-    assert (category[at_rate & ~below_only & not_209b] == "SENIOR_OR_DISABLED").all()
+    assert (
+        category[at_rate & ~below_only & not_209b & covers] == "SENIOR_OR_DISABLED"
+    ).all()
     # In Oregon a person exactly at the rate gets neither SSI nor the pathway.
     assert not (category[at_rate & below_only] == "SENIOR_OR_DISABLED").any()
 
@@ -238,6 +249,12 @@ def test_unflagged_states_keep_their_share_of_the_poverty_guideline(year, couple
     states = [
         state for state in STATES if state not in SSI_RATE_STATES and state != "MO"
     ]
+    # States without a group for people who do not receive SSI use the SSI
+    # rate for the noncitizens their pathway still reaches.
+    covers = SYSTEM.parameters(
+        f"{year}-01-01"
+    ).gov.hhs.medicaid.eligibility.categories.senior_or_disabled.covers_non_ssi_recipients
+    states = [state for state in states if covers[state]]
     simulation = unit_simulation(year, states, couple)
     limit = simulation.calculate(
         "medicaid_optional_senior_or_disabled_income_limit", year
diff --git a/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_for_medicaid.py b/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_for_medicaid.py
index ca1ab1f51fd..6bdb3e33db1 100644
--- a/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_for_medicaid.py
+++ b/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_for_medicaid.py
@@ -11,6 +11,7 @@ class is_optional_senior_or_disabled_for_medicaid(Variable):
         "https://www.law.cornell.edu/uscode/text/42/1396a#m",
         "https://www.law.cornell.edu/uscode/text/42/1396b#v",
         "https://www.ecfr.gov/current/title-42/section-435.406#p-435.406(b)",
+        "https://www.ecfr.gov/current/title-42/section-440.255#p-440.255(c)",
     )
 
     def formula(person, period, parameters):
diff --git a/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/medicaid_optional_senior_or_disabled_income_limit.py b/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/medicaid_optional_senior_or_disabled_income_limit.py
index cb5260bda63..6b295e39737 100644
--- a/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/medicaid_optional_senior_or_disabled_income_limit.py
+++ b/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/medicaid_optional_senior_or_disabled_income_limit.py
@@ -14,6 +14,8 @@ class medicaid_optional_senior_or_disabled_income_limit(Variable):
     reference = (
         "https://www.law.cornell.edu/uscode/text/42/1396a#m",
         "https://www.ecfr.gov/current/title-42/section-435.210",
+        "https://www.law.cornell.edu/uscode/text/42/1396b#v",
+        "https://www.law.cornell.edu/uscode/text/42/1382#a",
         "https://dssmanuals.mo.gov/mo-healthnet-for-the-aged-blind-and-disabled/0805-000-00/0805-015-00/0805-015-45-income-maximum/",
         "https://dssmanuals.mo.gov/wp-content/uploads/2022/07/mhabd-appendix-j.pdf#page=1",
     )
@@ -49,9 +51,17 @@ def formula(person, period, parameters):
         # dollar amount for an individual or a couple, rather than a share of
         # the poverty guideline (the group of 42 CFR 435.210; Louisiana pegs
         # its 42 U.S.C. 1396a(m) level to the same rate).
+        # States that cover aged, blind, or disabled people only if they
+        # receive SSI apply this limit to noncitizens kept in the pathway for
+        # emergency Medicaid, which waives SSI receipt alone (42 U.S.C.
+        # 1396b(v)(2)(B)), so they must meet SSI's income test. North
+        # Dakota's 209(b) recipients also read it, and its level is SSI's
+        # (N.D. Admin. Code 75-02-02.1-40(1)(a)(2)).
         ssi = parameters(period).gov.ssa.ssi.amount
         ssi_rate = where(is_couple, ssi.couple, ssi.individual) * MONTHS_IN_YEAR
-        uses_ssi_rate = p.income.limit.uses_ssi_federal_benefit_rate[state].astype(bool)
+        sets_ssi_rate = p.income.limit.uses_ssi_federal_benefit_rate[state].astype(bool)
+        covers_group = p.covers_non_ssi_recipients[state].astype(bool)
+        uses_ssi_rate = sets_ssi_rate | ~covers_group
         return select(
             [is_mo, uses_ssi_rate],
             [mo_monthly_limit * MONTHS_IN_YEAR, ssi_rate],

From b0783762785a1f0498e242147c74e4455bd62269 Mon Sep 17 00:00:00 2001
From: Ziming <ziming@policyengine.org>
Date: Mon, 26 Oct 2026 20:28:43 -0400
Subject: [PATCH 08/10] Give the five-year-bar cases real income so SSI pays
 nothing

Cases 7 and 8 set only the pathway's countable income. With no SSI
income, the model paid the full SSI rate and classified the residents as
SSI recipients. Social Security that puts SSI countable income at or
above the SSI rate keeps them off SSI, as the cases intend.

Co-Authored-By: Claude Opus 5.5 <noreply@anthropic.com>
---
 ..._optional_senior_or_disabled_for_medicaid.yaml | 15 ++++++++++++---
 1 file changed, 12 insertions(+), 3 deletions(-)

diff --git a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_for_medicaid.yaml b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_for_medicaid.yaml
index 210a9f9f27f..4ab2870dece 100644
--- a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_for_medicaid.yaml
+++ b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_for_medicaid.yaml
@@ -82,7 +82,9 @@
 # A permanent resident two years after entry is in the five-year bar (8 U.S.C.
 # 1613) and fails the Medicaid immigration test. The pathway then tests income
 # against the 2026 SSI rate, 12 x $994 = $11,928, at or below it (42 U.S.C.
-# 1382(a)(1)(A)). Countable income is an input.
+# 1382(a)(1)(A)). Social Security of $1,015 a month leaves countable income of
+# (1,015 - 20) x 12 = $11,940, so SSI pays nothing and the person is not an SSI
+# recipient. The pathway's countable income is an input.
 - name: Case 7, Alabaman permanent resident in the five-year bar with income over the SSI rate gets neither the pathway nor emergency Medicaid.
   period: 2026
   input:
@@ -90,10 +92,12 @@
     state_code: AL
     immigration_status: LEGAL_PERMANENT_RESIDENT
     years_since_us_entry: 2
+    social_security_retirement: 12_180
     medicaid_optional_senior_or_disabled_countable_income: 11_940
     has_emergency_medical_condition: true
   output:
     is_medicaid_immigration_status_eligible: false
+    ssi: 0
     medicaid_optional_senior_or_disabled_income_limit: 11_928
     is_optional_senior_or_disabled_income_eligible: false
     is_optional_senior_or_disabled_for_medicaid: false
@@ -101,8 +105,10 @@
     is_emergency_medicaid_eligible: false
 
 # The SSI couple rate in 2026 is 12 x $1,491 = $17,892; the couple's countable
-# income, $8,946 each, is exactly at it. Only the first spouse has an
-# emergency medical condition.
+# income, $8,946 each, is exactly at it. Social Security of $755.50 a month
+# each gives the couple (1,511 - 20) x 12 = $17,892, so SSI pays nothing and
+# neither spouse is an SSI recipient. Only the first spouse has an emergency
+# medical condition.
 - name: Case 8, Alabaman permanent-resident couple in the five-year bar at the SSI couple rate keeps the pathway.
   period: 2026
   input:
@@ -111,12 +117,14 @@
         age: 70
         immigration_status: LEGAL_PERMANENT_RESIDENT
         years_since_us_entry: 2
+        social_security_retirement: 9_066
         medicaid_optional_senior_or_disabled_countable_income: 8_946
         has_emergency_medical_condition: true
       person2:
         age: 68
         immigration_status: LEGAL_PERMANENT_RESIDENT
         years_since_us_entry: 2
+        social_security_retirement: 9_066
         medicaid_optional_senior_or_disabled_countable_income: 8_946
         has_emergency_medical_condition: false
     marital_units:
@@ -134,6 +142,7 @@
         state_code: AL
   output:
     is_medicaid_immigration_status_eligible: [false, false]
+    ssi: [0, 0]
     medicaid_optional_senior_or_disabled_income_limit: [17_892, 17_892]
     is_optional_senior_or_disabled_income_eligible: [true, true]
     is_optional_senior_or_disabled_for_medicaid: [true, true]

From 1a6d3c99515bdf5808ea264d44118a9067e9cc29 Mon Sep 17 00:00:00 2001
From: Ziming <ziming@policyengine.org>
Date: Tue, 27 Oct 2026 14:53:46 -0400
Subject: [PATCH 09/10] Apply review: cite KFF's pathway tables and pin the 14
 flags

- C2/G3: cite KFF June 2024 Appendix Tables 5 and 6 and the 2019
  survey's Appendix Table 1 instead of the 2024 Appendix Table 1.
- SA1: property tests pin the 14 states' flags (and so West Virginia's)
  and their SSI-rate limit, including North Dakota's.
- SA2: Case 9, a permanent resident past the five-year bar without 40
  quarters, passes the Medicaid immigration test and loses the pathway.
- G1: cite N.D. Admin. Code 75-02-02.1-40 in the limit's references.
- G2, G4, G5, G7, G9: clarify descriptions, the WV edition and comments.
- G10: rename covers_group to in_covered_group.

Co-Authored-By: Claude Opus 5.5 <noreply@anthropic.com>
---
 .../covers_non_ssi_recipients.yaml            |  8 +++--
 .../income/limit/couple.yaml                  |  2 +-
 .../income/limit/individual.yaml              |  2 +-
 ...ional_senior_or_disabled_for_medicaid.yaml | 26 ++++++++++++++++-
 ...dicaid_abd_ssi_rate_standard_properties.py | 29 ++++++++++++++++++-
 ...ptional_senior_or_disabled_for_medicaid.py |  6 ++--
 ...ptional_senior_or_disabled_income_limit.py |  1 +
 7 files changed, 65 insertions(+), 9 deletions(-)

diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/covers_non_ssi_recipients.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/covers_non_ssi_recipients.yaml
index 38a24c2c7b6..c3b74216bf2 100644
--- a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/covers_non_ssi_recipients.yaml
+++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/covers_non_ssi_recipients.yaml
@@ -1,4 +1,4 @@
-description: The state covers aged, blind, or disabled people who do not receive SSI as categorically needy under the Medicaid optional senior or disabled pathway, if this is true.
+description: The state covers the optional Medicaid group for aged, blind, or disabled people who meet SSI's income and resource requirements without receiving SSI (42 CFR 435.210), or the poverty-level aged and disabled group (42 U.S.C. 1396a(m)), if this is true.
 metadata:
   unit: bool
   period: year
@@ -10,8 +10,10 @@ metadata:
       href: https://www.ecfr.gov/current/title-42/section-435.210
     - title: 42 U.S. Code § 1396a(m) - Poverty-level aged and disabled group
       href: https://www.law.cornell.edu/uscode/text/42/1396a#m
-    - title: KFF, Medicaid Eligibility and Enrollment Policies for Seniors and People with Disabilities (Non-MAGI) During the Unwinding (June 2024), Appendix Table 1
+    - title: KFF, Medicaid Eligibility and Enrollment Policies for Seniors and People with Disabilities (Non-MAGI) During the Unwinding (June 2024), Appendix Tables 5 and 6
       href: https://www.kff.org/report-section/medicaid-eligibility-and-enrollment-policies-for-seniors-and-people-with-disabilities-non-magi-during-the-unwinding-appendix/
+    - title: "KFF, Medicaid Financial Eligibility for Seniors and People with Disabilities: Findings from a 50-State Survey (June 2019, 2018 data), Appendix Table 1"
+      href: https://www.kff.org/report-section/medicaid-financial-eligibility-for-seniors-and-people-with-disabilities-findings-from-a-50-state-survey-appendix-tables/
     - title: Ala. Admin. Code r. 560-X-25-.03(1) - Coverage Groups
       href: https://www.law.cornell.edu/regulations/alabama/Ala-Admin-Code-r-560-X-25-.03
     - title: Delaware Social Services Manual 17100 - SSI Beneficiaries
@@ -52,7 +54,7 @@ metadata:
       href: https://health.wyo.gov/wp-content/uploads/2025/12/Chapter-18-1.pdf#page=8
     - title: Wyoming Medicaid Eligibility Online Manual M1005 - SSI and SSI Related
       href: https://ecom.wyo.gov/m1000-aged-blind-or-disabled-program/m1005-ssi-and-ssi-related
-    - title: West Virginia Income Maintenance Manual 23.11.4 - SSI-Related/Non-Cash Assistance
+    - title: West Virginia Income Maintenance Manual 23.11.4 - SSI-Related/Non-Cash Assistance (October 5, 2026 edition)
       href: https://bfa.wv.gov/media/40005/download?inline#page=1889
 
 AK:
diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/income/limit/couple.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/income/limit/couple.yaml
index 0eb1c1e8aaa..45f093c19a3 100644
--- a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/income/limit/couple.yaml
+++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/income/limit/couple.yaml
@@ -1,4 +1,4 @@
-description: Maximum countable income limit for a couple to qualify for Medicaid under the optional senior or disabled pathway, as percent of Federal Poverty Line. States whose limit is the SSI federal benefit rate are listed in uses_ssi_federal_benefit_rate and omitted here.
+description: Maximum countable income limit for a couple to qualify for Medicaid under the optional senior or disabled pathway, as percent of Federal Poverty Line. States whose limit is the SSI federal benefit rate are listed in uses_ssi_federal_benefit_rate and omitted here; states where covers_non_ssi_recipients is false also use that rate, and their values here apply only if that flag is true.
 metadata:
   unit: /1
   label: Medicaid senior or disabled income limit (couple)
diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/income/limit/individual.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/income/limit/individual.yaml
index 489de5e9165..99c150219c2 100644
--- a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/income/limit/individual.yaml
+++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/income/limit/individual.yaml
@@ -1,4 +1,4 @@
-description: Maximum countable income limit for an individual to qualify for Medicaid under the optional senior or disabled pathway, as percent of Federal Poverty Line. States whose limit is the SSI federal benefit rate are listed in uses_ssi_federal_benefit_rate and omitted here.
+description: Maximum countable income limit for an individual to qualify for Medicaid under the optional senior or disabled pathway, as percent of Federal Poverty Line. States whose limit is the SSI federal benefit rate are listed in uses_ssi_federal_benefit_rate and omitted here; states where covers_non_ssi_recipients is false also use that rate, and their values here apply only if that flag is true.
 metadata:
   unit: /1
   label: Medicaid senior or disabled income limit (individual)
diff --git a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_for_medicaid.yaml b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_for_medicaid.yaml
index 4ab2870dece..9f7afb5c3a5 100644
--- a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_for_medicaid.yaml
+++ b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_for_medicaid.yaml
@@ -61,7 +61,8 @@
 # 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.
+# 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.
 - name: Case 6, undocumented aged Alabaman keeps the pathway, unlike the citizen in Case 3, and qualifies for emergency Medicaid.
   period: 2026
   input:
@@ -149,3 +150,26 @@
     medicaid_category: [SENIOR_OR_DISABLED, SENIOR_OR_DISABLED]
     is_medicaid_eligible: [false, false]
     is_emergency_medicaid_eligible: [true, false]
+
+# A permanent resident ten years after entry is past the five-year bar, so
+# passes the Medicaid immigration test, but with no qualifying quarters fails
+# SSI's noncitizen test (8 U.S.C. 1612(a)(2)(B)) and gets no SSI. Alabama has
+# no group for aged people who do not receive SSI, and the emergency Medicaid
+# exception does not reach someone who passes the Medicaid immigration test.
+- name: Case 9, Alabaman permanent resident past the five-year bar without 40 quarters does not keep the pathway.
+  period: 2026
+  input:
+    age: 70
+    state_code: AL
+    immigration_status: LEGAL_PERMANENT_RESIDENT
+    years_since_us_entry: 10
+    ssi_qualifying_quarters_earnings: 0
+    social_security_retirement: 10_800
+  output:
+    is_medicaid_immigration_status_eligible: true
+    ssi: 0
+    is_optional_senior_or_disabled_income_eligible: true
+    is_optional_senior_or_disabled_for_medicaid: false
+    medicaid_category: NONE
+    is_medicaid_eligible: false
+    is_emergency_medicaid_eligible: false
diff --git a/policyengine_us/tests/unit/test_medicaid_abd_ssi_rate_standard_properties.py b/policyengine_us/tests/unit/test_medicaid_abd_ssi_rate_standard_properties.py
index 847b148c802..03e6f445eda 100644
--- a/policyengine_us/tests/unit/test_medicaid_abd_ssi_rate_standard_properties.py
+++ b/policyengine_us/tests/unit/test_medicaid_abd_ssi_rate_standard_properties.py
@@ -195,7 +195,8 @@ def test_no_medicaid_without_ssi_above_the_ssi_rate(year):
     classification = categories.ssi_recipient.classification
     states = [state for state in SSI_RATE_STATES for _ in OFFSETS]
     # States without a group for people who do not receive SSI give the
-    # pathway to nobody in this citizen grid.
+    # pathway to nobody in this citizen grid. All seven states here have the
+    # group; the mask matters once North Dakota joins the grid (#10373).
     covers = np.array(
         [
             bool(categories.senior_or_disabled.covers_non_ssi_recipients[state])
@@ -272,3 +273,29 @@ def test_unflagged_states_keep_their_share_of_the_poverty_guideline(year, couple
         ]
     )
     np.testing.assert_allclose(limit, expected, rtol=1e-6)
+
+
+# States whose rules cover aged, blind, or disabled people as categorically
+# needy only if they receive SSI (cited in covers_non_ssi_recipients.yaml).
+SSI_ONLY_STATES = sorted(
+    ["AL", "DE", "GA", "KS", "KY", "MD", "MS", "ND", "NM", "NV", "SD", "TN", "TX", "WY"]
+)
+
+
+@pytest.mark.parametrize("year", YEARS)
+def test_ssi_only_states_match_their_rules(year):
+    flags = SYSTEM.parameters(
+        f"{year}-01-01"
+    ).gov.hhs.medicaid.eligibility.categories.senior_or_disabled.covers_non_ssi_recipients
+    assert sorted(state for state in STATES if not flags[state]) == SSI_ONLY_STATES
+
+
+@pytest.mark.parametrize("couple", [False, True])
+@pytest.mark.parametrize("year", YEARS)
+def test_ssi_only_states_use_the_ssi_rate(year, couple):
+    simulation = unit_simulation(year, SSI_ONLY_STATES, couple)
+    limit = simulation.calculate(
+        "medicaid_optional_senior_or_disabled_income_limit", year
+    )
+    individual, couple_rate = SSA_MONTHLY_RATES[year]
+    np.testing.assert_array_equal(limit, 12 * (couple_rate if couple else individual))
diff --git a/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_for_medicaid.py b/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_for_medicaid.py
index 6bdb3e33db1..a96f2df6cbb 100644
--- a/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_for_medicaid.py
+++ b/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_for_medicaid.py
@@ -25,7 +25,7 @@ def formula(person, period, parameters):
             period
         ).gov.hhs.medicaid.eligibility.categories.senior_or_disabled
         immigration_eligible = person("is_medicaid_immigration_status_eligible", period)
-        covers_group = (
+        in_covered_group = (
             p.covers_non_ssi_recipients[state].astype(bool) | ~immigration_eligible
         )
         is_senior_or_disabled = person("is_ssi_aged_blind_disabled", period)
@@ -33,4 +33,6 @@ def formula(person, period, parameters):
             "is_optional_senior_or_disabled_income_eligible", period
         )
         asset_eligible = person("is_optional_senior_or_disabled_asset_eligible", period)
-        return covers_group & is_senior_or_disabled & income_eligible & asset_eligible
+        return (
+            in_covered_group & is_senior_or_disabled & income_eligible & asset_eligible
+        )
diff --git a/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/medicaid_optional_senior_or_disabled_income_limit.py b/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/medicaid_optional_senior_or_disabled_income_limit.py
index 6b295e39737..6e676553384 100644
--- a/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/medicaid_optional_senior_or_disabled_income_limit.py
+++ b/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/medicaid_optional_senior_or_disabled_income_limit.py
@@ -18,6 +18,7 @@ class medicaid_optional_senior_or_disabled_income_limit(Variable):
         "https://www.law.cornell.edu/uscode/text/42/1382#a",
         "https://dssmanuals.mo.gov/mo-healthnet-for-the-aged-blind-and-disabled/0805-000-00/0805-015-00/0805-015-45-income-maximum/",
         "https://dssmanuals.mo.gov/wp-content/uploads/2022/07/mhabd-appendix-j.pdf#page=1",
+        "https://www.ndlegis.gov/information/acdata/pdf/75-02-02.1.pdf#page=89",
     )
 
     def formula(person, period, parameters):

From b5e2f0256c4134998d230233accfae6a7cc9ebb9 Mon Sep 17 00:00:00 2001
From: Ziming <ziming@policyengine.org>
Date: Tue, 27 Oct 2026 17:50:21 -0400
Subject: [PATCH 10/10] Update the Texas SSI break-even partner case for the
 SSI-only states

At the earned-income break-even the person gets $0 SSI, so is not an SSI
recipient. Texas has no optional Medicaid group for aged, blind or
disabled people who do not receive SSI (MEPD A-3000), so Medicaid is $0
and the premium tax credit applies at 158% FPL ($18,344.29).

Approved by Ziming Hua (@hua7450) through the partner-test gate on
2026-10-27.

Co-Authored-By: Claude Opus 5.5 <noreply@anthropic.com>
---
 .../edge_cases/federal/cash/ssi/federal.yaml  | 20 ++++++++++---------
 1 file changed, 11 insertions(+), 9 deletions(-)

diff --git a/policyengine_us/tests/policy/baseline/partners/analytics_coverage/edge_cases/federal/cash/ssi/federal.yaml b/policyengine_us/tests/policy/baseline/partners/analytics_coverage/edge_cases/federal/cash/ssi/federal.yaml
index 802de5f7ba3..b3c8136f0c2 100644
--- a/policyengine_us/tests/policy/baseline/partners/analytics_coverage/edge_cases/federal/cash/ssi/federal.yaml
+++ b/policyengine_us/tests/policy/baseline/partners/analytics_coverage/edge_cases/federal/cash/ssi/federal.yaml
@@ -282,18 +282,20 @@
         is_ssi_aged: true
         msp: 0
         msp_eligible: false
-        # Despite $0 SSI, still Medicaid-eligible via TX's optional
-        # senior-or-disabled pathway: SSI-method countable income $11,928
-        # <= 75% of FPG (0.75 x $15,960 = $11,970), so the calibration-
-        # derived TX adult per-capita cost applies.
-        medicaid: 13_708.50
-        is_medicaid_eligible: true
+        # $0 SSI, so not an SSI recipient. Texas covers aged, blind and
+        # disabled people at home only if they receive SSI; its optional
+        # groups are institutional, waiver and buy-in groups (MEPD A-3000),
+        # with no 75% FPG group, so no Medicaid.
+        medicaid: 0
+        is_medicaid_eligible: false
         chip: 0
-        is_aca_ptc_eligible: false
+        # Without Medicaid, Medicare or an ESI offer, the PTC applies at
+        # 158% FPL: SLCSP $19,482.51 - 4.58% x $24,876 MAGI ($1,138.23).
+        is_aca_ptc_eligible: true
     tax_units:
       tax_unit:
-        aca_ptc: 0
-        premium_tax_credit: 0
+        aca_ptc: 18_344.29
+        premium_tax_credit: 18_344.29
 - name: ssi_unearned_income_reduction (federal)
   period: 2026
   absolute_error_margin: 0.1