diff --git a/changelog.d/medicaid-abd-pathway-values.fixed.md b/changelog.d/medicaid-abd-pathway-values.fixed.md new file mode 100644 index 00000000000..32d74e3be39 --- /dev/null +++ b/changelog.d/medicaid-abd-pathway-values.fixed.md @@ -0,0 +1 @@ +Updated Medicaid's aged, blind and disabled pathway: California's $20 deduction followed by the $230/$310 disregard before December 2020, its health insurance premium deduction, and its full Medicare Part B premium disregard, income-related amount included, from December 2020; Connecticut's 2026 disregard; South Carolina's $50 disregard; no SSI $20 disregard in Minnesota (Minn. Stat. 256B.056, subd. 1b); Missouri's 2015-2026 asset limits with July 1 updates, with a couple's resources equal to the couple limit qualifying, and from fiscal year 2018 an individual's resources equal to the individual limit, under RSMo 208.010.2(7); California's resources equal to the limit qualifying, with the $130,000 / $195,000 limit from July 2022; and asset limits equal to the Medicare Savings Program resource limit in Arkansas, Oklahoma and South Carolina, where resources equal to the limit qualify. diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/assets/limit/couple.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/assets/limit/couple.yaml index d221c7a2ad5..afea68f27d3 100644 --- a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/assets/limit/couple.yaml +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/assets/limit/couple.yaml @@ -8,22 +8,50 @@ metadata: reference: - title: "Medicaid Eligibility and Enrollment Policies for Seniors and People with Disabilities (Non-MAGI) During the Unwinding | KFF (June 2024)" 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: "California DHCS All County Welfare Directors Letter 21-31, Increases to the Asset Limits for Non-Modified Adjusted Gross Income Medi-Cal Programs #page 2-4" + href: https://www.dhcs.ca.gov/services/medi-cal/eligibility/letters/Documents/21-31.pdf#page=2 - title: "Asset Limit Changes for Non-MAGI Medi-Cal | California DHCS (asset limit reinstated at $130,000 plus $65,000 per additional household member effective January 1, 2026)" href: https://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/Asset-Limit-Changes-for-Non-MAGI-Medi-Cal.aspx - title: "California DHCS All County Welfare Directors Letter 25-14 (reinstatement of the non-MAGI Medi-Cal asset limit)" href: https://www.dhcs.ca.gov/services/medi-cal/eligibility/letters/Documents/25-14.pdf + - title: Missouri DSS MO HealthNet for the Aged, Blind and Disabled Appendix J - Eligibility Standards for Non-MAGI Programs (10/2026 edition; spend down resource maximum effective July 1, 2026) + href: https://dssmanuals.mo.gov/wp-content/uploads/2022/07/mhabd-appendix-j.pdf#page=1 + - title: Missouri Revised Statutes 208.010.2(7) + href: https://revisor.mo.gov/main/OneSection.aspx?section=208.010 + - title: 13 Missouri Code of State Regulations 40-8.020(4)(A)-(C) + href: https://www.sos.mo.gov/CMSImages/AdRules/csr/current/13csr/13c40-8.pdf#page=2 + - title: Missouri DSS Family Support Division, IM-70 Annual MO HealthNet for the Aged, Blind, and Disabled (MHABD) Asset Limit Increase (individual $5,035, couple $10,070 effective July 1, 2021) + href: https://web.archive.org/web/20210801111201/https://dssmanuals.mo.gov/2021/07/01/im-70-2/ + - title: Missouri DSS Family Support Division, IM-77 Annual MHABD Asset Limit Increase (individual $5,301.85, couple $10,603.70 effective July 1, 2022) + href: https://web.archive.org/web/20220705011659/https://dssmanuals.mo.gov/2022/06/14/im-77-3/ + - title: Missouri DSS MHABD Appendix J - Eligibility Standards for MHABD (10/2022 edition; spend down resource maximum effective July 1, 2022) + href: https://web.archive.org/web/20220927091025/https://dssmanuals.mo.gov/wp-content/uploads/2022/07/mhabd-appendix-j.pdf#page=1 + - title: Missouri DSS Family Support Division, IM-57 July 2023 Annual Non-MAGI Program Adjustments (individual $5,726, couple $11,452 effective July 1, 2023) + href: https://web.archive.org/web/20230925041524/https://dssmanuals.mo.gov/2023/06/08/im-57-4/ + - title: Missouri DSS MHABD Appendix J - Eligibility Standards for Non-MAGI Programs (07/2024 edition; spend down resource maximum effective July 1, 2024) + href: https://web.archive.org/web/20240612134513/https://dssmanuals.mo.gov/wp-content/uploads/2022/07/mhabd-appendix-j.pdf#page=1 + - title: Missouri DSS MHABD Appendix J - Eligibility Standards for Non-MAGI Programs (07-2025 edition; spend down resource maximum effective July 1, 2025) + href: https://web.archive.org/web/20250831223642/https://dssmanuals.mo.gov/wp-content/uploads/2022/07/mhabd-appendix-j.pdf#page=1 + - title: Missouri DHSS, Medicaid Spend Down Limit Changes (effective July 1, 2023) + href: https://health.mo.gov/care-providing/long-term-care/medicaid-spend-down-limit-changes + - title: Missouri DHSS, Medicaid Resource Limit/Spenddown Amount (effective July 1, 2024) + href: https://health.mo.gov/care-providing/long-term-care/medicaid-resource-limitspenddown-amount + - title: Missouri DHSS, Resource Limit/Spenddown Amount (effective July 1, 2025) + href: https://health.mo.gov/care-providing/long-term-care/resource-limitspenddown-amount +# AR, OK and SC are omitted: uses_msp_limit sets their limit at the +# Medicare Savings Program resource limit, so the formula ignores this +# parameter for them and their keys resolve to 0. AL: 2015-01-01: 3_000 AK: 2015-01-01: 3_000 AZ: 2015-01-01: .inf -AR: - 2015-01-01: 11_340 - 2024-01-01: 14_130 CA: 2015-01-01: 3_000 + # Annual calculations read January 1, so this first applies in 2023. + 2022-07-01: 195_000 2024-01-01: .inf 2026-01-01: 195_000 CO: @@ -70,8 +98,21 @@ MN: MS: 2015-01-01: 3_000 MO: - 2015-01-01: 6_000 - 2024-01-01: 11_452 + # Annual calculations read parameters on January 1, so each July 1 value + # first applies in the next calendar year. + # Before July 1, 2017, the limit for blind applicants was 4,000; this + # parameter has no blind split. + 2015-01-01: 2_000 + 2017-07-01: 4_000 + 2018-07-01: 6_000 + 2019-07-01: 8_000 + 2020-07-01: 10_000 + 2021-07-01: 10_070 + 2022-07-01: 10_603.7 + 2023-07-01: 11_452 + 2024-07-01: 11_818.45 + 2025-07-01: 12_137.55 + 2026-07-01: 12_441 MT: 2015-01-01: 3_000 NE: @@ -93,18 +134,12 @@ ND: 2015-01-01: 6_000 OH: 2015-01-01: 3_000 -OK: - 2015-01-01: 3_000 - 2024-01-01: 14_130 OR: 2015-01-01: 3_000 PA: 2015-01-01: 3_000 RI: 2015-01-01: 6_000 -SC: - 2015-01-01: 11_340 - 2024-01-01: 14_130 SD: 2015-01-01: 3_000 TN: diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/assets/limit/couple_limit_inclusive.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/assets/limit/couple_limit_inclusive.yaml new file mode 100644 index 00000000000..1f91f47ed1d --- /dev/null +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/assets/limit/couple_limit_inclusive.yaml @@ -0,0 +1,131 @@ +description: The state counts a couple's resources equal to the couple asset limit as within the limit under the Medicaid optional senior or disabled pathway, if this is true. +metadata: + unit: bool + period: year + label: Medicaid senior or disabled couple asset limit includes the limit amount + breakdown: + - state_code + reference: + - title: Missouri Revised Statutes 208.010.2(7) + href: https://revisor.mo.gov/main/OneSection.aspx?section=208.010 + - title: Missouri Revised Statutes 208.010.2(4) (version effective October 11, 2013 to August 28, 2016) + href: https://revisor.mo.gov/main/OneSection.aspx?section=208.010&bid=10947 + - title: "Missouri H.B. 1565 (2016), truly agreed and finally passed, section 208.010.2(4) and (7) #page 3-4" + href: https://house.mo.gov/billtracking/bills161/billpdf/truly/HB1565T.PDF#page=3 + - title: "13 Missouri Code of State Regulations 40-2.030(12) (11/30/15 edition) #page 9-10" + href: https://web.archive.org/web/20170107023023/http://s1.sos.mo.gov/cmsimages/adrules/csr/current/13csr/13c40-2.pdf#page=9 + - title: California Welfare and Institutions Code 14005.40(c)(5) (version operative January 1, 2026; (c)(3) before July 9, 2019) + href: https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=WIC§ionNum=14005.40 + - title: Cal. Code Regs. Tit. 22, § 50420(a) - Property Limit + href: https://www.law.cornell.edu/regulations/california/22-CCR-50420 + - title: 42 U.S.C. 1396a(m)(1)(C) + href: https://www.law.cornell.edu/uscode/text/42/1396a#m_1_C + +AK: + 2015-01-01: false +AL: + 2015-01-01: false +AR: + 2015-01-01: false +AZ: + 2015-01-01: false +CA: + # Resources may not exceed the limit (22 CCR 50420(a); WIC 14005.40(c)(5)). + 2015-01-01: true +CO: + 2015-01-01: false +CT: + 2015-01-01: false +DC: + 2015-01-01: false +DE: + 2015-01-01: false +FL: + 2015-01-01: false +GA: + 2015-01-01: false +HI: + 2015-01-01: false +IA: + 2015-01-01: false +ID: + 2015-01-01: false +IL: + 2015-01-01: false +IN: + 2015-01-01: false +KS: + 2015-01-01: false +KY: + 2015-01-01: false +LA: + 2015-01-01: false +MA: + 2015-01-01: false +MD: + 2015-01-01: false +ME: + 2015-01-01: false +MI: + 2015-01-01: false +MN: + 2015-01-01: false +MO: + # A married claimant living with a spouse "may own resources not to exceed" + # the couple amount: RSMo 208.010.2(4) before August 28, 2016, and + # 208.010.2(7) from fiscal year 2018 (July 1, 2017). In between, + # 13 CSR 40-2.030(12) (11/30/15 edition) made a couple ineligible only when + # resources "exceed[] a value of two thousand dollars". + 2015-01-01: true +MS: + 2015-01-01: false +MT: + 2015-01-01: false +NC: + 2015-01-01: false +ND: + 2015-01-01: false +NE: + 2015-01-01: false +NH: + 2015-01-01: false +NJ: + 2015-01-01: false +NM: + 2015-01-01: false +NV: + 2015-01-01: false +NY: + 2015-01-01: false +OH: + 2015-01-01: false +OK: + 2015-01-01: false +OR: + 2015-01-01: false +PA: + 2015-01-01: false +RI: + 2015-01-01: false +SC: + 2015-01-01: false +SD: + 2015-01-01: false +TN: + 2015-01-01: false +TX: + 2015-01-01: false +UT: + 2015-01-01: false +VA: + 2015-01-01: false +VT: + 2015-01-01: false +WA: + 2015-01-01: false +WI: + 2015-01-01: false +WV: + 2015-01-01: false +WY: + 2015-01-01: false diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/assets/limit/individual.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/assets/limit/individual.yaml index 0e9ad620691..5f2cd8074a8 100644 --- a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/assets/limit/individual.yaml +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/assets/limit/individual.yaml @@ -8,22 +8,50 @@ metadata: reference: - title: "Medicaid Eligibility and Enrollment Policies for Seniors and People with Disabilities (Non-MAGI) During the Unwinding | KFF (June 2024)" 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: "California DHCS All County Welfare Directors Letter 21-31, Increases to the Asset Limits for Non-Modified Adjusted Gross Income Medi-Cal Programs #page 2-4" + href: https://www.dhcs.ca.gov/services/medi-cal/eligibility/letters/Documents/21-31.pdf#page=2 - title: "Asset Limit Changes for Non-MAGI Medi-Cal | California DHCS (asset limit reinstated at $130,000 for an individual effective January 1, 2026)" href: https://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/Asset-Limit-Changes-for-Non-MAGI-Medi-Cal.aspx - title: "California DHCS All County Welfare Directors Letter 25-14 (reinstatement of the non-MAGI Medi-Cal asset limit)" href: https://www.dhcs.ca.gov/services/medi-cal/eligibility/letters/Documents/25-14.pdf + - title: Missouri DSS MO HealthNet for the Aged, Blind and Disabled Appendix J - Eligibility Standards for Non-MAGI Programs (10/2026 edition; spend down resource maximum effective July 1, 2026) + href: https://dssmanuals.mo.gov/wp-content/uploads/2022/07/mhabd-appendix-j.pdf#page=1 + - title: Missouri Revised Statutes 208.010.2(7) + href: https://revisor.mo.gov/main/OneSection.aspx?section=208.010 + - title: 13 Missouri Code of State Regulations 40-8.020(4)(A)-(C) + href: https://www.sos.mo.gov/CMSImages/AdRules/csr/current/13csr/13c40-8.pdf#page=2 + - title: Missouri DSS Family Support Division, IM-70 Annual MO HealthNet for the Aged, Blind, and Disabled (MHABD) Asset Limit Increase (individual $5,035, couple $10,070 effective July 1, 2021) + href: https://web.archive.org/web/20210801111201/https://dssmanuals.mo.gov/2021/07/01/im-70-2/ + - title: Missouri DSS Family Support Division, IM-77 Annual MHABD Asset Limit Increase (individual $5,301.85, couple $10,603.70 effective July 1, 2022) + href: https://web.archive.org/web/20220705011659/https://dssmanuals.mo.gov/2022/06/14/im-77-3/ + - title: Missouri DSS MHABD Appendix J - Eligibility Standards for MHABD (10/2022 edition; spend down resource maximum effective July 1, 2022) + href: https://web.archive.org/web/20220927091025/https://dssmanuals.mo.gov/wp-content/uploads/2022/07/mhabd-appendix-j.pdf#page=1 + - title: Missouri DSS Family Support Division, IM-57 July 2023 Annual Non-MAGI Program Adjustments (individual $5,726, couple $11,452 effective July 1, 2023) + href: https://web.archive.org/web/20230925041524/https://dssmanuals.mo.gov/2023/06/08/im-57-4/ + - title: Missouri DSS MHABD Appendix J - Eligibility Standards for Non-MAGI Programs (07/2024 edition; spend down resource maximum effective July 1, 2024) + href: https://web.archive.org/web/20240612134513/https://dssmanuals.mo.gov/wp-content/uploads/2022/07/mhabd-appendix-j.pdf#page=1 + - title: Missouri DSS MHABD Appendix J - Eligibility Standards for Non-MAGI Programs (07-2025 edition; spend down resource maximum effective July 1, 2025) + href: https://web.archive.org/web/20250831223642/https://dssmanuals.mo.gov/wp-content/uploads/2022/07/mhabd-appendix-j.pdf#page=1 + - title: Missouri DHSS, Medicaid Spend Down Limit Changes (effective July 1, 2023) + href: https://health.mo.gov/care-providing/long-term-care/medicaid-spend-down-limit-changes + - title: Missouri DHSS, Medicaid Resource Limit/Spenddown Amount (effective July 1, 2024) + href: https://health.mo.gov/care-providing/long-term-care/medicaid-resource-limitspenddown-amount + - title: Missouri DHSS, Resource Limit/Spenddown Amount (effective July 1, 2025) + href: https://health.mo.gov/care-providing/long-term-care/resource-limitspenddown-amount +# AR, OK and SC are omitted: uses_msp_limit sets their limit at the +# Medicare Savings Program resource limit, so the formula ignores this +# parameter for them and their keys resolve to 0. AL: 2015-01-01: 2_000 AK: 2015-01-01: 2_000 AZ: 2015-01-01: .inf -AR: - 2015-01-01: 7_560 - 2024-01-01: 9_430 CA: 2015-01-01: 2_000 + # Annual calculations read January 1, so this first applies in 2023. + 2022-07-01: 130_000 2024-01-01: .inf 2026-01-01: 130_000 CO: @@ -70,8 +98,21 @@ MN: MS: 2015-01-01: 2_000 MO: - 2015-01-01: 3_000 - 2024-01-01: 5_726 + # Annual calculations read parameters on January 1, so each July 1 value + # first applies in the next calendar year. + # Before July 1, 2017, the limit for blind applicants was 2,000; this + # parameter has no blind split. + 2015-01-01: 1_000 + 2017-07-01: 2_000 + 2018-07-01: 3_000 + 2019-07-01: 4_000 + 2020-07-01: 5_000 + 2021-07-01: 5_035 + 2022-07-01: 5_301.85 + 2023-07-01: 5_726 + 2024-07-01: 5_909.25 + 2025-07-01: 6_068.8 + 2026-07-01: 6_220.5 MT: 2015-01-01: 2_000 NE: @@ -93,18 +134,12 @@ ND: 2015-01-01: 3_000 OH: 2015-01-01: 2_000 -OK: - 2015-01-01: 2_000 - 2024-01-01: 9_430 OR: 2015-01-01: 2_000 PA: 2015-01-01: 2_000 RI: 2015-01-01: 4_000 -SC: - 2015-01-01: 7_560 - 2024-01-01: 9_430 SD: 2015-01-01: 2_000 TN: diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/assets/limit/individual_limit_inclusive.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/assets/limit/individual_limit_inclusive.yaml new file mode 100644 index 00000000000..7d336aa88e1 --- /dev/null +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/assets/limit/individual_limit_inclusive.yaml @@ -0,0 +1,133 @@ +description: The state counts an individual's resources equal to the individual asset limit as within the limit under the Medicaid optional senior or disabled pathway, if this is true. +metadata: + unit: bool + period: year + label: Medicaid senior or disabled individual asset limit includes the limit amount + breakdown: + - state_code + reference: + - title: Missouri Revised Statutes 208.010.2(7) + href: https://revisor.mo.gov/main/OneSection.aspx?section=208.010 + - title: Missouri Revised Statutes 208.010.2(4) (version effective October 11, 2013 to August 28, 2016) + href: https://revisor.mo.gov/main/OneSection.aspx?section=208.010&bid=10947 + - title: "Missouri H.B. 1565 (2016), truly agreed and finally passed, section 208.010.2(4) and (7) #page 3-4" + href: https://house.mo.gov/billtracking/bills161/billpdf/truly/HB1565T.PDF#page=3 + - title: "13 Missouri Code of State Regulations 40-2.030(12) (11/30/15 edition) #page 9-10" + href: https://web.archive.org/web/20170107023023/http://s1.sos.mo.gov/cmsimages/adrules/csr/current/13csr/13c40-2.pdf#page=9 + - title: California Welfare and Institutions Code 14005.40(c)(5) (version operative January 1, 2026; (c)(3) before July 9, 2019) + href: https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=WIC§ionNum=14005.40 + - title: Cal. Code Regs. Tit. 22, § 50420(a) - Property Limit + href: https://www.law.cornell.edu/regulations/california/22-CCR-50420 + - title: 42 U.S.C. 1396a(m)(1)(C) + href: https://www.law.cornell.edu/uscode/text/42/1396a#m_1_C + +AK: + 2015-01-01: false +AL: + 2015-01-01: false +AR: + 2015-01-01: false +AZ: + 2015-01-01: false +CA: + # Resources may not exceed the limit (22 CCR 50420(a); WIC 14005.40(c)(5)). + 2015-01-01: true +CO: + 2015-01-01: false +CT: + 2015-01-01: false +DC: + 2015-01-01: false +DE: + 2015-01-01: false +FL: + 2015-01-01: false +GA: + 2015-01-01: false +HI: + 2015-01-01: false +IA: + 2015-01-01: false +ID: + 2015-01-01: false +IL: + 2015-01-01: false +IN: + 2015-01-01: false +KS: + 2015-01-01: false +KY: + 2015-01-01: false +LA: + 2015-01-01: false +MA: + 2015-01-01: false +MD: + 2015-01-01: false +ME: + 2015-01-01: false +MI: + 2015-01-01: false +MN: + 2015-01-01: false +MO: + # Before fiscal year 2018, a single claimant with resources of 1,000 "or + # more" is ineligible: RSMo 208.010.2(4) before August 28, 2016, and + # 13 CSR 40-2.030(12) (11/30/15 edition) until June 30, 2017. + 2015-01-01: false + # From fiscal year 2018 (July 1, 2017), a claimant "owns or possesses + # resources not to exceed" the individual amount (RSMo 208.010.2(7)). + # Annual calculations read January 1, so this value first applies in 2018. + 2017-07-01: true +MS: + 2015-01-01: false +MT: + 2015-01-01: false +NC: + 2015-01-01: false +ND: + 2015-01-01: false +NE: + 2015-01-01: false +NH: + 2015-01-01: false +NJ: + 2015-01-01: false +NM: + 2015-01-01: false +NV: + 2015-01-01: false +NY: + 2015-01-01: false +OH: + 2015-01-01: false +OK: + 2015-01-01: false +OR: + 2015-01-01: false +PA: + 2015-01-01: false +RI: + 2015-01-01: false +SC: + 2015-01-01: false +SD: + 2015-01-01: false +TN: + 2015-01-01: false +TX: + 2015-01-01: false +UT: + 2015-01-01: false +VA: + 2015-01-01: false +VT: + 2015-01-01: false +WA: + 2015-01-01: false +WI: + 2015-01-01: false +WV: + 2015-01-01: false +WY: + 2015-01-01: false diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/assets/limit/uses_msp_limit.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/assets/limit/uses_msp_limit.yaml new file mode 100644 index 00000000000..0af56ad0ffa --- /dev/null +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/assets/limit/uses_msp_limit.yaml @@ -0,0 +1,129 @@ +description: The state sets the Medicaid asset limit for aged, blind, or disabled people who do not receive SSI at the Medicare Savings Program resource limit, if this is true. +metadata: + unit: bool + period: year + label: Medicaid senior or disabled asset limit is the Medicare Savings Program limit + breakdown: + - state_code + reference: + - title: Arkansas Code of Rules 016.20.10-001, Medical Services Policy MS 23110 - ARSeniors, QMB, SMB and QI-1 resources + href: https://www.law.cornell.edu/regulations/arkansas/016-20-10-Ark-Code-R-001 + - title: Arkansas DHS Division of County Operations, Medical Quick Reference Chart 2026 + href: https://humanservices.arkansas.gov/wp-content/uploads/Medical-Quick-Reference-Chart-2026-Final-without-BHSS.pdf#page=2 + - title: Oklahoma Human Services Appendix C-1 (edition 7/1/2026), Maximum Income, Resource, and Payment Standards, Schedule VI (QMB Plus) + href: https://web.archive.org/web/20260903155011/https://oklahoma.gov/content/dam/ok/en/okdhs/documents/searchcenter/okdhsformresults/c-1.pdf#page=2 + - title: Oklahoma Administrative Code 317:35-7-40 - Eligibility as Qualified Medicare Beneficiary Plus + href: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-assistance-for-adults-and-children-eligibility/medical-services/determination-of-eligibility-for-medical-services/eligibility-as-qualified-medicare-beneficiary-plus.html + - title: Oklahoma Human Services Appendix C-1 (edition 12/1/2015), Schedule VI (QMB Plus) + href: https://web.archive.org/web/20151216003834/http://www.okdhs.org/okdhs%20form%20library/C-1.pdf + - title: Oklahoma Human Services Appendix C-1 (edition 4/1/2023), Schedule VI (QMB Plus) + href: https://web.archive.org/web/20230420231329/https://oklahoma.gov/content/dam/ok/en/okdhs/documents/searchcenter/okdhsformresults/c-1.pdf#page=2 + - title: Oklahoma Administrative Code 317:35-7-40(a)(1) (revised 05-11-01) + href: https://web.archive.org/web/20151029121301/http://www.okdhs.org/library/policy/oac317/035/07/0040000.htm + - title: "South Carolina Medicaid State Plan, Attachment 2.6-A, pages 21a-22 (poverty-level aged and disabled resources are the QMB resource standard) #page 41-42" + href: https://scdhhs.gov/sites/dhhs/files/documents/stateplan/Attachment_2.6-A.pdf#page=41 + - title: South Carolina DHHS Medicaid Policy and Procedures Manual 103.14 - Program Resource Limits + href: https://img1.scdhhs.gov/mppm/SCMPPM/Section_100.docx + +AK: + 2015-01-01: false +AL: + 2015-01-01: false +AR: + 2015-01-01: true +AZ: + 2015-01-01: false +CA: + 2015-01-01: false +CO: + 2015-01-01: false +CT: + 2015-01-01: false +DC: + 2015-01-01: false +DE: + 2015-01-01: false +FL: + 2015-01-01: false +GA: + 2015-01-01: false +HI: + 2015-01-01: false +IA: + 2015-01-01: false +ID: + 2015-01-01: false +IL: + 2015-01-01: false +IN: + 2015-01-01: false +KS: + 2015-01-01: false +KY: + 2015-01-01: false +LA: + 2015-01-01: false +MA: + 2015-01-01: false +MD: + 2015-01-01: false +ME: + 2015-01-01: false +MI: + 2015-01-01: false +MN: + 2015-01-01: false +MO: + 2015-01-01: false +MS: + 2015-01-01: false +MT: + 2015-01-01: false +NC: + 2015-01-01: false +ND: + 2015-01-01: false +NE: + 2015-01-01: false +NH: + 2015-01-01: false +NJ: + 2015-01-01: false +NM: + 2015-01-01: false +NV: + 2015-01-01: false +NY: + 2015-01-01: false +OH: + 2015-01-01: false +OK: + 2015-01-01: true +OR: + 2015-01-01: false +PA: + 2015-01-01: false +RI: + 2015-01-01: false +SC: + 2015-01-01: true +SD: + 2015-01-01: false +TN: + 2015-01-01: false +TX: + 2015-01-01: false +UT: + 2015-01-01: false +VA: + 2015-01-01: false +VT: + 2015-01-01: false +WA: + 2015-01-01: false +WI: + 2015-01-01: false +WV: + 2015-01-01: false +WY: + 2015-01-01: false diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/income/additional_disregard/couple.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/income/additional_disregard/couple.yaml new file mode 100644 index 00000000000..b8dfc367f69 --- /dev/null +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/income/additional_disregard/couple.yaml @@ -0,0 +1,122 @@ +description: The state subtracts this disregard from countable income after the SSI income exclusions for couples applying for the optional pathway to Medicaid eligibility for seniors or people with disabilities. +metadata: + unit: currency-USD + period: month + label: Medicaid senior or disabled additional income disregard (couple) + breakdown: + - state_code + reference: + - title: California Welfare and Institutions Code 14005.40(c)(2)(A) + href: https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=WIC§ionNum=14005.40 + - title: "California DHCS All County Welfare Directors Letter 00-57, Aged and Disabled Federal Poverty Level program, MC 176 financial eligibility form, line 16 #page 1,3" + href: https://www.dhcs.ca.gov/services/medi-cal/eligibility/letters/Documents/c00-57.pdf#page=1 + - title: California DHCS All County Welfare Directors Letter 20-24, Aged and Disabled Federal Poverty Level program + href: https://www.dhcs.ca.gov/services/medi-cal/eligibility/letters/Documents/20-24.pdf#page=2 + +AK: + 2015-01-01: 0 +AL: + 2015-01-01: 0 +AR: + 2015-01-01: 0 +AZ: + 2015-01-01: 0 +CA: + # MC 176 subtracts this disregard (line 16) after the 20-dollar any-income + # deduction and the earned income deductions (lines 8-14). ACWDL 20-24 + # ended it on December 1, 2020; that date first applies in 2021 annual + # calculations. + 2015-01-01: 310 + 2020-12-01: 0 +CO: + 2015-01-01: 0 +CT: + 2015-01-01: 0 +DC: + 2015-01-01: 0 +DE: + 2015-01-01: 0 +FL: + 2015-01-01: 0 +GA: + 2015-01-01: 0 +HI: + 2015-01-01: 0 +IA: + 2015-01-01: 0 +ID: + 2015-01-01: 0 +IL: + 2015-01-01: 0 +IN: + 2015-01-01: 0 +KS: + 2015-01-01: 0 +KY: + 2015-01-01: 0 +LA: + 2015-01-01: 0 +MA: + 2015-01-01: 0 +MD: + 2015-01-01: 0 +ME: + 2015-01-01: 0 +MI: + 2015-01-01: 0 +MN: + 2015-01-01: 0 +MO: + 2015-01-01: 0 +MS: + 2015-01-01: 0 +MT: + 2015-01-01: 0 +NC: + 2015-01-01: 0 +ND: + 2015-01-01: 0 +NE: + 2015-01-01: 0 +NH: + 2015-01-01: 0 +NJ: + 2015-01-01: 0 +NM: + 2015-01-01: 0 +NV: + 2015-01-01: 0 +NY: + 2015-01-01: 0 +OH: + 2015-01-01: 0 +OK: + 2015-01-01: 0 +OR: + 2015-01-01: 0 +PA: + 2015-01-01: 0 +RI: + 2015-01-01: 0 +SC: + 2015-01-01: 0 +SD: + 2015-01-01: 0 +TN: + 2015-01-01: 0 +TX: + 2015-01-01: 0 +UT: + 2015-01-01: 0 +VA: + 2015-01-01: 0 +VT: + 2015-01-01: 0 +WA: + 2015-01-01: 0 +WI: + 2015-01-01: 0 +WV: + 2015-01-01: 0 +WY: + 2015-01-01: 0 diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/income/additional_disregard/individual.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/income/additional_disregard/individual.yaml new file mode 100644 index 00000000000..745b4dcc0ad --- /dev/null +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/income/additional_disregard/individual.yaml @@ -0,0 +1,122 @@ +description: The state subtracts this disregard from countable income after the SSI income exclusions for individuals applying for the optional pathway to Medicaid eligibility for seniors or people with disabilities. +metadata: + unit: currency-USD + period: month + label: Medicaid senior or disabled additional income disregard (individual) + breakdown: + - state_code + reference: + - title: California Welfare and Institutions Code 14005.40(c)(2)(A) + href: https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=WIC§ionNum=14005.40 + - title: "California DHCS All County Welfare Directors Letter 00-57, Aged and Disabled Federal Poverty Level program, MC 176 financial eligibility form, line 16 #page 1,3" + href: https://www.dhcs.ca.gov/services/medi-cal/eligibility/letters/Documents/c00-57.pdf#page=1 + - title: California DHCS All County Welfare Directors Letter 20-24, Aged and Disabled Federal Poverty Level program + href: https://www.dhcs.ca.gov/services/medi-cal/eligibility/letters/Documents/20-24.pdf#page=2 + +AK: + 2015-01-01: 0 +AL: + 2015-01-01: 0 +AR: + 2015-01-01: 0 +AZ: + 2015-01-01: 0 +CA: + # MC 176 subtracts this disregard (line 16) after the 20-dollar any-income + # deduction and the earned income deductions (lines 8-14). ACWDL 20-24 + # ended it on December 1, 2020; that date first applies in 2021 annual + # calculations. + 2015-01-01: 230 + 2020-12-01: 0 +CO: + 2015-01-01: 0 +CT: + 2015-01-01: 0 +DC: + 2015-01-01: 0 +DE: + 2015-01-01: 0 +FL: + 2015-01-01: 0 +GA: + 2015-01-01: 0 +HI: + 2015-01-01: 0 +IA: + 2015-01-01: 0 +ID: + 2015-01-01: 0 +IL: + 2015-01-01: 0 +IN: + 2015-01-01: 0 +KS: + 2015-01-01: 0 +KY: + 2015-01-01: 0 +LA: + 2015-01-01: 0 +MA: + 2015-01-01: 0 +MD: + 2015-01-01: 0 +ME: + 2015-01-01: 0 +MI: + 2015-01-01: 0 +MN: + 2015-01-01: 0 +MO: + 2015-01-01: 0 +MS: + 2015-01-01: 0 +MT: + 2015-01-01: 0 +NC: + 2015-01-01: 0 +ND: + 2015-01-01: 0 +NE: + 2015-01-01: 0 +NH: + 2015-01-01: 0 +NJ: + 2015-01-01: 0 +NM: + 2015-01-01: 0 +NV: + 2015-01-01: 0 +NY: + 2015-01-01: 0 +OH: + 2015-01-01: 0 +OK: + 2015-01-01: 0 +OR: + 2015-01-01: 0 +PA: + 2015-01-01: 0 +RI: + 2015-01-01: 0 +SC: + 2015-01-01: 0 +SD: + 2015-01-01: 0 +TN: + 2015-01-01: 0 +TX: + 2015-01-01: 0 +UT: + 2015-01-01: 0 +VA: + 2015-01-01: 0 +VT: + 2015-01-01: 0 +WA: + 2015-01-01: 0 +WI: + 2015-01-01: 0 +WV: + 2015-01-01: 0 +WY: + 2015-01-01: 0 diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/income/deducts_health_insurance_premiums.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/income/deducts_health_insurance_premiums.yaml new file mode 100644 index 00000000000..5de0c8d8c1c --- /dev/null +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/income/deducts_health_insurance_premiums.yaml @@ -0,0 +1,118 @@ +description: The state deducts health insurance premiums that the person pays from countable income under the optional Medicaid pathway for seniors or people with disabilities, if this is true. +metadata: + unit: bool + period: year + label: Medicaid senior or disabled pathway deducts health insurance premiums + breakdown: + - state_code + reference: + - title: Cal. Code Regs. Tit. 22, § 50555.2 (a), (c) Health Insurance Premiums + href: https://www.law.cornell.edu/regulations/california/22-CCR-50555.2 + - title: California DHCS All County Welfare Directors Letter 00-57, MC 176 Aged and Disabled FPL Financial Eligibility Form, line 17 + href: https://www.dhcs.ca.gov/services/medi-cal/eligibility/letters/Documents/c00-57.pdf#page=3 + - title: "California DHCS All County Welfare Directors Letter 20-24, Aged and Disabled Federal Poverty Level program #page 2-3" + href: https://www.dhcs.ca.gov/services/medi-cal/eligibility/letters/Documents/20-24.pdf#page=2 + +AK: + 2015-01-01: false +AL: + 2015-01-01: false +AR: + 2015-01-01: false +AZ: + 2015-01-01: false +CA: + # The ABD FPL program deducted premiums from its start in 2001. + 2015-01-01: true +CO: + 2015-01-01: false +CT: + 2015-01-01: false +DC: + 2015-01-01: false +DE: + 2015-01-01: false +FL: + 2015-01-01: false +GA: + 2015-01-01: false +HI: + 2015-01-01: false +IA: + 2015-01-01: false +ID: + 2015-01-01: false +IL: + 2015-01-01: false +IN: + 2015-01-01: false +KS: + 2015-01-01: false +KY: + 2015-01-01: false +LA: + 2015-01-01: false +MA: + 2015-01-01: false +MD: + 2015-01-01: false +ME: + 2015-01-01: false +MI: + 2015-01-01: false +MN: + 2015-01-01: false +MO: + 2015-01-01: false +MS: + 2015-01-01: false +MT: + 2015-01-01: false +NC: + 2015-01-01: false +ND: + 2015-01-01: false +NE: + 2015-01-01: false +NH: + 2015-01-01: false +NJ: + 2015-01-01: false +NM: + 2015-01-01: false +NV: + 2015-01-01: false +NY: + 2015-01-01: false +OH: + 2015-01-01: false +OK: + 2015-01-01: false +OR: + 2015-01-01: false +PA: + 2015-01-01: false +RI: + 2015-01-01: false +SC: + 2015-01-01: false +SD: + 2015-01-01: false +TN: + 2015-01-01: false +TX: + 2015-01-01: false +UT: + 2015-01-01: false +VA: + 2015-01-01: false +VT: + 2015-01-01: false +WA: + 2015-01-01: false +WI: + 2015-01-01: false +WV: + 2015-01-01: false +WY: + 2015-01-01: false diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/income/disregard/couple.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/income/disregard/couple.yaml index b048655d3df..e7b76a0f663 100644 --- a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/income/disregard/couple.yaml +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/income/disregard/couple.yaml @@ -14,6 +14,24 @@ metadata: href: https://portal.ct.gov/-/media/aginganddisability/agingservices/choices/benefitsquickguide.pdf#page=2 - title: Connecticut CHOICES Benefits Quick Guide (Rev 04.04.2025) href: https://portal.ct.gov/ads/-/media/ads-beta/choices/choices-benefits-quick-guide.pdf?rev=3b8c59ca12224218bc4c4438649e7ac7#page=1 + - title: "California DHCS All County Welfare Directors Letter 00-57, Aged and Disabled Federal Poverty Level program, MC 176 financial eligibility form, line 8" + href: https://www.dhcs.ca.gov/services/medi-cal/eligibility/letters/Documents/c00-57.pdf#page=3 + - title: "California DHCS All County Welfare Directors Letter 20-24, Aged and Disabled Federal Poverty Level program #page 2-3,5" + href: https://www.dhcs.ca.gov/services/medi-cal/eligibility/letters/Documents/20-24.pdf#page=2 + - title: Connecticut DSS Program Standards Chart (as of January 1, 2026), AABD / MAABD disregards + href: https://portal.ct.gov/-/media/departments-and-agencies/dss/fact-sheets-and-issue-briefs/fact-sheets/dss-program-standards-chart-effective-010126.pdf + - title: Connecticut DSS Uniform Policy Manual 5030.15 - Unearned Income Disregards, AABD and MAABD + href: https://portal.ct.gov/dss/-/media/departments-and-agencies/dss/upms/upm5---treatment-of-income-income-eligibility/5030_15.doc + - title: Connecticut CHOICES Benefits Quick Guide (modified May 29, 2026), HUSKY C + href: https://portal.ct.gov/ads/-/media/ads-beta/choices/choices-benefits-quick-guide.pdf#page=3 + - title: South Carolina DHHS Medicaid Policy and Procedures Manual 303.02.01 and 303.06.03 - ABD general income disregard + href: https://img1.scdhhs.gov/mppm/SCMPPM/Section_300.docx + - title: South Carolina Medicaid State Plan, Supplement 8a to Attachment 2.6-A (effective January 1, 2009) + href: https://scdhhs.gov/sites/dhhs/files/documents/stateplan/Attachment_2.6-A.pdf#page=70 + - title: Minnesota Statutes 256B.056, subdivision 1b - Aged, blind, and disabled income methodology + href: https://www.revisor.mn.gov/statutes/cite/256B.056#stat.256B.056.1b + - title: Minnesota DHS Health Care Programs Eligibility Policy Manual 2.3.3.3.2.2, MA-ABD Disregards and Deductions + href: https://hcopub.dhs.state.mn.us/epm/2_3_3_3_2_2.htm AL: 2015-01-01: 20 @@ -24,14 +42,23 @@ AZ: AR: 2015-01-01: 20 CA: - 2015-01-01: 310 + # The 20-dollar any-income deduction (MC 176 line 8), which ACWDL 20-24 keeps. + # Before December 2020 California also subtracted the disregard in + # additional_disregard after the SSI exclusions. + 2015-01-01: 20 CO: 2015-01-01: 20 CT: + # UPM 5030.15 A subtracts the individual disregard from each unit member's + # own unearned income. The model subtracts this couple value (2 x the + # individual standard from 2024) from the couple's combined unearned income, + # so it deducts too much when a spouse has less unearned income than the + # individual disregard (issue 10458). It rises each January 1. 2015-01-01: 339 2023-01-01: 818 2024-01-01: 1_022 2025-01-01: 1_070 + 2026-01-01: 1_124 DC: 2015-01-01: 20 DE: @@ -65,7 +92,9 @@ MA: MI: 2015-01-01: 20 MN: - 2015-01-01: 20 + # Minn. Stat. 256B.056, subd. 1b: the SSI $20 general disregard is included + # in the standard and not deducted from income. + 2015-01-01: 0 MS: 2015-01-01: 20 MO: @@ -99,7 +128,7 @@ PA: RI: 2015-01-01: 20 SC: - 2015-01-01: 20 + 2015-01-01: 50 SD: 2015-01-01: 20 TN: diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/income/disregard/individual.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/income/disregard/individual.yaml index 9f608e3f4f7..39ff218f6a5 100644 --- a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/income/disregard/individual.yaml +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/income/disregard/individual.yaml @@ -14,6 +14,24 @@ metadata: href: https://portal.ct.gov/-/media/aginganddisability/agingservices/choices/benefitsquickguide.pdf#page=2 - title: Connecticut CHOICES Benefits Quick Guide (Rev 04.04.2025) href: https://portal.ct.gov/ads/-/media/ads-beta/choices/choices-benefits-quick-guide.pdf?rev=3b8c59ca12224218bc4c4438649e7ac7#page=1 + - title: "California DHCS All County Welfare Directors Letter 00-57, Aged and Disabled Federal Poverty Level program, MC 176 financial eligibility form, line 8" + href: https://www.dhcs.ca.gov/services/medi-cal/eligibility/letters/Documents/c00-57.pdf#page=3 + - title: "California DHCS All County Welfare Directors Letter 20-24, Aged and Disabled Federal Poverty Level program #page 2-3" + href: https://www.dhcs.ca.gov/services/medi-cal/eligibility/letters/Documents/20-24.pdf#page=2 + - title: Connecticut DSS Program Standards Chart (as of January 1, 2026), AABD / MAABD disregards + href: https://portal.ct.gov/-/media/departments-and-agencies/dss/fact-sheets-and-issue-briefs/fact-sheets/dss-program-standards-chart-effective-010126.pdf + - title: Connecticut DSS Uniform Policy Manual 5030.15 - Unearned Income Disregards, AABD and MAABD + href: https://portal.ct.gov/dss/-/media/departments-and-agencies/dss/upms/upm5---treatment-of-income-income-eligibility/5030_15.doc + - title: Connecticut CHOICES Benefits Quick Guide (modified May 29, 2026), HUSKY C + href: https://portal.ct.gov/ads/-/media/ads-beta/choices/choices-benefits-quick-guide.pdf#page=3 + - title: South Carolina DHHS Medicaid Policy and Procedures Manual 303.02.01 and 303.06.03 - ABD general income disregard + href: https://img1.scdhhs.gov/mppm/SCMPPM/Section_300.docx + - title: South Carolina Medicaid State Plan, Supplement 8a to Attachment 2.6-A (effective January 1, 2009) + href: https://scdhhs.gov/sites/dhhs/files/documents/stateplan/Attachment_2.6-A.pdf#page=70 + - title: Minnesota Statutes 256B.056, subdivision 1b - Aged, blind, and disabled income methodology + href: https://www.revisor.mn.gov/statutes/cite/256B.056#stat.256B.056.1b + - title: Minnesota DHS Health Care Programs Eligibility Policy Manual 2.3.3.3.2.2, MA-ABD Disregards and Deductions + href: https://hcopub.dhs.state.mn.us/epm/2_3_3_3_2_2.htm AL: 2015-01-01: 20 @@ -24,7 +42,10 @@ AZ: AR: 2015-01-01: 20 CA: - 2015-01-01: 230 + # The 20-dollar any-income deduction (MC 176 line 8), which ACWDL 20-24 keeps. + # Before December 2020 California also subtracted the disregard in + # additional_disregard after the SSI exclusions. + 2015-01-01: 20 CO: 2015-01-01: 20 CT: @@ -32,6 +53,7 @@ CT: 2023-01-01: 482 2024-01-01: 511 2025-01-01: 535 + 2026-01-01: 562 DC: 2015-01-01: 20 DE: @@ -65,7 +87,9 @@ MA: MI: 2015-01-01: 20 MN: - 2015-01-01: 20 + # Minn. Stat. 256B.056, subd. 1b: the SSI $20 general disregard is included + # in the standard and not deducted from income. + 2015-01-01: 0 MS: 2015-01-01: 20 MO: @@ -99,7 +123,7 @@ PA: RI: 2015-01-01: 20 SC: - 2015-01-01: 20 + 2015-01-01: 50 SD: 2015-01-01: 20 TN: diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/income/disregards_medicare_part_b_premium.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/income/disregards_medicare_part_b_premium.yaml new file mode 100644 index 00000000000..890542eda67 --- /dev/null +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/income/disregards_medicare_part_b_premium.yaml @@ -0,0 +1,121 @@ +description: The state disregards the full Medicare Part B premium, regardless of who pays it, from countable income under the optional Medicaid pathway for seniors or people with disabilities, if this is true. +metadata: + unit: bool + period: year + label: Medicaid senior or disabled pathway Medicare Part B premium disregard + breakdown: + - state_code + reference: + - title: California Welfare and Institutions Code 14005.401(a) + href: https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=WIC§ionNum=14005.401 + - title: "California DHCS All County Welfare Directors Letter 20-18, Medicare Part B premium disregard #page 1-2" + href: https://www.dhcs.ca.gov/services/medi-cal/eligibility/letters/Documents/20-18.pdf#page=1 + - title: "California DHCS All County Welfare Directors Letter 20-24, Aged and Disabled Federal Poverty Level program #page 3-8" + href: https://www.dhcs.ca.gov/services/medi-cal/eligibility/letters/Documents/20-24.pdf#page=3 + +AK: + 2015-01-01: false +AL: + 2015-01-01: false +AR: + 2015-01-01: false +AZ: + 2015-01-01: false +CA: + # Before this date Part B counted only when the person paid it + # (22 CCR 50555.2(c)); deducts_health_insurance_premiums covers that. + # The 2020-12-01 value first applies in 2021 annual calculations. + 2015-01-01: false + 2020-12-01: true +CO: + 2015-01-01: false +CT: + 2015-01-01: false +DC: + 2015-01-01: false +DE: + 2015-01-01: false +FL: + 2015-01-01: false +GA: + 2015-01-01: false +HI: + 2015-01-01: false +IA: + 2015-01-01: false +ID: + 2015-01-01: false +IL: + 2015-01-01: false +IN: + 2015-01-01: false +KS: + 2015-01-01: false +KY: + 2015-01-01: false +LA: + 2015-01-01: false +MA: + 2015-01-01: false +MD: + 2015-01-01: false +ME: + 2015-01-01: false +MI: + 2015-01-01: false +MN: + 2015-01-01: false +MO: + 2015-01-01: false +MS: + 2015-01-01: false +MT: + 2015-01-01: false +NC: + 2015-01-01: false +ND: + 2015-01-01: false +NE: + 2015-01-01: false +NH: + 2015-01-01: false +NJ: + 2015-01-01: false +NM: + 2015-01-01: false +NV: + 2015-01-01: false +NY: + 2015-01-01: false +OH: + 2015-01-01: false +OK: + 2015-01-01: false +OR: + 2015-01-01: false +PA: + 2015-01-01: false +RI: + 2015-01-01: false +SC: + 2015-01-01: false +SD: + 2015-01-01: false +TN: + 2015-01-01: false +TX: + 2015-01-01: false +UT: + 2015-01-01: false +VA: + 2015-01-01: false +VT: + 2015-01-01: false +WA: + 2015-01-01: false +WI: + 2015-01-01: false +WV: + 2015-01-01: false +WY: + 2015-01-01: false 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 213a22aad23..acb17407053 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 @@ -16,6 +16,8 @@ metadata: href: https://portal.ct.gov/-/media/aginganddisability/agingservices/choices/benefitsquickguide.pdf#page=2 - title: Connecticut CHOICES Benefits Quick Guide (Rev 04.04.2025) href: https://portal.ct.gov/ads/-/media/ads-beta/choices/choices-benefits-quick-guide.pdf?rev=3b8c59ca12224218bc4c4438649e7ac7#page=1 + - title: California DHCS All County Welfare Directors Letter 20-24, Aged and Disabled Federal Poverty Level program (138 percent of the poverty level effective December 1, 2020) + href: https://www.dhcs.ca.gov/services/medi-cal/eligibility/letters/Documents/20-24.pdf#page=1 AK: 2018-01-01: 0.74 @@ -27,8 +29,9 @@ AZ: AR: 2018-01-01: 0.80 CA: + # The 2020-12-01 value first applies in 2021 annual calculations. 2018-01-01: 1.00 - 2021-01-01: 1.38 + 2020-12-01: 1.38 CT: 2018-01-01: 0.63 2021-01-01: 0.98 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 e7fde8fec47..b3b8c444538 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 @@ -16,6 +16,8 @@ metadata: href: https://portal.ct.gov/-/media/aginganddisability/agingservices/choices/benefitsquickguide.pdf#page=2 - title: Connecticut CHOICES Benefits Quick Guide (Rev 04.04.2025) href: https://portal.ct.gov/ads/-/media/ads-beta/choices/choices-benefits-quick-guide.pdf?rev=3b8c59ca12224218bc4c4438649e7ac7#page=1 + - title: California DHCS All County Welfare Directors Letter 20-24, Aged and Disabled Federal Poverty Level program (138 percent of the poverty level effective December 1, 2020) + href: https://www.dhcs.ca.gov/services/medi-cal/eligibility/letters/Documents/20-24.pdf#page=1 AK: 2018-01-01: 0.74 @@ -27,8 +29,9 @@ AZ: AR: 2018-01-01: 0.80 CA: + # The 2020-12-01 value first applies in 2021 annual calculations. 2018-01-01: 1.00 - 2021-01-01: 1.38 + 2020-12-01: 1.38 CT: 2018-01-01: 0.63 2021-01-01: 0.98 diff --git a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_asset_eligible.yaml b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_asset_eligible.yaml index ac7e535b194..9324bba79fa 100644 --- a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_asset_eligible.yaml +++ b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_asset_eligible.yaml @@ -93,16 +93,16 @@ output: is_optional_senior_or_disabled_asset_eligible: [false, false] -# Missouri's 2026 limits are 5,726 for one person and 11,452 for a couple. -# One spouse holds more than the individual limit, but the couple's -# combined resources are tested against the couple limit. -- name: Missouri spouse over the individual limit is eligible when combined resources are under the couple limit +# Missouri's limits from July 1, 2025 are 6,068.80 for one person and +# 12,137.55 for a couple. One spouse holds more than the individual limit, +# but the couple's combined resources are tested against the couple limit. +- name: Missouri spouse over the individual limit is eligible when combined resources are under the couple limit. period: 2026 input: people: person1: age: 70 - ssi_countable_resources: 6_000 + ssi_countable_resources: 6_500 person2: age: 68 ssi_countable_resources: 5_000 @@ -118,10 +118,10 @@ members: [person1, person2] state_code: MO output: - # 11,000 combined is under 11,452. + # 11,500 combined is under 12,137.55. is_optional_senior_or_disabled_asset_eligible: [true, true] -- name: Missouri couple at the couple resource limit is ineligible +- name: Missouri couple at the couple resource limit is eligible. period: 2026 input: people: @@ -130,7 +130,7 @@ ssi_countable_resources: 6_000 person2: age: 68 - ssi_countable_resources: 5_452 + ssi_countable_resources: 6_137.55 tax_units: tax_unit: members: [person1, person2] @@ -143,5 +143,550 @@ members: [person1, person2] state_code: MO output: - # 11,452 combined is not under the 11,452 couple limit. + # RSMo 208.010.2(7): a couple "may own resources not to exceed" the limit. + # 12,137.55 combined equals the 12,137.55 couple limit. + is_optional_senior_or_disabled_asset_eligible: [true, true] + +- name: Missouri couple one cent over the couple resource limit is ineligible. + period: 2026 + input: + people: + person1: + age: 70 + ssi_countable_resources: 6_000 + person2: + age: 68 + ssi_countable_resources: 6_137.56 + tax_units: + tax_unit: + members: [person1, person2] + tax_unit_is_joint: true + marital_units: + marital_unit: + members: [person1, person2] + households: + household: + members: [person1, person2] + state_code: MO + output: + # 12,137.56 combined exceeds the 12,137.55 couple limit. is_optional_senior_or_disabled_asset_eligible: [false, false] + +- name: Missouri's July 2026 individual limit applies from 2027. + period: 2027 + input: + age: 70 + ssi_countable_resources: 6_200 + state_code: MO + output: + # 6,200 is under the 6,220.50 limit effective July 1, 2026. + is_optional_senior_or_disabled_asset_eligible: true + +- name: Arkansas uses the Medicare Savings Program individual resource limit. + period: 2026 + input: + age: 70 + ssi_countable_resources: 9_900 + state_code: AR + output: + # 9,900 is under the 2026 limit of 9,950. + is_optional_senior_or_disabled_asset_eligible: true + +- name: Oklahoma uses the Medicare Savings Program couple resource limit. + period: 2026 + input: + people: + person1: + age: 70 + ssi_countable_resources: 7_450 + person2: + age: 68 + ssi_countable_resources: 7_450 + tax_units: + tax_unit: + members: [person1, person2] + tax_unit_is_joint: true + marital_units: + marital_unit: + members: [person1, person2] + households: + household: + members: [person1, person2] + state_code: OK + output: + # 14,900 combined is under the 2026 couple limit of 14,910. + is_optional_senior_or_disabled_asset_eligible: [true, true] + +- name: South Carolina uses the 2025 Medicare Savings Program individual resource limit. + period: 2025 + input: + age: 70 + ssi_countable_resources: 9_600 + state_code: SC + output: + # 9,600 is under the 2025 limit of 9,660. + is_optional_senior_or_disabled_asset_eligible: true + +- name: Arkansas applicant at the 2026 Medicare Savings Program individual resource limit is eligible. + period: 2026 + input: + age: 70 + ssi_countable_resources: 9_950 + state_code: AR + output: + # MS 23110(6): resources "equal to but not exceeding" the MSP standard. + # 9,950 equals the 2026 limit of 9,950. + is_optional_senior_or_disabled_asset_eligible: true + +- name: Arkansas applicant one dollar over the 2026 Medicare Savings Program individual resource limit is ineligible. + period: 2026 + input: + age: 70 + ssi_countable_resources: 9_951 + state_code: AR + output: + # 9,951 exceeds the 2026 limit of 9,950. + is_optional_senior_or_disabled_asset_eligible: false + +- name: South Carolina applicant at the 2026 Medicare Savings Program individual resource limit is eligible. + period: 2026 + input: + age: 70 + ssi_countable_resources: 9_950 + state_code: SC + output: + # MPPM 303.06.02: countable resources "must be at or below" 9,950. + is_optional_senior_or_disabled_asset_eligible: true + +- name: Oklahoma couple at the 2026 Medicare Savings Program couple resource limit is eligible. + period: 2026 + input: + people: + person1: + age: 70 + ssi_countable_resources: 7_455 + person2: + age: 68 + ssi_countable_resources: 7_455 + tax_units: + tax_unit: + members: [person1, person2] + tax_unit_is_joint: true + marital_units: + marital_unit: + members: [person1, person2] + households: + household: + members: [person1, person2] + state_code: OK + output: + # C-1 Schedule VI: resources "equal to or less than" 14,910. + # 7,455 + 7,455 = 14,910 combined. + is_optional_senior_or_disabled_asset_eligible: [true, true] + +- name: Oklahoma uses the 2023 Medicare Savings Program individual resource limit. + period: 2023 + input: + age: 70 + ssi_countable_resources: 5_000 + state_code: OK + output: + # 5,000 is under the 2023 limit of 9,090. + is_optional_senior_or_disabled_asset_eligible: true + +- name: Oklahoma uses the 2015 Medicare Savings Program couple resource limit. + period: 2015 + input: + people: + person1: + age: 70 + ssi_countable_resources: 5_000 + person2: + age: 68 + ssi_countable_resources: 5_000 + tax_units: + tax_unit: + members: [person1, person2] + tax_unit_is_joint: true + marital_units: + marital_unit: + members: [person1, person2] + households: + household: + members: [person1, person2] + state_code: OK + output: + # 10,000 combined is under the 2015 couple limit of 10,930. + is_optional_senior_or_disabled_asset_eligible: [true, true] + +- name: Arkansas uses the 2016 Medicare Savings Program individual resource limit. + period: 2016 + input: + age: 70 + ssi_countable_resources: 7_400 + state_code: AR + output: + # 7,400 is over the 2016 limit of 7,280. + is_optional_senior_or_disabled_asset_eligible: false + +- name: South Carolina uses the 2023 Medicare Savings Program individual resource limit. + period: 2023 + input: + age: 70 + ssi_countable_resources: 9_000 + state_code: SC + output: + # 9,000 is under the 2023 limit of 9,090. + is_optional_senior_or_disabled_asset_eligible: true + +- name: South Carolina applies the 2025 Medicare Savings Program limit, not the 2026 limit, in 2025. + period: 2025 + input: + age: 70 + ssi_countable_resources: 9_700 + state_code: SC + output: + # 9,700 is over the 2025 limit of 9,660, though under the 2026 limit of 9,950. + is_optional_senior_or_disabled_asset_eligible: false + +- name: Missouri applies the 1,000-dollar individual resource limit in 2017. + period: 2017 + input: + age: 70 + ssi_countable_resources: 1_500 + state_code: MO + output: + # 13 CSR 40-2.030(12) (11/30/15 edition): 1,000 "or more" before + # July 1, 2017. 1,500 is over it. + is_optional_senior_or_disabled_asset_eligible: false + +- name: Missouri couple at the July 2017 couple resource limit is eligible in 2018. + period: 2018 + input: + people: + person1: + age: 70 + ssi_countable_resources: 2_000 + person2: + age: 68 + ssi_countable_resources: 2_000 + tax_units: + tax_unit: + members: [person1, person2] + tax_unit_is_joint: true + marital_units: + marital_unit: + members: [person1, person2] + households: + household: + members: [person1, person2] + state_code: MO + output: + # RSMo 208.010.2(7): resources "not to exceed" the couple amount qualify. + # 4,000 combined equals the 4,000 couple limit effective July 1, 2017. + is_optional_senior_or_disabled_asset_eligible: [true, true] + +- name: Missouri applies the July 2018 individual resource limit in 2019. + period: 2019 + input: + age: 70 + ssi_countable_resources: 2_500 + state_code: MO + output: + # 2,500 is under the 3,000 limit effective July 1, 2018. + is_optional_senior_or_disabled_asset_eligible: true + +- name: Missouri applies the July 2019 individual resource limit in 2020. + period: 2020 + input: + age: 70 + ssi_countable_resources: 3_500 + state_code: MO + output: + # 3,500 is under the 4,000 limit effective July 1, 2019. + is_optional_senior_or_disabled_asset_eligible: true + +- name: Missouri applies the July 2020 individual resource limit in 2021. + period: 2021 + input: + age: 70 + ssi_countable_resources: 4_500 + state_code: MO + output: + # 4,500 is under the 5,000 limit effective July 1, 2020. + is_optional_senior_or_disabled_asset_eligible: true + +- name: Missouri applies the July 2021 individual resource limit in 2022. + period: 2022 + input: + age: 70 + ssi_countable_resources: 5_020 + state_code: MO + output: + # 5,020 is under the 5,035 limit effective July 1, 2021 (IM-70). + is_optional_senior_or_disabled_asset_eligible: true + +- name: Missouri applies the July 2022 individual resource limit in 2023. + period: 2023 + input: + age: 70 + ssi_countable_resources: 5_200 + state_code: MO + output: + # 5,200 is under the 5,301.85 limit effective July 1, 2022 (IM-77). + is_optional_senior_or_disabled_asset_eligible: true + +- name: Missouri applies the July 2023 individual resource limit in 2024. + period: 2024 + input: + age: 70 + ssi_countable_resources: 5_500 + state_code: MO + output: + # 5,500 is under the 5,726 limit effective July 1, 2023 (IM-57). + is_optional_senior_or_disabled_asset_eligible: true + +- name: Missouri applies the July 2024 individual resource limit in 2025. + period: 2025 + input: + age: 70 + ssi_countable_resources: 5_800 + state_code: MO + output: + # 5,800 is under the 5,909.25 limit effective July 1, 2024. + is_optional_senior_or_disabled_asset_eligible: true + +- name: Missouri applies the July 2025 individual resource limit in 2026. + period: 2026 + input: + age: 70 + ssi_countable_resources: 6_000 + state_code: MO + output: + # 6,000 is under the 6,068.80 limit effective July 1, 2025. + is_optional_senior_or_disabled_asset_eligible: true + +- name: Arkansas applicant under the 2015 Medicare Savings Program individual resource limit is eligible. + period: 2015 + input: + age: 70 + ssi_countable_resources: 7_000 + state_code: AR + output: + # 7,000 is under the 2015 Medicare Savings Program limit of 7,280. + is_optional_senior_or_disabled_asset_eligible: true + +- name: South Carolina couple one dollar over the 2026 Medicare Savings Program couple resource limit is ineligible. + period: 2026 + input: + people: + person1: + age: 70 + ssi_countable_resources: 7_455 + person2: + age: 68 + ssi_countable_resources: 7_456 + tax_units: + tax_unit: + members: [person1, person2] + tax_unit_is_joint: true + marital_units: + marital_unit: + members: [person1, person2] + households: + household: + members: [person1, person2] + state_code: SC + output: + # 14,911 combined exceeds the 2026 couple limit of 14,910. + is_optional_senior_or_disabled_asset_eligible: [false, false] + +- name: California applicant at the 2026 individual resource limit is eligible. + period: 2026 + input: + age: 70 + ssi_countable_resources: 130_000 + state_code: CA + output: + # WIC 14005.40(c)(5): resources that "do not exceed" the limit qualify. + is_optional_senior_or_disabled_asset_eligible: true + +- name: California applicant one cent over the 2026 individual resource limit is ineligible. + period: 2026 + input: + age: 70 + ssi_countable_resources: 130_000.01 + state_code: CA + output: + is_optional_senior_or_disabled_asset_eligible: false + +- name: California couple at the 2026 couple resource limit is eligible. + period: 2026 + input: + people: + person1: + age: 70 + ssi_countable_resources: 97_500 + person2: + age: 68 + ssi_countable_resources: 97_500 + tax_units: + tax_unit: + members: [person1, person2] + tax_unit_is_joint: true + marital_units: + marital_unit: + members: [person1, person2] + households: + household: + members: [person1, person2] + state_code: CA + output: + # 195,000 combined equals the two-person limit (ACWDL 25-14). + is_optional_senior_or_disabled_asset_eligible: [true, true] + +- name: California applies the July 2022 individual resource limit in 2023. + period: 2023 + input: + age: 70 + ssi_countable_resources: 130_000 + state_code: CA + output: + # ACWDL 21-31: 130,000 from July 1, 2022, read in 2023; 130,000 is at it. + is_optional_senior_or_disabled_asset_eligible: true + +- name: Missouri individual at the 1,000-dollar limit is ineligible in 2017. + period: 2017 + input: + age: 70 + ssi_countable_resources: 1_000 + state_code: MO + output: + # 13 CSR 40-2.030(12) (11/30/15 edition): resources of 1,000 "or more" + # make a single person ineligible before July 1, 2017. + is_optional_senior_or_disabled_asset_eligible: false + +- name: Missouri couple at the 2,000-dollar couple limit is eligible in 2017. + period: 2017 + input: + people: + person1: + age: 70 + ssi_countable_resources: 1_000 + person2: + age: 68 + ssi_countable_resources: 1_000 + marital_units: + marital_unit: + members: [person1, person2] + households: + household: + members: [person1, person2] + state_code: MO + output: + # 13 CSR 40-2.030(12) (11/30/15 edition): a couple is ineligible only when + # resources "exceed[] a value of two thousand dollars". + is_optional_senior_or_disabled_asset_eligible: [true, true] + +- name: Missouri individual at the July 2017 individual resource limit is eligible in 2018. + period: 2018 + input: + age: 70 + ssi_countable_resources: 2_000 + state_code: MO + output: + # RSMo 208.010.2(7), from fiscal year 2018: resources "not to exceed" + # 2,000. + is_optional_senior_or_disabled_asset_eligible: true + +- name: Missouri individual at the 2026 individual resource limit is eligible. + period: 2026 + input: + age: 70 + ssi_countable_resources: 6_068.8 + state_code: MO + output: + # RSMo 208.010.2(7): resources "not to exceed" the individual amount. + is_optional_senior_or_disabled_asset_eligible: true + +- name: Missouri individual one cent over the 2026 individual resource limit is ineligible. + period: 2026 + input: + age: 70 + ssi_countable_resources: 6_068.81 + state_code: MO + output: + is_optional_senior_or_disabled_asset_eligible: false + +- name: Missouri couple whose split resources sum to the 2026 couple limit is eligible. + period: 2026 + input: + people: + person1: + age: 70 + ssi_countable_resources: 5_000.1 + person2: + age: 68 + ssi_countable_resources: 7_137.45 + tax_units: + tax_unit: + members: [person1, person2] + tax_unit_is_joint: true + marital_units: + marital_unit: + members: [person1, person2] + households: + household: + members: [person1, person2] + state_code: MO + output: + # 5,000.10 + 7,137.45 = 12,137.55, the couple limit; RSMo 208.010.2(7) + # "not to exceed". The inputs are stored as float32, and their sum is + # 12,137.5503, so only the whole-cent rounding keeps the couple eligible. + is_optional_senior_or_disabled_asset_eligible: [true, true] + +- name: California applicant at the 2,000-dollar individual resource limit is eligible in 2019. + period: 2019 + input: + age: 70 + ssi_countable_resources: 2_000 + state_code: CA + output: + # 22 CCR 50420(a): the property reserve "shall not exceed" 2,000. + is_optional_senior_or_disabled_asset_eligible: true + +- name: California couple at the 3,000-dollar couple resource limit is eligible in 2019. + period: 2019 + input: + people: + person1: + age: 70 + ssi_countable_resources: 1_500 + person2: + age: 68 + ssi_countable_resources: 1_500 + tax_units: + tax_unit: + members: [person1, person2] + tax_unit_is_joint: true + marital_units: + marital_unit: + members: [person1, person2] + households: + household: + members: [person1, person2] + state_code: CA + output: + # 22 CCR 50420(a): 3,000 combined equals the two-person limit. + is_optional_senior_or_disabled_asset_eligible: [true, true] + +- name: California applicant one cent over the 2,000-dollar individual resource limit is ineligible in 2022. + period: 2022 + input: + age: 70 + ssi_countable_resources: 2_000.01 + state_code: CA + output: + # Annual calculations read January 1, so 2022 uses the 2,000 limit; the + # 130,000 limit of July 1, 2022 (ACWDL 21-31) first applies in 2023. + is_optional_senior_or_disabled_asset_eligible: false diff --git a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_income_eligible.yaml b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_income_eligible.yaml index eed9a1321b7..3a62b73d763 100644 --- a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_income_eligible.yaml +++ b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_income_eligible.yaml @@ -717,3 +717,45 @@ state_code: ND output: is_optional_senior_or_disabled_income_eligible: [false] + +- name: Minnesota senior with Social Security at 100 percent of the poverty guideline is income eligible. + period: 2026 + input: + age: 70 + social_security_retirement: 15_960 + state_code: MN + output: + # Minn. Stat. 256B.056, subd. 1b: no $20 deduction. 1,330 a month equals + # the 2026 limit of 15,960 / 12 = 1,330. + is_optional_senior_or_disabled_income_eligible: true + +- name: Minnesota senior with Social Security one dollar a month over the poverty guideline is not income eligible. + period: 2026 + input: + age: 70 + social_security_retirement: 15_972 + state_code: MN + output: + # 1,331 a month exceeds 1,330. A $20 deduction would have given 1,311. + is_optional_senior_or_disabled_income_eligible: false + +- name: California applicant who pays IRMAA is income eligible once the full Part B premium is disregarded in 2026. + period: 2026 + input: + people: + person1: + age: 70 + medicare_enrolled: true + social_security_retirement: 25_200 + tax_units: + tax_unit: + members: [person1] + medicare_irmaa_magi: 150_000 + households: + household: + members: [person1] + state_code: CA + output: + # 2,100 - 20 - 405.80 = 1,674.20 a month, under 138% FPL (1,835.40). + # With only the 202.90 base premium, 1,877.10 is over the limit. + is_optional_senior_or_disabled_income_eligible: true diff --git a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/income/medicaid_optional_senior_or_disabled_countable_income.yaml b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/income/medicaid_optional_senior_or_disabled_countable_income.yaml index 883b6e7bed9..27519017286 100644 --- a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/income/medicaid_optional_senior_or_disabled_countable_income.yaml +++ b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/income/medicaid_optional_senior_or_disabled_countable_income.yaml @@ -105,3 +105,594 @@ # rounding, 1,131.75 would exceed the $1,131 standard. medicaid_optional_senior_or_disabled_countable_income: 13_572 is_optional_senior_or_disabled_income_eligible: true + +- name: California subtracts only the 20-dollar any-income deduction from December 2020. + period: 2026 + absolute_error_margin: 0.01 + input: + age: 70 + medicare_enrolled: false + ssi_marital_unearned_income: 12_000 + state_code: CA + output: + # DHCS ACWDL 20-24, no Part B or other premiums: (1,000 - 20) x 12 = 11,760. + medicaid_optional_senior_or_disabled_countable_income: 11_760 + +- name: Connecticut subtracts its 2026 disregard from unearned income. + period: 2026 + absolute_error_margin: 0.01 + input: + age: 70 + ssi_marital_unearned_income: 12_000 + state_code: CT + output: + # (1,000 - 562) x 12 = 5,256. + medicaid_optional_senior_or_disabled_countable_income: 5_256 + +- name: South Carolina subtracts a 50-dollar general disregard. + period: 2026 + absolute_error_margin: 0.01 + input: + age: 70 + ssi_marital_unearned_income: 12_000 + state_code: SC + output: + # (1,000 - 50) x 12 = 11,400. + medicaid_optional_senior_or_disabled_countable_income: 11_400 + +- name: California deducts the base Medicare Part B premium for a Medicare enrollee. + period: 2026 + absolute_error_margin: 0.01 + input: + age: 70 + medicare_enrolled: true + ssi_marital_unearned_income: 12_000 + state_code: CA + output: + # DHCS ACWDL 20-24 deducts Part B regardless of how it is paid; the + # 2026 base premium is 202.90 a month. + # (1,000 - 20 - 202.90) x 12 = 9,325.20. + medicaid_optional_senior_or_disabled_countable_income: 9_325.2 + +- name: California applies one 20-dollar deduction to a couple's combined unearned income. + period: 2026 + absolute_error_margin: 0.01 + input: + people: + person1: + age: 70 + is_tax_unit_head: true + medicare_enrolled: false + ssi_unearned_income: 15_600 + person2: + age: 68 + is_tax_unit_spouse: true + medicare_enrolled: false + ssi_unearned_income: 7_800 + marital_units: + marital_unit: + members: [person1, person2] + households: + household: + members: [person1, person2] + state_code: CA + output: + ssi_couple_computation_applies: [true, true] + # ACWDL 20-24 Example 3: (1,950 - 20) x 12 / 2 = 11,580 each. + medicaid_optional_senior_or_disabled_countable_income: [11_580, 11_580] + +- name: Connecticut couple with each spouse above the individual disregard gets the full 2026 couple disregard. + period: 2026 + absolute_error_margin: 0.01 + input: + people: + person1: + age: 70 + is_tax_unit_head: true + ssi_unearned_income: 15_600 + person2: + age: 68 + is_tax_unit_spouse: true + ssi_unearned_income: 7_800 + marital_units: + marital_unit: + members: [person1, person2] + households: + household: + members: [person1, person2] + state_code: CT + output: + # (1,950 - 1,124) x 12 / 2 = 4,956 each. + medicaid_optional_senior_or_disabled_countable_income: [4_956, 4_956] + +- name: South Carolina gives its 50-dollar disregard only once to a couple. + period: 2026 + absolute_error_margin: 0.01 + input: + people: + person1: + age: 70 + is_tax_unit_head: true + ssi_unearned_income: 15_600 + person2: + age: 68 + is_tax_unit_spouse: true + ssi_unearned_income: 7_800 + marital_units: + marital_unit: + members: [person1, person2] + households: + household: + members: [person1, person2] + state_code: SC + output: + # MPPM 303.06.03C: (1,950 - 50) x 12 / 2 = 11,400 each. A 50-dollar + # disregard for each spouse would give 11,100. + medicaid_optional_senior_or_disabled_countable_income: [11_400, 11_400] + +- name: California subtracts the 20-dollar deduction in 2021. + period: 2021 + absolute_error_margin: 0.01 + input: + age: 70 + medicare_enrolled: false + ssi_marital_unearned_income: 12_000 + state_code: CA + output: + # ACWDL 20-24 ended the 230 disregard on December 1, 2020, which first + # applies in 2021 annual calculations. (1,000 - 20) x 12 = 11,760. + medicaid_optional_senior_or_disabled_countable_income: 11_760 + +- name: California subtracts the 20-dollar deduction and then the 230-dollar disregard in 2020. + period: 2020 + absolute_error_margin: 0.01 + input: + age: 70 + medicare_enrolled: true + ssi_marital_unearned_income: 12_000 + state_code: CA + output: + # ACWDL 00-57 MC 176 lines 8 and 16. 2020 reads January 1, 2020: the 230 + # disregard applies, the Part B disregard does not, and the MSP pays Part + # B, so no person-paid premium is deducted. + # (1,000 - 20 - 230) x 12 = 9,000. + medicaid_optional_senior_or_disabled_countable_income: 9_000 + +- name: California deducts both spouses' Part B premiums and other health insurance premiums from a couple's combined income. + period: 2026 + absolute_error_margin: 0.01 + input: + people: + person1: + age: 70 + is_tax_unit_head: true + medicare_enrolled: true + ssi_unearned_income: 15_600 + person2: + age: 68 + is_tax_unit_spouse: true + medicare_enrolled: true + ssi_unearned_income: 7_800 + health_insurance_premiums_without_medicare_part_b: 360 + marital_units: + marital_unit: + members: [person1, person2] + households: + household: + members: [person1, person2] + state_code: CA + output: + # ACWDL 20-24 Example 3: the couple's premiums are summed before the + # split. Monthly, 1,950 - 20 - 2 x 202.90 - 30 = 1,494.20. + # 1,494.20 x 12 / 2 = 8,965.20 each. + medicaid_optional_senior_or_disabled_countable_income: [8_965.2, 8_965.2] + +- name: California subtracts the 230-dollar disregard after the earned income deductions in 2020. + period: 2020 + absolute_error_margin: 0.01 + input: + age: 70 + medicare_enrolled: false + ssi_marital_earned_income: 12_000 + state_code: CA + output: + # ACWDL 00-57 MC 176 lines 10-16: the unused 20-dollar deduction joins the + # 65-dollar deduction, then half the rest counts, then the disregard. + # ((1,000 - 65 - 20) / 2 - 230) x 12 = 2,730. + medicaid_optional_senior_or_disabled_countable_income: 2_730 + +- name: California subtracts the 310-dollar couple disregard in 2020. + period: 2020 + absolute_error_margin: 0.01 + input: + people: + person1: + age: 70 + is_tax_unit_head: true + medicare_enrolled: false + ssi_unearned_income: 15_600 + person2: + age: 68 + is_tax_unit_spouse: true + medicare_enrolled: false + ssi_unearned_income: 7_800 + marital_units: + marital_unit: + members: [person1, person2] + households: + household: + members: [person1, person2] + state_code: CA + output: + # ACWDL 00-57 MC 176 lines 8 and 16: (1,950 - 20 - 310) x 12 / 2 = 9,720 each. + medicaid_optional_senior_or_disabled_countable_income: [9_720, 9_720] + +- name: California deducted other health insurance premiums before 12/2020. + period: 2019 + absolute_error_margin: 0.01 + input: + age: 70 + medicare_enrolled: false + ssi_marital_unearned_income: 12_000 + health_insurance_premiums_without_medicare_part_b: 1_800 + state_code: CA + output: + # ACWDL 00-57 MC 176 lines 8, 16 and 17: (1,000 - 20 - 230 - 150) x 12 = 7,200. + medicaid_optional_senior_or_disabled_countable_income: 7_200 + +- name: California deducts the 2021 Medicare Part B premium. + period: 2021 + absolute_error_margin: 0.01 + input: + age: 70 + medicare_enrolled: true + ssi_marital_unearned_income: 12_000 + state_code: CA + output: + # The December 2020 Part B disregard first applies in 2021 annual + # calculations. The 2021 base premium is 148.50 a month. + # (1,000 - 20 - 148.50) x 12 = 9,978. + medicaid_optional_senior_or_disabled_countable_income: 9_978 + +- name: California deducts premiums entered as total health insurance premiums. + period: 2026 + absolute_error_margin: 0.01 + input: + age: 70 + medicare_enrolled: false + ssi_marital_unearned_income: 12_000 + health_insurance_premiums: 1_200 + state_code: CA + output: + # ACWDL 20-24: (1,000 - 20 - 100) x 12 = 10,560. + medicaid_optional_senior_or_disabled_countable_income: 10_560 + +- name: California keeps the Part B disregard when the MSP pays Part B and other premiums are entered as a total. + period: 2026 + absolute_error_margin: 0.01 + input: + age: 70 + medicare_enrolled: true + social_security_retirement: 12_000 + health_insurance_premiums: 1_200 + state_code: CA + output: + msp_part_b_premium_coverage: 2_434.8 + # ACWDL 20-24: (1,000 - 20 - 202.90 - 100) x 12 = 8,125.20. + medicaid_optional_senior_or_disabled_countable_income: 8_125.2 + +- name: California does not count a self-paid Part B premium twice when it is part of the total premium input. + period: 2026 + absolute_error_margin: 0.01 + input: + age: 70 + medicare_enrolled: true + social_security_retirement: 22_200 + health_insurance_premiums: 3_634.8 + state_code: CA + output: + medicare_part_b_premium: 2_434.8 + # ACWDL 20-24: (1,850 - 20 - 202.90 - 100) x 12 = 18,325.20. + medicaid_optional_senior_or_disabled_countable_income: 18_325.2 + +- name: California deducts the applicant's Part B premium from income that includes deemed spouse income. + period: 2026 + absolute_error_margin: 0.01 + input: + people: + person1: + age: 70 + is_tax_unit_head: true + medicare_enrolled: true + ssi_unearned_income: 1_200 + person2: + age: 60 + is_tax_unit_spouse: true + ssi_unearned_income: 30_240 + marital_units: + marital_unit: + members: [person1, person2] + households: + household: + members: [person1, person2] + state_code: CA + output: + # ACWDL 20-24 Examples 2 and 5 deduct premiums from the combined income. + # Monthly, 100 + 2,520 - 20 - 202.90 = 2,397.10, so 28,765.20 a year. + # Flooring the applicant's own income first would lose 122.90 a month + # and give 30,240. + medicaid_optional_senior_or_disabled_countable_income: [28_765.2, 0] + +- name: California applicant whose Part B premium offsets deemed spouse income is income eligible. + period: 2026 + input: + people: + person1: + age: 70 + is_tax_unit_head: true + medicare_enrolled: true + ssi_unearned_income: 1_200 + person2: + age: 60 + is_tax_unit_spouse: true + ssi_unearned_income: 30_240 + marital_units: + marital_unit: + members: [person1, person2] + households: + household: + members: [person1, person2] + state_code: CA + output: + # 28,765.20 of countable income is under the 29,863.20 limit. + is_optional_senior_or_disabled_income_eligible: [true, true] + +- name: California countable income does not go below zero when premiums exceed income. + period: 2026 + absolute_error_margin: 0.01 + input: + age: 70 + medicare_enrolled: true + health_insurance_premiums_without_medicare_part_b: 3_000 + ssi_marital_unearned_income: 1_200 + state_code: CA + output: + # (100 - 20) x 12 = 960, less 2,434.80 Part B and 3,000 premiums, floored at 0. + medicaid_optional_senior_or_disabled_countable_income: 0 + +- name: California does not deduct a non-applicant spouse's premiums, as in ACWDL 20-24 Example 5. + period: 2026 + absolute_error_margin: 0.01 + input: + people: + person1: + age: 70 + is_tax_unit_head: true + medicare_enrolled: true + ssi_unearned_income: 18_000 + person2: + age: 60 + is_tax_unit_spouse: true + ssi_unearned_income: 12_000 + employment_income: 8_400 + health_insurance_premiums_without_medicare_part_b: 1_200 + marital_units: + marital_unit: + members: [person1, person2] + households: + household: + members: [person1, person2] + state_code: CA + output: + # SSI deeming: the spouse's 1,000 unearned plus (700 - 65) / 2 = 317.50 + # earned, so 1,317.50 a month is deemed. Monthly countable income is + # 1,500 + 1,317.50 - 20 - 202.90 = 2,594.60, over the limit, which is + # the letter's result. + medicaid_optional_senior_or_disabled_income_deemed_from_ineligible_spouse: [15_810, 0] + medicaid_optional_senior_or_disabled_countable_income: [31_135.2, 0] + +- name: North Carolina does not deduct Medicare Part B or other health insurance premiums. + period: 2026 + absolute_error_margin: 0.01 + input: + age: 70 + medicare_enrolled: true + health_insurance_premiums_without_medicare_part_b: 1_200 + ssi_marital_unearned_income: 12_000 + state_code: NC + output: + # Only California deducts premiums: (1,000 - 20) x 12 = 11,760. + medicaid_optional_senior_or_disabled_countable_income: 11_760 + +- name: Minnesota applies no 20-dollar disregard, to unearned or earned income. + period: 2026 + absolute_error_margin: 0.01 + input: + age: 70 + ssi_marital_earned_income: 12_000 + state_code: MN + output: + # Minn. Stat. 256B.056, subd. 1b: no $20, so none moves to earned income. + # The SSI $65 and one-half earned income exclusions still apply: + # (1,000 - 65) / 2 x 12 = 5,610. With the $20 it would be 5,490. + medicaid_optional_senior_or_disabled_countable_income: 5_610 + +- name: California deducts the full Part B premium, IRMAA included, that the person pays in 2026. + period: 2026 + absolute_error_margin: 0.01 + input: + people: + person1: + age: 70 + medicare_enrolled: true + social_security_retirement: 22_200 + health_insurance_premiums_without_medicare_part_b: 1_200 + tax_units: + tax_unit: + members: [person1] + medicare_irmaa_magi: 150_000 + households: + household: + members: [person1] + state_code: CA + output: + # Part B is 202.90 base plus 202.90 IRMAA a month (42 USC 1395r(i)). + # ACWDL 20-18 p2 disregards "the amount of the individual's Medicare + # Part B premium": (1,850 - 20 - 100 - 405.80) x 12 = 15,890.40. + medicare_part_b_premium: 4_869.6 + medicaid_optional_senior_or_disabled_countable_income: 15_890.4 + +- name: California disregards the full Part B premium when an MSP pays the base and the person pays the IRMAA in 2026. + period: 2026 + absolute_error_margin: 0.01 + input: + people: + person1: + age: 70 + medicare_enrolled: true + social_security_retirement: 14_400 + tax_units: + tax_unit: + members: [person1] + medicare_irmaa_magi: 150_000 + households: + household: + members: [person1] + state_code: CA + output: + # The MSP pays the 202.90 base; the person pays the 202.90 IRMAA. + # The disregard applies "regardless of the state's payment" (ACWDL 20-18 + # p2): (1,200 - 20 - 405.80) x 12 = 9,290.40. + msp_part_b_premium_coverage: 2_434.8 + medicare_part_b_premium: 2_434.8 + medicaid_optional_senior_or_disabled_countable_income: 9_290.4 + +- name: California deducted a Part B premium that the person paid before 12/2020. + period: 2019 + absolute_error_margin: 0.01 + input: + age: 70 + medicare_enrolled: true + social_security_retirement: 17_400 + medicare_part_b_premium: 1_626 + health_insurance_premiums_without_medicare_part_b: 1_200 + state_code: CA + output: + # 22 CCR 50555.2(c) and MC 176 line 17: Part B counts in the months that + # the person pays it (135.50 a month in 2019). The person's income is over + # the QI limit, so no Medicare Savings Program pays it. + # (1,450 - 20 - 230 - 100 - 135.50) x 12 = 11,574, under the 12,490 limit. + # Without the Part B deduction, 13,200 would be over it. + medicaid_optional_senior_or_disabled_countable_income: 11_574 + +- name: California gives an applicant whose spouse is not aged or disabled the 230-dollar individual disregard in 2019. + period: 2019 + absolute_error_margin: 0.01 + input: + people: + person1: + age: 70 + is_tax_unit_head: true + medicare_enrolled: false + ssi_unearned_income: 15_000 + person2: + age: 50 + is_tax_unit_spouse: true + ssi_earned_income: 6_000 + marital_units: + marital_unit: + members: [person1, person2] + households: + household: + members: [person1, person2] + state_code: CA + output: + # The spouse is not aged or disabled, so the applicant is a qualified + # individual, not part of a qualified couple (ACWDL 00-57 p1; MC 176 + # line 16): 230, not 310. The spouse's 500 a month is over the 2019 + # deeming threshold (1,157 - 771 = 386), so it counts. + # MC 176 lines 8-16: (1,250 - 20) + (500 - 65) / 2 = 1,447.50; less 230 + # = 1,217.50 a month. Lines 19 and 21 (the spouse's MNL, the 1-person + # FPL) are not modeled, so this case asserts no eligibility. + ssi_couple_computation_applies: [false, false] + medicaid_optional_senior_or_disabled_income_deemed_from_ineligible_spouse: [2_610, 0] + medicaid_optional_senior_or_disabled_countable_income: [14_610, 0] + +- name: Minnesota applies no 20-dollar disregard to a couple. + period: 2026 + absolute_error_margin: 0.01 + input: + people: + person1: + age: 70 + is_tax_unit_head: true + ssi_unearned_income: 15_600 + person2: + age: 68 + is_tax_unit_spouse: true + ssi_unearned_income: 7_800 + marital_units: + marital_unit: + members: [person1, person2] + households: + household: + members: [person1, person2] + state_code: MN + output: + ssi_couple_computation_applies: [true, true] + # Minn. Stat. 256B.056, subd. 1b: 1,950 x 12 / 2 = 11,700 each. + # A 20-dollar couple disregard would give 11,580. + medicaid_optional_senior_or_disabled_countable_income: [11_700, 11_700] + +- name: California couple countable income does not go below zero when premiums exceed income. + period: 2026 + absolute_error_margin: 0.01 + input: + people: + person1: + age: 70 + is_tax_unit_head: true + medicare_enrolled: true + ssi_unearned_income: 1_200 + person2: + age: 68 + is_tax_unit_spouse: true + medicare_enrolled: true + marital_units: + marital_unit: + members: [person1, person2] + households: + household: + members: [person1, person2] + state_code: CA + output: + ssi_couple_computation_applies: [true, true] + # (100 - 20) x 12 = 960, less 2 x 2,434.80 Part B, floored at 0. + medicaid_optional_senior_or_disabled_countable_income: [0, 0] + +- name: California applicant in ACWDL 20-24 Example 5 is not income eligible. + period: 2026 + input: + people: + person1: + age: 70 + is_tax_unit_head: true + medicare_enrolled: true + ssi_unearned_income: 18_000 + person2: + age: 60 + is_tax_unit_spouse: true + ssi_unearned_income: 12_000 + employment_income: 8_400 + health_insurance_premiums_without_medicare_part_b: 1_200 + marital_units: + marital_unit: + members: [person1, person2] + households: + household: + members: [person1, person2] + state_code: CA + output: + # Monthly countable income of 2,594.60 is over the limit, which is the + # letter's result. + is_optional_senior_or_disabled_income_eligible: [false, false] diff --git a/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_asset_eligible.py b/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_asset_eligible.py index 6b400e8bebd..81c18aa24e0 100644 --- a/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_asset_eligible.py +++ b/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_asset_eligible.py @@ -6,14 +6,20 @@ class is_optional_senior_or_disabled_asset_eligible(Variable): entity = Person label = "Asset-eligibility for State’s optional Medicaid pathway for seniors or people with disabilities" 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/42/1396d#p", + "https://revisor.mo.gov/main/OneSection.aspx?section=208.010", + "https://www.law.cornell.edu/regulations/california/22-CCR-50420", + ) def formula(person, period, parameters): # Assets # SSI financial responsibility rules (42 CFR 435.602): the unit is # the individual or the married couple, not the tax filing unit. personal_assets = person("ssi_countable_resources", period) # $ - assets = person.marital_unit.sum(personal_assets) + # Inputs are stored as float32, so compare whole cents with the limit. + assets = np.round(person.marital_unit.sum(personal_assets), 2) is_couple = person.marital_unit.nb_persons() == 2 state = person.household("state_code_str", period) @@ -23,10 +29,30 @@ def formula(person, period, parameters): ).gov.hhs.medicaid.eligibility.categories.senior_or_disabled # Asset limit - asset_limit = where( + state_limit = where( is_couple, p.assets.limit.couple[state], p.assets.limit.individual[state], ) + # Flagged states use the QMB / Medicare Savings Program resource + # standard instead of a state dollar limit. + msp = parameters(period).gov.hhs.medicare.savings_programs.eligibility.asset + msp_limit = where(is_couple, msp.couple, msp.individual) + uses_msp_limit = p.assets.limit.uses_msp_limit[state].astype(bool) - return assets < asset_limit + # The MSP resource standard (42 USC 1396d(p)(1)(C)) and the AR, OK + # and SC rules allow resources equal to the limit. + within_msp_limit = assets <= msp_limit + # RSMo 208.010.2(7): a Missouri claimant "owns or possesses resources + # not to exceed" the individual amount, and a married couple "may own + # resources not to exceed" the couple amount. California resources may + # not exceed the limit (22 CCR 50420(a); WIC 14005.40(c)(5)). + inclusive = where( + is_couple, + p.assets.limit.couple_limit_inclusive[state], + p.assets.limit.individual_limit_inclusive[state], + ).astype(bool) + within_state_limit = where( + inclusive, assets <= state_limit, assets < state_limit + ) + return where(uses_msp_limit, within_msp_limit, within_state_limit) diff --git a/policyengine_us/variables/gov/hhs/medicaid/income/medicaid_optional_senior_or_disabled_countable_income.py b/policyengine_us/variables/gov/hhs/medicaid/income/medicaid_optional_senior_or_disabled_countable_income.py index 044371e7419..3bf485dfcba 100644 --- a/policyengine_us/variables/gov/hhs/medicaid/income/medicaid_optional_senior_or_disabled_countable_income.py +++ b/policyengine_us/variables/gov/hhs/medicaid/income/medicaid_optional_senior_or_disabled_countable_income.py @@ -17,6 +17,14 @@ class medicaid_optional_senior_or_disabled_countable_income(Variable): "https://dssmanuals.mo.gov/mo-healthnet-for-the-aged-blind-and-disabled/0805-000-00/0805-015-00/", "https://dssmanuals.mo.gov/mo-healthnet-for-the-aged-blind-and-disabled/0805-000-00/0805-015-00/0805-015-25/", "https://dssmanuals.mo.gov/mo-healthnet-for-the-aged-blind-and-disabled/0805-000-00/0805-015-00/0805-015-40/", + # California ABD FPL disregard and Part B and health insurance premium + # deductions + "https://www.dhcs.ca.gov/services/medi-cal/eligibility/letters/Documents/c00-57.pdf#page=3", + "https://www.dhcs.ca.gov/services/medi-cal/eligibility/letters/Documents/20-24.pdf#page=3", + "https://www.dhcs.ca.gov/services/medi-cal/eligibility/letters/Documents/20-18.pdf#page=2", + "https://www.law.cornell.edu/regulations/california/22-CCR-50555.2", + "https://www.law.cornell.edu/uscode/text/42/1395r#i", + "https://www.law.cornell.edu/cfr/text/20/416.1163", ) def formula(person, period, parameters): @@ -43,11 +51,11 @@ def formula(person, period, parameters): state = person.household("state_code_str", period) p = parameters( period - ).gov.hhs.medicaid.eligibility.categories.senior_or_disabled.income.disregard + ).gov.hhs.medicaid.eligibility.categories.senior_or_disabled.income income_disregard = where( couple_computation, - p.couple[state], - p.individual[state], + p.disregard.couple[state], + p.disregard.individual[state], ) personal_countable = _apply_medicaid_optional_senior_or_disabled_exclusions( earned_income, @@ -58,6 +66,49 @@ def formula(person, period, parameters): period, ) + # 22 CCR 50555.2 deducts person-paid premiums, Part B only when the + # person pays it. From 12/2020 (ACWDL 20-18, 20-24) CA disregards Part B + # "regardless of how the premium is paid": swap the person-paid Part B + # in the shared aggregate for the individual's full Part B premium, the + # base premium plus any IRMAA (42 USC 1395r(i)), whoever pays it. + # NOTE: medicare_enrolled (Part A and/or Part B) stands in for Part B + # enrollment, as in medical_expense_health_insurance_premiums. + # NOTE: gov.hhs.medicare.part_b.base_premium starts in 2021, so a + # person-paid Part B before 2021 reads the 2021 premium. + # NOTE: ACWDL 20-24 Example 5 also deducts a non-applicant spouse's + # premiums. Spousal income here follows SSI deeming (20 CFR 416.1163), + # so that premium is not modeled, nor is MC 176's maintenance need + # deduction for the spouse (lines 19 and 21; issue 10543). + medicare_enrolled = person("medicare_enrolled", period) + paid_premiums = person("medical_expense_health_insurance_premiums", period) + paid_part_b = person("medicare_part_b_premium", period) * medicare_enrolled + full_part_b = ( + person("gross_medicare_part_b_premium", period) * medicare_enrolled + ) + disregards_part_b = p.disregards_medicare_part_b_premium[state].astype(bool) + own_premiums = where( + disregards_part_b, + max_(paid_premiums - paid_part_b, 0) + full_part_b, + paid_premiums, + ) + premiums = where( + couple_computation, + person.marital_unit.sum(own_premiums), + own_premiums, + ) + deducts_premiums = p.deducts_health_insurance_premiums[state].astype(bool) + # MC 176 (ACWDL 00-57) lines 16-17 subtract the additional disregard + # and the premiums from income after the SSI exclusions. + additional_disregard = ( + where( + couple_computation, + p.additional_disregard.couple[state], + p.additional_disregard.individual[state], + ) + * MONTHS_IN_YEAR + ) + deductions = where(deducts_premiums, premiums, 0) + additional_disregard + spousal_deemed = person( "medicaid_optional_senior_or_disabled_income_deemed_from_ineligible_spouse", period, @@ -66,12 +117,13 @@ def formula(person, period, parameters): is_eligible_spouse = person("is_ssi_eligible_spouse", period) is_eligible = is_eligible_individual | is_eligible_spouse - return where( - ~is_eligible, - 0, - where( - couple_computation, - personal_countable / 2, - personal_countable + spousal_deemed, - ), + # ACWDL 20-24 Examples 2 and 5 combine the non-applicant spouse's + # income with the applicant's income before the deductions, as + # 20 CFR 416.1163(d)(2) does, so subtract the deductions from the + # combined income and floor the result. + countable = where( + couple_computation, + max_(personal_countable - deductions, 0) / 2, + max_(personal_countable + spousal_deemed - deductions, 0), ) + return where(is_eligible, countable, 0) diff --git a/source_conflicts/candidates.yaml b/source_conflicts/candidates.yaml index 37bfa3cd0f5..deafc3b0bfe 100644 --- a/source_conflicts/candidates.yaml +++ b/source_conflicts/candidates.yaml @@ -4271,6 +4271,45 @@ candidates: in every state as an approximation. Missouri''s MHABD limits round up the same way (medicaid_optional_senior_or_disabled_income_limit.py), and its MHF parent limit uses the published schedule (mo_mhf_parent_income_limit.py). Verify the rounding gap-fill; the separate January-versus-April timing difference is a model approximation.' +- id: us-mo:mhabd-resource-limit-boundary + program: medicaid + years: + from: 2018 + type: state-fiscal + question: From fiscal year 2018, is a Missouri aged, blind or disabled claimant or couple whose countable resources + equal the limit eligible, as the statute's "not to exceed" says, or ineligible, as the rule's "at or in excess of" + says? + sources: + - kind: statute + citation: RSMo 208.010.2(7) + url: https://revisor.mo.gov/main/OneSection.aspx?section=208.010 + - kind: statute + citation: RSMo 536.014(2) + url: https://revisor.mo.gov/main/OneSection.aspx?section=536.014 + - kind: regulation + citation: 13 CSR 40-8.020(4)(B) + url: https://www.sos.mo.gov/CMSImages/AdRules/csr/current/13csr/13c40-8.pdf#page=2 + readings: + statute: A claimant "owns or possesses resources not to exceed" the individual amount and a married couple "may + own resources not to exceed" the couple amount, so resources equal to either limit qualify. + other: A household with countable assets "at or in excess of" the limit is ineligible. + example: In 2026, an individual with $6,068.80 or a couple with $12,137.55 of countable resources is eligible under + the statute and ineligible under the rule. + pe_us: + follows: statute + code: + - policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/assets/limit/individual_limit_inclusive.yaml + - policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/assets/limit/couple_limit_inclusive.yaml + prs: + - https://github.com/PolicyEngine/policyengine-us/pull/10364 + state: ruled + note: Ruled on 2026-10-27 by the project lead for these Medicaid fixes to follow the statute, first for couples + (ruling record https://github.com/PolicyEngine/policyengine-us/pull/10364#issuecomment-6451309562). It was applied + to individuals from fiscal year 2018 on 2026-10-29, when the project lead directed that the round-3 review fixes + be applied (https://github.com/PolicyEngine/policyengine-us/pull/10364#pullrequestreview-5675190584). RSMo + 536.014(2) makes a rule that is in conflict with state law not valid. Missouri fiscal year 2018 began July 1, + 2017. Before then, RSMo 208.010.2(4) (before August 28, 2016) and 13 CSR 40-2.030(12) set a strict single-person + test and an inclusive couple test, and the sources did not disagree. - id: us-mo:negative-federal-agi-combined-return program: income-tax years: