diff --git a/changelog.d/medicaid-abd-wv-ssi-rate-standard.fixed.md b/changelog.d/medicaid-abd-wv-ssi-rate-standard.fixed.md new file mode 100644 index 00000000000..51ae53eb992 --- /dev/null +++ b/changelog.d/medicaid-abd-wv-ssi-rate-standard.fixed.md @@ -0,0 +1 @@ +Use the SSI federal benefit rate, not 75% of the poverty guideline, as the Medicaid aged, blind, and disabled income limit in West Virginia and North Dakota. diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/income/limit/couple.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/income/limit/couple.yaml index 0eb1c1e8aaa..7e0c2a190c3 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 @@ -85,8 +85,6 @@ NY: 2018-01-01: 0.82 NC: 2018-01-01: 1.00 -ND: - 2018-01-01: 0.75 OK: 2018-01-01: 1.00 PA: @@ -108,8 +106,6 @@ VT: 2021-01-01: 0.80 VA: 2018-01-01: 0.80 -WV: - 2018-01-01: 0.75 WI: 2018-01-01: 0.83 2021-01-01: 1.00 diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/income/limit/individual.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/income/limit/individual.yaml index 489de5e9165..46c61240f02 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 @@ -85,8 +85,6 @@ NY: 2018-01-01: 0.82 NC: 2018-01-01: 1.00 -ND: - 2018-01-01: 0.75 OK: 2018-01-01: 1.00 PA: @@ -108,8 +106,6 @@ VT: 2021-01-01: 0.80 VA: 2018-01-01: 0.80 -WV: - 2018-01-01: 0.75 WI: 2018-01-01: 0.83 2021-01-01: 1.00 diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/income/limit/requires_income_below_limit.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/income/limit/requires_income_below_limit.yaml index f89e1442506..617ab2747aa 100644 --- a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/income/limit/requires_income_below_limit.yaml +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/income/limit/requires_income_below_limit.yaml @@ -22,6 +22,12 @@ metadata: href: https://www.law.cornell.edu/regulations/colorado/10-CCR-2505-10-8.100_v2 - title: Iowa Administrative Code 441-75.1(17) (persons who meet the income guidelines of SSI but are not receiving cash assistance) href: https://www.law.cornell.edu/regulations/iowa/Iowa-Admin-Code-r-441-75-1 + - title: "North Dakota Administrative Code 75-02-02.1-40(1)(a)(2) (the income level \"which establishes supplemental security income eligibility\") and 75-02-02.1-41.1 (recipient liability is net income \"remaining after\" the Medicaid income level) #page 89,93" + href: https://www.ndlegis.gov/information/acdata/pdf/75-02-02.1.pdf#page=89 + - title: West Virginia Income Maintenance Manual § 4.14.3 Step 5 - SSI-Related income eligibility ("equal to or less than the appropriate SSI Maximum Payment Level") + href: https://bfa.wv.gov/media/40005/download?inline#page=662 + - title: West Virginia Income Maintenance Manual (archived) § 10.23.C Step 5 - SSI-Related income eligibility (rev. 5/13) + href: https://www.wvdhhr.org/bcf/policy/imm/new_manual/immanual/manual_pdf_files/chapter_10/ch10_23.pdf#page=4 - title: 42 U.S. Code § 1382(a)(1)(A) and (2)(A) - SSI eligible individual (income "at a rate of not more than" the benefit rate) href: https://www.law.cornell.edu/uscode/text/42/1382#a - title: SSA POMS SI 02005.001.C.3 - Retrospective Monthly Accounting Computation, the Federal eligibility test ("If the CI is equal to or less than the FBR ... the individual, based on income, is eligible") diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/income/limit/uses_ssi_federal_benefit_rate.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/income/limit/uses_ssi_federal_benefit_rate.yaml index 27ccbd3980b..ee4ac8b5f37 100644 --- a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/income/limit/uses_ssi_federal_benefit_rate.yaml +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/income/limit/uses_ssi_federal_benefit_rate.yaml @@ -26,6 +26,10 @@ metadata: href: https://dphhs.mt.gov/assets/hcsd/mamanual/ABD200July012016.pdf#page=1 - title: Montana Medicaid State Plan, Attachment 3.1-F, page 7 (TN 24-0002, effective July 1, 2024) href: https://www.medicaid.gov/sites/default/files/2024-05/MT-24-0002.pdf#page=10 + - title: North Dakota Administrative Code 75-02-02.1-40(1)(a)(2) - Income levels (categorically needy aged, blind, or disabled) + href: https://www.ndlegis.gov/information/acdata/pdf/75-02-02.1.pdf#page=89 + - title: North Dakota Non-ACA Medicaid Policy Manual 510-05-85-40 - Income Levels + href: https://www.nd.gov/dhs/policymanuals/51005/510_05_85_40.htm - title: Ohio Administrative Code 5160:1-3-02.4 - Medicaid coverage for the categorically needy href: https://codes.ohio.gov/ohio-administrative-code/rule-5160:1-3-02.4 - title: Ohio Administrative Code 5160:1-3-03.5 - Medicaid application of income standards @@ -36,6 +40,10 @@ metadata: href: https://app.leg.wa.gov/wac/default.aspx?cite=182-512-0010 - title: Washington Administrative Code 182-512-0100(2)(a) - SSI-related categorically needy medical eligibility href: https://app.leg.wa.gov/wac/default.aspx?cite=182-512-0100 + - title: "West Virginia Income Maintenance Manual, Chapter 4 Appendix A (SSI Max), § 23.9 (SSI Related/Non-Cash Assistance, optional categorically needy) and § 23.11.4 SSI-Related/Non-Cash Assistance #page 405,1859,1889" + href: https://bfa.wv.gov/media/40005/download?inline#page=405 + - title: West Virginia Income Maintenance Manual (archived), § 16.7.H SSI-Related/Non-Cash Assistance (rev. 10/13) + href: https://www.wvdhhr.org/bcf/policy/imm/new_manual/immanual/manual_pdf_files/chapter_16/ch16_7.pdf#page=8 AK: 2018-01-01: false @@ -94,7 +102,7 @@ MT: NC: 2018-01-01: false ND: - 2018-01-01: false + 2018-01-01: true NE: 2018-01-01: false NH: @@ -136,6 +144,6 @@ WA: WI: 2018-01-01: false WV: - 2018-01-01: false + 2018-01-01: true WY: 2018-01-01: false diff --git a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/is_209b_ssi_recipient_for_medicaid.yaml b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/is_209b_ssi_recipient_for_medicaid.yaml index f2781fc7aa2..9ced49446da 100644 --- a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/is_209b_ssi_recipient_for_medicaid.yaml +++ b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/is_209b_ssi_recipient_for_medicaid.yaml @@ -186,3 +186,40 @@ is_optional_senior_or_disabled_asset_eligible: true output: is_209b_ssi_recipient_for_medicaid: true + +# North Dakota tests SSI recipients against the income level "which +# establishes supplemental security income eligibility" (N.D.A.C. +# 75-02-02.1-40(1)(a)(2)): the SSI couple rate, $1,491 a month ($17,892 a +# year) in 2026, not 75% of the two-person guideline ($16,230). This couple +# has $1,400 a month of combined countable income, so they receive $91 a +# month of SSI between them. +- name: Case 18, North Dakota SSI couple under the SSI couple rate qualifies without spenddown. + period: 2026 + input: + people: + person1: + age: 70 + ssi: 546 + medicaid_optional_senior_or_disabled_countable_income: 8_400 + medicaid_medically_needy_medical_expenses: 0 + is_optional_senior_or_disabled_asset_eligible: true + person2: + age: 68 + ssi: 546 + medicaid_optional_senior_or_disabled_countable_income: 8_400 + medicaid_medically_needy_medical_expenses: 0 + is_optional_senior_or_disabled_asset_eligible: true + 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: ND + output: + # 16,800 combined is under the 17,892 couple standard. + is_209b_ssi_recipient_for_medicaid: [true, true] 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 dfa96b82c42..eed9a1321b7 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 @@ -631,3 +631,89 @@ state_code: IA output: is_optional_senior_or_disabled_income_eligible: [true, true] + +# West Virginia's SSI-Related/Non-Cash Assistance group (IMM § 23.11.4) +# tests countable income against the SSI Maximum Payment level in Chapter 4, +# Appendix A: $994 a month ($11,928 a year) for one person and $1,491 a +# month ($17,892 a year) for two in 2026. The group section reads "under" +# that level and applies the § 4.14 method, whose Step 5 reads: "If the net +# countable monthly income is equal to or less than the appropriate SSI +# Maximum Payment Level, the assistance group (AG) is eligible" (§ 4.14.3). +# The model follows Step 5 and SSI's "not more than" test, as for Colorado +# and Iowa. +- name: Income exactly at West Virginia's individual standard is eligible + period: 2026 + input: + people: + person1: + medicaid_optional_senior_or_disabled_countable_income: 11_928 + tax_units: + tax_unit: + members: [person1] + households: + household: + members: [person1] + state_code: WV + output: + is_optional_senior_or_disabled_income_eligible: [true] + +# $11,929 is over the SSI standard, although it is under 75% of the 2026 +# poverty guideline ($11,970), the limit West Virginia had before. +- name: Income one dollar over West Virginia's individual standard is ineligible + period: 2026 + input: + people: + person1: + medicaid_optional_senior_or_disabled_countable_income: 11_929 + tax_units: + tax_unit: + members: [person1] + households: + household: + members: [person1] + state_code: WV + output: + is_optional_senior_or_disabled_income_eligible: [false] + +- name: Joint income exactly at West Virginia's couple standard is eligible + period: 2026 + input: + people: + person1: + medicaid_optional_senior_or_disabled_countable_income: 8_946 + person2: + medicaid_optional_senior_or_disabled_countable_income: 8_946 + tax_units: + tax_unit: + members: [person1, person2] + tax_unit_is_joint: true + marital_units: + marital_unit1: + members: [person1, person2] + households: + household: + members: [person1, person2] + state_code: WV + output: + is_optional_senior_or_disabled_income_eligible: [true, true] + +# North Dakota's income level for categorically needy aged, blind, or +# disabled recipients "is that which establishes supplemental security +# income eligibility" (N.D.A.C. 75-02-02.1-40(1)(a)(2)): $994 a month +# ($11,928 a year) for one person in 2026. $996 a month is over it, +# although it is under 75% of the 2026 poverty guideline ($11,970). +- name: North Dakota income between the SSI rate and 75% of poverty is ineligible + period: 2026 + input: + people: + person1: + medicaid_optional_senior_or_disabled_countable_income: 11_952 + tax_units: + tax_unit: + members: [person1] + households: + household: + members: [person1] + state_code: ND + output: + is_optional_senior_or_disabled_income_eligible: [false] diff --git a/policyengine_us/tests/unit/test_medicaid_abd_ssi_rate_standard_properties.py b/policyengine_us/tests/unit/test_medicaid_abd_ssi_rate_standard_properties.py index f9f38924c16..99960f834b1 100644 --- a/policyengine_us/tests/unit/test_medicaid_abd_ssi_rate_standard_properties.py +++ b/policyengine_us/tests/unit/test_medicaid_abd_ssi_rate_standard_properties.py @@ -1,13 +1,17 @@ """Properties of the Medicaid income standard for aged, blind, and disabled people who do not receive SSI, in states that set it at the SSI rate. -Seven states set that standard at the SSI federal benefit rate, a monthly +Nine states set that standard at the SSI federal benefit rate, a monthly dollar amount for an individual or a couple, not a share of the poverty guideline. They are flagged in the parameter `gov.hhs.medicaid.eligibility.categories.senior_or_disabled.income.limit.uses_ssi_federal_benefit_rate`. -Six of them have not elected the poverty-level group of 42 U.S.C. 1396a(m) +Eight of them have not elected the poverty-level group of 42 U.S.C. 1396a(m) (Montana's state plan marks the group of 42 CFR 435.210 instead); Louisiana -has elected that group and pegs its level to the same rate. Montana's manual +has elected that group and pegs its level to the same rate. North Dakota, a +section 209(b) state, sets the level for its categorically needy aged, +blind, or disabled recipients at "that which establishes supplemental +security income eligibility" (N.D.A.C. 75-02-02.1-40(1)(a)(2)), and the +model's 209(b) SSI-recipient income test reads the same limit. Montana's manual (ABD 008) is the model case: its standards "are the benefit amounts paid by the Social Security Administration to Supplemental Security Income (SSI) cash recipients", applicants "with monthly countable income equal to or @@ -18,13 +22,13 @@ The states' rules differ on income exactly at the standard. Oregon's excludes it: an individual "must have adjusted income (see OAR 461-001-0000) below the standard in this section" (OAR 461-155-0250(3)). -The other six include it. Oregon is flagged in +The other eight include it. Oregon is flagged in `gov.hhs.medicaid.eligibility.categories.senior_or_disabled.income.limit.requires_income_below_limit`. The state sets and comparisons below are written from those rules, not read from the parameters, so the first two tests check the parameters against them. Each later test evaluates a grid of households in one -vectorized simulation and checks, for every one of the seven states and +vectorized simulation and checks, for every one of the nine states and every year from 2018 to 2026: - the limit equals twelve times the rate SSA published for that year, for an @@ -71,11 +75,11 @@ ] # States whose own rules set the standard at the SSI rate (cited in # uses_ssi_federal_benefit_rate.yaml). -SSI_RATE_STATES = sorted(["CO", "IA", "LA", "MT", "OH", "OR", "WA"]) +SSI_RATE_STATES = sorted(["CO", "IA", "LA", "MT", "ND", "OH", "OR", "WA", "WV"]) # States whose rules require income below the standard rather than at or # below it. Oregon: "must have adjusted income (see OAR 461-001-0000) below # the standard in this section" (OAR 461-155-0250(3); every version since -# 1-01-14 says "below", in section (4) until April 2017). The other six +# 1-01-14 says "below", in section (4) until April 2017). The other eight # include the standard: Montana "equal to or less than these income # standards" (ABD 008); Louisiana "income equal to or less than the federal # benefit rate (FBR)" (LAC 50:III.2305(B)); Ohio "countable income ... which @@ -86,7 +90,14 @@ # and SSI covers income "at a rate of not more than" the benefit rate (42 # U.S.C. 1382(a)(1)(A) and (2)(A)): "If the CI is equal to or less than the # FBR ... the individual, based on income, is eligible" (POMS SI -# 02005.001.C.3). +# 02005.001.C.3); West Virginia's group (IMM § 23.11.4, "under" the SSI +# Maximum Payment level) applies the § 4.14 method, whose Step 5 reads "If +# the net countable monthly income is equal to or less than the appropriate +# SSI Maximum Payment Level, the assistance group (AG) is eligible" (IMM +# § 4.14.3); North Dakota uses the level "which establishes supplemental +# security income eligibility" and counts as recipient liability only net +# income "remaining after" that level (N.D.A.C. 75-02-02.1-40(1)(a)(2), +# 75-02-02.1-41.1). BELOW_ONLY_STATES = ["OR"] # Annual dollars around the standard: far below, one month's dollar below, # exactly at, one dollar above, and well above. diff --git a/source_conflicts/candidates.yaml b/source_conflicts/candidates.yaml index e06355446bb..72ff9e81ef7 100644 --- a/source_conflicts/candidates.yaml +++ b/source_conflicts/candidates.yaml @@ -7298,6 +7298,44 @@ candidates: threshold and federal-method conditions by year. Code not yet on main: gov/states/wv/tax/income/subtractions/wv_claim_of_right_subtraction.yaml, policyengine_us/variables/gov/states/wv/tax/income/subtractions/wv_subtractions.py, wv_claim_of_right_subtraction, gov.states.wv.tax.income.subtractions.claim_of_right.threshold.' +- id: us-wv:medicaid-ssi-related-non-cash-income-at-standard + program: medicaid + years: + from: 2018 + type: calendar + question: Does West Virginia's SSI-Related/Non-Cash Assistance group cover countable income exactly equal to the + SSI Maximum Payment level? + sources: + - kind: statute + citation: 42 U.S.C. 1396a(a)(10)(A)(ii)(I); 42 U.S.C. 1382(a)(1)(A) and (2)(A) (income "at a rate of not more than" + the benefit rate) + url: https://www.govinfo.gov/content/pkg/USCODE-2023-title42/html/USCODE-2023-title42-chap7-subchapXVI-partA-sec1382.htm + - kind: regulation + citation: 42 CFR 435.210(b) + url: https://www.ecfr.gov/current/title-42/section-435.210 + - kind: manual + citation: West Virginia Income Maintenance Manual § 23.11.4 (consolidated PDF built 2026-10-05, PDF p.1889) + url: https://bfa.wv.gov/media/40005/download?inline#page=1889 + - kind: manual + citation: West Virginia Income Maintenance Manual § 4.14.3 Step 5 (PDF p.662) + url: https://bfa.wv.gov/media/40005/download?inline#page=662 + readings: + statute: The optional group covers people who meet SSI's income requirement, which admits income at or below + the benefit rate. + other: Section 23.11.4 requires countable income "under" the SSI Maximum Payment level; the § 4.14 method it + applies (Step 5) makes income "equal to or less than" the level eligible. + example: An aged West Virginian with countable income of exactly $994 a month in 2026 qualifies under the statute + and Step 5 but not under § 23.11.4's wording. + pe_us: + follows: statute + code: + - policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/income/limit/requires_income_below_limit.yaml + prs: + - https://github.com/PolicyEngine/policyengine-us/pull/10373 + state: unreviewed + note: 'PE-US keeps WV out of requires_income_below_limit, so income equal to the SSI rate qualifies. This assumes + the group is the 42 CFR 435.210 group of section 1902(a)(10)(A)(ii)(I); West Virginia''s state plan page for the + group was not checked. The archived 2013 manual pairs the same two wordings (§ 16.7.H and § 10.23.C).' - id: us-wv:senior-modification-excluded-line-range program: income-tax years: