Use the SSI rate as the Medicaid aged/disabled income limit in West Virginia and North Dakota

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.

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

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

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")

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

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]

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]

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.