From c8de3079b60bd197de84321c7425d3d2898d2312 Mon Sep 17 00:00:00 2001 From: Ziming Date: Wed, 21 Oct 2026 17:34:47 -0400 Subject: [PATCH 1/9] Update Medicaid medically needy limits and switch on five states - Switch on the senior and disabled medically needy flags for AR, IA, IL, NJ and ND. - Add medicaid_medically_needy_income_limit, which applies a share of the poverty guideline (IL, MN, ND, NY, UT, WI) or of the SSI federal benefit rate (KS, WA) in place of a dollar limit; Washington applies its one-person limit to couples. - Update dollar limits in CT, DC, NH, RI and NY (2022), and asset limits in CA, IL and NY. Closes #10357 Closes #10358 Co-Authored-By: Claude Opus 5.5 --- .../medicaid-medically-needy-limits.fixed.md | 1 + .../medically_needy/categories/disabled.yaml | 24 +- .../medically_needy/categories/senior.yaml | 24 +- .../medically_needy/limit/assets/couple.yaml | 27 +++ .../limit/assets/individual.yaml | 27 +++ .../medically_needy/limit/income/couple.yaml | 77 ++++++- .../income/couple_uses_individual_limit.yaml | 113 ++++++++++ .../limit/income/fpg_rate.yaml | 62 ++++++ .../limit/income/individual.yaml | 77 ++++++- .../limit/income/ssi_rate.yaml | 22 ++ .../is_medically_needy_for_medicaid.yaml | 112 ++++++++++ ...medicaid_medically_needy_income_limit.yaml | 207 ++++++++++++++++++ ...caid_medically_needy_medical_expenses.yaml | 10 +- .../is_medically_needy_for_medicaid.py | 6 +- .../medicaid_medically_needy_income_limit.py | 46 ++++ 15 files changed, 794 insertions(+), 41 deletions(-) create mode 100644 changelog.d/medicaid-medically-needy-limits.fixed.md create mode 100644 policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/couple_uses_individual_limit.yaml create mode 100644 policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/fpg_rate.yaml create mode 100644 policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/ssi_rate.yaml create mode 100644 policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_income_limit.yaml create mode 100644 policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_income_limit.py diff --git a/changelog.d/medicaid-medically-needy-limits.fixed.md b/changelog.d/medicaid-medically-needy-limits.fixed.md new file mode 100644 index 00000000000..3494371ba71 --- /dev/null +++ b/changelog.d/medicaid-medically-needy-limits.fixed.md @@ -0,0 +1 @@ +Turned on the Medicaid medically needy pathway for aged, blind and disabled people in Arkansas, Iowa, Illinois, New Jersey and North Dakota, and updated medically needy income and asset limits in 13 states, tying them to the poverty guideline or the SSI federal benefit rate where state rules do. diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/categories/disabled.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/categories/disabled.yaml index f78bce94897..f074b02c968 100644 --- a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/categories/disabled.yaml +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/categories/disabled.yaml @@ -7,13 +7,27 @@ metadata: reference: - title: "Medicaid Financial Eligibility for Seniors and People with Disabilities: Findings from a 50-State Survey | KFF" 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: KFF, Medicaid Eligibility Levels for Older Adults and People with Disabilities (Non-MAGI) in 2026, Appendix Table 4 + href: https://www.kff.org/medicaid/medicaid-eligibility-levels-for-older-adults-and-people-with-disabilities-non-magi-in-2026/ + - title: Arkansas DHS Division of County Operations, Health Care Eligibility Quick Reference (January 2025), AABD Adult Spend Down + href: https://humanservices.arkansas.gov/wp-content/uploads/Quick-Reference.pdf#page=1 + - title: "Iowa Administrative Code 441-75.8 - Medically needy #page 20,24" + href: https://www.legis.iowa.gov/docs/iac/chapter/441.75.pdf#page=20 + - title: Illinois Department of Human Services Policy Manual PM 15-08-00 - Spenddown + href: https://www.dhs.state.il.us/page.aspx?item=16536 + - title: New Jersey DMAHS, Medically Needy Segment fact sheet + href: https://www.nj.gov/humanservices/dmahs/clients/medicaid/medically_needy_fact_sheet.pdf#page=1 + - title: North Dakota Non-ACA Medicaid Manual 510-05-85-40 - Medically needy income levels + href: https://www.nd.gov/dhs/policymanuals/51005/510_05_85_40.htm + - title: North Dakota Administrative Code 75-02-02.1-26(1) - Asset limits, medically needy aged, blind, and disabled + href: https://ndlegis.gov/information/acdata/pdf/75-02-02.1.pdf#page=40 AK: 2015-01-01: false AL: 2015-01-01: false AR: - 2015-01-01: false + 2015-01-01: true AZ: 2015-01-01: true CA: @@ -33,11 +47,11 @@ GA: HI: 2015-01-01: true IA: - 2015-01-01: false + 2015-01-01: true ID: 2015-01-01: true IL: - 2015-01-01: false + 2015-01-01: true IN: 2015-01-01: true KS: @@ -65,13 +79,13 @@ MT: NC: 2015-01-01: true ND: - 2015-01-01: false + 2015-01-01: true NE: 2015-01-01: true NH: 2015-01-01: true NJ: - 2015-01-01: false + 2015-01-01: true NM: 2015-01-01: true NV: diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/categories/senior.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/categories/senior.yaml index 95b66a8b8bf..34e55264c8f 100644 --- a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/categories/senior.yaml +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/categories/senior.yaml @@ -7,13 +7,27 @@ metadata: reference: - title: "Medicaid Financial Eligibility for Seniors and People with Disabilities: Findings from a 50-State Survey | KFF" 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: KFF, Medicaid Eligibility Levels for Older Adults and People with Disabilities (Non-MAGI) in 2026, Appendix Table 4 + href: https://www.kff.org/medicaid/medicaid-eligibility-levels-for-older-adults-and-people-with-disabilities-non-magi-in-2026/ + - title: Arkansas DHS Division of County Operations, Health Care Eligibility Quick Reference (January 2025), AABD Adult Spend Down + href: https://humanservices.arkansas.gov/wp-content/uploads/Quick-Reference.pdf#page=1 + - title: "Iowa Administrative Code 441-75.8 - Medically needy #page 20,24" + href: https://www.legis.iowa.gov/docs/iac/chapter/441.75.pdf#page=20 + - title: Illinois Department of Human Services Policy Manual PM 15-08-00 - Spenddown + href: https://www.dhs.state.il.us/page.aspx?item=16536 + - title: New Jersey DMAHS, Medically Needy Segment fact sheet + href: https://www.nj.gov/humanservices/dmahs/clients/medicaid/medically_needy_fact_sheet.pdf#page=1 + - title: North Dakota Non-ACA Medicaid Manual 510-05-85-40 - Medically needy income levels + href: https://www.nd.gov/dhs/policymanuals/51005/510_05_85_40.htm + - title: North Dakota Administrative Code 75-02-02.1-26(1) - Asset limits, medically needy aged, blind, and disabled + href: https://ndlegis.gov/information/acdata/pdf/75-02-02.1.pdf#page=40 AK: 2015-01-01: false AL: 2015-01-01: false AR: - 2015-01-01: false + 2015-01-01: true AZ: 2015-01-01: true CA: @@ -33,11 +47,11 @@ GA: HI: 2015-01-01: true IA: - 2015-01-01: false + 2015-01-01: true ID: 2015-01-01: true IL: - 2015-01-01: false + 2015-01-01: true IN: 2015-01-01: true KS: @@ -65,13 +79,13 @@ MT: NC: 2015-01-01: true ND: - 2015-01-01: false + 2015-01-01: true NE: 2015-01-01: true NH: 2015-01-01: true NJ: - 2015-01-01: false + 2015-01-01: true NM: 2015-01-01: true NV: diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/assets/couple.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/assets/couple.yaml index 2e95d5e4ff9..c58b38bcbc0 100644 --- a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/assets/couple.yaml +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/assets/couple.yaml @@ -8,6 +8,24 @@ metadata: reference: - title: "Medicaid Financial Eligibility for Seniors and People with Disabilities: Findings from a 50-State Survey | KFF" 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, Asset Limit Changes for Non-MAGI Medi-Cal (Phase I) #page 2-4" + href: https://www.dhcs.ca.gov/services/medi-cal/eligibility/letters/Documents/21-31.pdf#page=2 + - title: "California DHCS All County Welfare Directors Letter 22-25, Elimination of Asset Limits for Non-MAGI Medi-Cal Programs #page 1-2" + href: https://www.dhcs.ca.gov/services/medi-cal/eligibility/letters/Documents/22-25.pdf#page=1 + - title: "California DHCS All County Welfare Directors Letter 25-14, Reinstatement of Asset Limits for Non-MAGI Medi-Cal Programs #page 1,8-9" + href: https://www.dhcs.ca.gov/services/medi-cal/eligibility/letters/Documents/25-14.pdf#page=1 + - title: Illinois Department of Human Services Policy Manual PM 07-02-01 - Asset Limits + href: https://www.dhs.state.il.us/page.aspx?Item=14876 + - title: New York DOH GIS 22 MA/11, 2023 Medicaid Levels and Other Updates + href: https://www.health.ny.gov/health_care/medicaid/publications/docs/gis/22ma11.pdf#page=2 + - title: New York DOH GIS 23 MA/02, Attachment 1, 2023 Income and Resource Standards + href: https://www.health.ny.gov/health_care/medicaid/publications/docs/gis/23ma02_att1.pdf#page=2 + - title: New York DOH GIS 24 MA/01, Attachment 1, 2024 Income and Resource Standards + href: https://www.health.ny.gov/health_care/medicaid/publications/docs/gis/24ma01_att1.pdf#page=2 + - title: New York DOH GIS 25 MA/03, Attachment 1, 2025 Income and Resource Standards + href: https://www.health.ny.gov/health_care/medicaid/publications/docs/gis/25ma03_att1.pdf#page=2 + - title: New York DOH GIS 26 MA/05, Attachment 1, 2026 Income and Resource Standards + href: https://www.health.ny.gov/health_care/medicaid/publications/docs/gis/26ma05_att1.pdf#page=2 AK: 2018-01-01: -.inf @@ -19,6 +37,9 @@ AZ: 2018-01-01: -.inf CA: 2018-01-01: 3_000 + 2022-07-01: 195_000 + 2024-01-01: .inf + 2026-01-01: 195_000 CO: 2018-01-01: -.inf CT: @@ -39,6 +60,7 @@ ID: 2018-01-01: -.inf IL: 2018-01-01: 3_000 + 2023-05-12: 17_500 IN: 2018-01-01: -.inf KS: @@ -79,6 +101,11 @@ NV: 2018-01-01: -.inf NY: 2018-01-01: 22_200 + 2022-01-01: 24_600 + 2023-01-01: 40_821 + 2024-01-01: 42_312 + 2025-01-01: 43_781 + 2026-01-01: 44_796 OH: 2018-01-01: -.inf OK: diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/assets/individual.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/assets/individual.yaml index c4a1ae47ba1..ff51210eb6b 100644 --- a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/assets/individual.yaml +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/assets/individual.yaml @@ -8,6 +8,24 @@ metadata: reference: - title: "Medicaid Financial Eligibility for Seniors and People with Disabilities: Findings from a 50-State Survey | KFF" 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, Asset Limit Changes for Non-MAGI Medi-Cal (Phase I) #page 2-4" + href: https://www.dhcs.ca.gov/services/medi-cal/eligibility/letters/Documents/21-31.pdf#page=2 + - title: "California DHCS All County Welfare Directors Letter 22-25, Elimination of Asset Limits for Non-MAGI Medi-Cal Programs #page 1-2" + href: https://www.dhcs.ca.gov/services/medi-cal/eligibility/letters/Documents/22-25.pdf#page=1 + - title: "California DHCS All County Welfare Directors Letter 25-14, Reinstatement of Asset Limits for Non-MAGI Medi-Cal Programs #page 1,8-9" + href: https://www.dhcs.ca.gov/services/medi-cal/eligibility/letters/Documents/25-14.pdf#page=1 + - title: Illinois Department of Human Services Policy Manual PM 07-02-01 - Asset Limits + href: https://www.dhs.state.il.us/page.aspx?Item=14876 + - title: New York DOH GIS 22 MA/11, 2023 Medicaid Levels and Other Updates + href: https://www.health.ny.gov/health_care/medicaid/publications/docs/gis/22ma11.pdf#page=2 + - title: New York DOH GIS 23 MA/02, Attachment 1, 2023 Income and Resource Standards + href: https://www.health.ny.gov/health_care/medicaid/publications/docs/gis/23ma02_att1.pdf#page=2 + - title: New York DOH GIS 24 MA/01, Attachment 1, 2024 Income and Resource Standards + href: https://www.health.ny.gov/health_care/medicaid/publications/docs/gis/24ma01_att1.pdf#page=2 + - title: New York DOH GIS 25 MA/03, Attachment 1, 2025 Income and Resource Standards + href: https://www.health.ny.gov/health_care/medicaid/publications/docs/gis/25ma03_att1.pdf#page=2 + - title: New York DOH GIS 26 MA/05, Attachment 1, 2026 Income and Resource Standards + href: https://www.health.ny.gov/health_care/medicaid/publications/docs/gis/26ma05_att1.pdf#page=2 AK: 2018-01-01: -.inf @@ -19,6 +37,9 @@ AZ: 2018-01-01: -.inf CA: 2018-01-01: 2_000 + 2022-07-01: 130_000 + 2024-01-01: .inf + 2026-01-01: 130_000 CO: 2018-01-01: -.inf CT: @@ -39,6 +60,7 @@ ID: 2018-01-01: -.inf IL: 2018-01-01: 2_000 + 2023-05-12: 17_500 IN: 2018-01-01: -.inf KS: @@ -79,6 +101,11 @@ NV: 2018-01-01: -.inf NY: 2018-01-01: 15_150 + 2022-01-01: 16_800 + 2023-01-01: 30_182 + 2024-01-01: 31_175 + 2025-01-01: 32_396 + 2026-01-01: 33_038 OH: 2018-01-01: -.inf OK: diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/couple.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/couple.yaml index 9f31964c2e0..06603c1f8db 100644 --- a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/couple.yaml +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/couple.yaml @@ -1,4 +1,4 @@ -description: Maximum income for a couple to qualify for Medicaid under the 'medically needy' pathway. +description: Maximum income for a couple to qualify for Medicaid under the 'medically needy' pathway. States whose limit is a share of the poverty guideline or the SSI federal benefit rate (fpg_rate, ssi_rate) are omitted here from the date that rule applies. metadata: label: Medicaid medically needy pathway for couples income limit breakdown: @@ -8,6 +8,50 @@ metadata: reference: - title: "Medicaid Financial Eligibility for Seniors and People with Disabilities: Findings from a 50-State Survey | KFF" 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: Connecticut State Plan Amendment CT-22-0031, Medically Needy Income Level (effective July 1, 2022) + href: https://www.medicaid.gov/medicaid/spa/downloads/CT-22-0031.pdf#page=7 + - title: Connecticut State Plan Amendment CT-24-0003, Medically Needy Income Level (effective January 1, 2024) + href: https://www.medicaid.gov/medicaid/spa/downloads/CT-24-0003.pdf#page=7 + - title: Connecticut State Plan Amendment CT-24-0006, Medically Needy Income Level (effective March 1, 2024) + href: https://www.medicaid.gov/medicaid/spa/downloads/CT-24-0006.pdf#page=7 + - title: Connecticut State Plan Amendment CT-25-0013, Medically Needy Income Level (effective March 1, 2025) + href: https://www.medicaid.gov/medicaid/spa/downloads/CT-25-0013.pdf#page=7 + - title: Connecticut State Plan Amendment CT-26-0006, Medically Needy Income Level (effective March 1, 2026) + href: https://www.medicaid.gov/medicaid/spa/downloads/CT-26-0006.pdf#page=7 + - title: Connecticut DSS Program Standards Chart (effective March 1, 2026), HUSKY C Medically Needy Income Limit + href: https://portal.ct.gov/dss/-/media/departments-and-agencies/dss/fact-sheets-and-issue-briefs/fact-sheets/dss-program-standards-chart-effective-030126.pdf + - title: "District of Columbia Municipal Regulations 29-901.1, Medically Needy Income Levels (50 DCR 8467, October 10, 2003) #page 1-2" + href: https://dbh.dc.gov/sites/default/files/dc/sites/dmh/publication/attachments/GrievanceFinalRulemaking.pdf#page=1 + - title: District of Columbia DHCF Non-MAGI Spend Down Notice (2023 Medically Needy Income Limit) + href: https://dhcf.dc.gov/sites/default/files/dc/sites/dhcf/documents/%2316%20Non%20MAGI%20Spend%20Down%20Notice.pdf#page=2 + - title: District of Columbia DHCF Spend Down Fact Sheet (revised September 2024) + href: https://dhcf.dc.gov/sites/default/files/dc/sites/dhcf/service_content/attachments/Spend_Down_Fact_Sheet.pdf#page=2 + - title: KFF, Medicaid Eligibility Levels for Older Adults and People with Disabilities (Non-MAGI) in 2026, Appendix Table 4 + href: https://www.kff.org/medicaid/medicaid-eligibility-levels-for-older-adults-and-people-with-disabilities-non-magi-in-2026/ + - title: New Hampshire State Plan Amendment NH-23-0029, Medically Needy Income Level (effective January 1, 2023) + href: https://www.medicaid.gov/medicaid/spa/downloads/NH-23-0029.pdf#page=7 + - title: New Hampshire State Plan Amendment NH-25-0012, Medically Needy Income Level (effective January 1, 2025) + href: https://www.medicaid.gov/medicaid/spa/downloads/NH-25-0012.pdf#page=7 + - title: New Hampshire State Plan Amendment NH-25-0019, Medically Needy Income Level (effective July 1, 2025) + href: https://www.medicaid.gov/medicaid/spa/downloads/NH-25-0019.pdf#page=7 + - title: New York DOH GIS 22 MA/11, 2023 Medicaid Levels and Other Updates + href: https://www.health.ny.gov/health_care/medicaid/publications/docs/gis/22ma11.pdf#page=1 + - title: Rhode Island 210-RICR-40-00-3, Medicaid Affordable Care Coverage Groups (version effective January 1, 2020) + href: https://rules.sos.ri.gov/Regulations/part/210-40-00-3?reg_id=10945 + - title: Rhode Island 210-RICR-40-00-3, section 3.2(A)(8), Medically Needy Income Limit + href: https://rules.sos.ri.gov/regulations/part/210-40-00-3 + - title: Rhode Island State Plan Amendment RI-21-0004, Medically Needy Income Level (effective January 1, 2021) + href: https://www.medicaid.gov/medicaid/spa/downloads/RI-21-0004.pdf#page=4 + - title: Rhode Island State Plan Amendment RI-22-0003, Medically Needy Income Level (effective January 1, 2022) + href: https://www.medicaid.gov/medicaid/spa/downloads/RI-22-0003.pdf#page=7 + - title: Rhode Island State Plan Amendment RI-23-0005, Medically Needy Income Level (effective January 1, 2023) + href: https://www.medicaid.gov/medicaid/spa/downloads/RI-23-0005.pdf#page=7 + - title: Rhode Island State Plan Amendment RI-24-0003, Medically Needy Income Level (effective January 1, 2024) + href: https://www.medicaid.gov/medicaid/spa/downloads/RI-24-0003.pdf#page=7 + - title: Rhode Island State Plan Amendment RI-25-0003, Medically Needy Income Level (effective January 1, 2025) + href: https://www.medicaid.gov/medicaid/spa/downloads/RI-25-0003.pdf#page=7 + - title: Rhode Island State Plan Amendment RI-26-0001, Medically Needy Income Level (effective January 1, 2026) + href: https://www.medicaid.gov/medicaid/spa/downloads/RI-26-0001.pdf#page=7 AK: 2018-01-01: -.inf @@ -23,8 +67,17 @@ CO: 2018-01-01: -.inf CT: 2018-01-01: 696 + 2022-07-01: 879 + 2024-01-01: 946 + 2024-03-01: 980 + 2025-03-01: 1_128 + 2026-03-01: 1_153 DC: 2018-01-01: 652 + 2023-01-01: 821.67 + 2024-01-01: 851.67 + 2025-01-01: 881.25 + 2026-01-01: 901.67 DE: 2018-01-01: -.inf FL: @@ -37,8 +90,6 @@ IA: 2018-01-01: 483 ID: 2018-01-01: -.inf -IL: - 2018-01-01: 1_372 IN: 2018-01-01: -.inf KS: @@ -55,8 +106,6 @@ ME: 2018-01-01: 341 MI: 2018-01-01: 1_372 -MN: - 2018-01-01: 1_098 MO: 2018-01-01: -.inf MS: @@ -65,12 +114,13 @@ MT: 2018-01-01: 525 NC: 2018-01-01: 317 -ND: - 2018-01-01: 1_139 NE: 2018-01-01: 392 NH: 2018-01-01: 675 + 2023-01-01: 1_033 + 2025-01-01: 1_066 + 2025-07-01: 1_093 NJ: 2018-01-01: 434 NM: @@ -79,6 +129,7 @@ NV: 2018-01-01: -.inf NY: 2018-01-01: 1_233 + 2022-01-01: 1_367 OH: 2018-01-01: -.inf OK: @@ -89,6 +140,14 @@ PA: 2018-01-01: 442 RI: 2018-01-01: 947 + 2019-01-01: 958 + 2020-01-01: 975 + 2021-01-01: 992 + 2022-01-01: 1_050 + 2023-01-01: 1_133 + 2024-01-01: 1_175 + 2025-01-01: 1_208 + 2026-01-01: 1_242 SC: 2018-01-01: -.inf SD: @@ -97,14 +156,10 @@ TN: 2018-01-01: 258 TX: 2018-01-01: 216 -UT: - 2018-01-01: 1_372 VA: 2018-01-01: 659 VT: 2018-01-01: 1_041 -WA: - 2018-01-01: 750 WV: 2018-01-01: 275 WI: diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/couple_uses_individual_limit.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/couple_uses_individual_limit.yaml new file mode 100644 index 00000000000..ca50470a3d5 --- /dev/null +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/couple_uses_individual_limit.yaml @@ -0,0 +1,113 @@ +description: The state applies its individual medically needy income limit to a couple, if this is true. +metadata: + unit: bool + period: year + label: Medicaid medically needy couple uses the individual income limit + breakdown: + - state_code + reference: + - title: Washington Administrative Code 182-519-0050(5) - Monthly income and countable resource standards for medically needy (MN) + href: https://app.leg.wa.gov/WAC/default.aspx?cite=182-519-0050 + +AK: + 2018-01-01: false +AL: + 2018-01-01: false +AR: + 2018-01-01: false +AZ: + 2018-01-01: false +CA: + 2018-01-01: false +CO: + 2018-01-01: false +CT: + 2018-01-01: false +DC: + 2018-01-01: false +DE: + 2018-01-01: false +FL: + 2018-01-01: false +GA: + 2018-01-01: false +HI: + 2018-01-01: false +IA: + 2018-01-01: false +ID: + 2018-01-01: false +IL: + 2018-01-01: false +IN: + 2018-01-01: false +KS: + 2018-01-01: false +KY: + 2018-01-01: false +LA: + 2018-01-01: false +MA: + 2018-01-01: false +MD: + 2018-01-01: false +ME: + 2018-01-01: false +MI: + 2018-01-01: false +MN: + 2018-01-01: false +MO: + 2018-01-01: false +MS: + 2018-01-01: false +MT: + 2018-01-01: false +NC: + 2018-01-01: false +ND: + 2018-01-01: false +NE: + 2018-01-01: false +NH: + 2018-01-01: false +NJ: + 2018-01-01: false +NM: + 2018-01-01: false +NV: + 2018-01-01: false +NY: + 2018-01-01: false +OH: + 2018-01-01: false +OK: + 2018-01-01: false +OR: + 2018-01-01: false +PA: + 2018-01-01: false +RI: + 2018-01-01: false +SC: + 2018-01-01: false +SD: + 2018-01-01: false +TN: + 2018-01-01: false +TX: + 2018-01-01: false +UT: + 2018-01-01: false +VA: + 2018-01-01: false +VT: + 2018-01-01: false +WA: + 2018-01-01: true +WI: + 2018-01-01: false +WV: + 2018-01-01: false +WY: + 2018-01-01: false diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/fpg_rate.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/fpg_rate.yaml new file mode 100644 index 00000000000..999d34492a8 --- /dev/null +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/fpg_rate.yaml @@ -0,0 +1,62 @@ +description: States set the medically needy income limit at this share of the federal poverty guideline for a household of one or two under the Medicaid program. States not listed, or with a share of zero, use the dollar limits. +metadata: + unit: /1 + period: year + label: Medicaid medically needy income limit as a share of the poverty guideline + breakdown: + - state_code + reference: + - title: Illinois Department of Human Services Policy Manual PM 15-06-02-a - Community Standard + href: https://www.dhs.state.il.us/page.aspx?item=16507 + - title: Illinois Department of Human Services Policy Manual PM 15-06-02-c - Standard for a client living with a spouse + href: https://www.dhs.state.il.us/page.aspx?item=16512 + - title: Illinois Department of Human Services Policy Manual PM 15-08-00 - Spenddown + href: https://www.dhs.state.il.us/page.aspx?item=16536 + - title: 89 Illinois Administrative Code 120.20(a) - Need standard, aged, blind, or disabled + href: https://www.ilga.gov/ftp/JCAR/AdminCode/089/089001200B00200R.html + - title: Minnesota Statutes 256B.056, subdivisions 1c(a), 4(a) and 5c(b) + href: https://www.revisor.mn.gov/statutes/cite/256B.056 + - title: Laws of Minnesota 2017, 1st Special Session, chapter 6, article 4, section 20 + href: https://www.revisor.mn.gov/laws/2017/1/Session+Law/Chapter/6/ + - title: Laws of Minnesota 2019, 1st Special Session, chapter 9, article 7, section 21 + href: https://www.revisor.mn.gov/laws/2019/1/Session+Law/Chapter/9/ + - title: Minnesota DHS Eligibility Policy Manual 2.3.3.4 - Spenddown standards + href: https://hcopub.dhs.state.mn.us/epm/2_3_3_4.htm + - title: North Dakota Non-ACA Medicaid Manual 510-05-85-40 - Medically needy income levels + href: https://www.nd.gov/dhs/policymanuals/51005/510_05_85_40.htm + - title: North Dakota Manual Letter 3702, Federal Poverty Level Updates (April 1, 2023) + href: https://www.nd.gov/dhs/policymanuals/51003/Content/ML/2023/ML%203702%20Federal%20Poverty%20Level%20Updates%2004-01-2023.pdf#page=6 + - title: North Dakota State Plan Amendment ND-23-0034 (effective January 1, 2024) + href: https://www.medicaid.gov/medicaid/spa/downloads/ND-23-0034.pdf#page=2 + - title: New York DOH GIS 22 MA/11, 2023 Medicaid Levels and Other Updates + href: https://www.health.ny.gov/health_care/medicaid/publications/docs/gis/22ma11.pdf#page=1 + - title: New York State Plan Amendment NY-23-0001 (effective January 1, 2023) + href: https://www.medicaid.gov/medicaid/spa/downloads/NY-23-0001.pdf#page=5 + - title: Utah Administrative Code R414-304-9(2) - Income Deductions + href: https://www.law.cornell.edu/regulations/utah/Utah-Admin-Code-R414-304-9 + - title: Utah Code 26B-3-108(9)(b) + href: https://le.utah.gov/xcode/Title26B/Chapter3/26B-3-S108.html + - title: Wisconsin Statutes 49.47(4)(c)1 + href: https://docs.legis.wisconsin.gov/statutes/statutes/49/iv/47/4/c + - title: Wisconsin DHS Operations Memo 19-26, SSI-Related Medicaid Medically Needy Income Limit Increase + href: https://www.dhs.wisconsin.gov/dms/memos/ops/dms-ops-2019-26.pdf#page=2 + - title: Wisconsin Medicaid Eligibility Handbook (EBD) 39.4.1 - Elderly, Blind, or Disabled Assets and Income Table + href: https://www.emhandbooks.wisconsin.gov/meh-ebd/policy_files/39/39.4.htm + +IL: + 2018-01-01: 1 +MN: + 2018-01-01: 0.8 + 2019-06-01: 0.81 + 2022-07-01: 1 +ND: + 2018-01-01: 0.83 + 2024-01-01: 0.9 +NY: + 2018-01-01: 0 + 2023-01-01: 1.38 +UT: + 2018-01-01: 1 +WI: + 2018-01-01: 0 + 2019-09-01: 1 diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/individual.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/individual.yaml index 031fbb3c93c..dbb1f78cb85 100644 --- a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/individual.yaml +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/individual.yaml @@ -1,4 +1,4 @@ -description: Maximum income for an individual to qualify for Medicaid under the 'medically needy' pathway. +description: Maximum income for an individual to qualify for Medicaid under the 'medically needy' pathway. States whose limit is a share of the poverty guideline or the SSI federal benefit rate (fpg_rate, ssi_rate) are omitted here from the date that rule applies. metadata: label: Medicaid medically needy pathway for individuals income limit breakdown: @@ -8,6 +8,50 @@ metadata: reference: - title: "Medicaid Financial Eligibility for Seniors and People with Disabilities: Findings from a 50-State Survey | KFF" 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: Connecticut State Plan Amendment CT-22-0031, Medically Needy Income Level (effective July 1, 2022) + href: https://www.medicaid.gov/medicaid/spa/downloads/CT-22-0031.pdf#page=7 + - title: Connecticut State Plan Amendment CT-24-0003, Medically Needy Income Level (effective January 1, 2024) + href: https://www.medicaid.gov/medicaid/spa/downloads/CT-24-0003.pdf#page=7 + - title: Connecticut State Plan Amendment CT-24-0006, Medically Needy Income Level (effective March 1, 2024) + href: https://www.medicaid.gov/medicaid/spa/downloads/CT-24-0006.pdf#page=7 + - title: Connecticut State Plan Amendment CT-25-0013, Medically Needy Income Level (effective March 1, 2025) + href: https://www.medicaid.gov/medicaid/spa/downloads/CT-25-0013.pdf#page=7 + - title: Connecticut State Plan Amendment CT-26-0006, Medically Needy Income Level (effective March 1, 2026) + href: https://www.medicaid.gov/medicaid/spa/downloads/CT-26-0006.pdf#page=7 + - title: Connecticut DSS Program Standards Chart (effective March 1, 2026), HUSKY C Medically Needy Income Limit + href: https://portal.ct.gov/dss/-/media/departments-and-agencies/dss/fact-sheets-and-issue-briefs/fact-sheets/dss-program-standards-chart-effective-030126.pdf + - title: "District of Columbia Municipal Regulations 29-901.1, Medically Needy Income Levels (50 DCR 8467, October 10, 2003) #page 1-2" + href: https://dbh.dc.gov/sites/default/files/dc/sites/dmh/publication/attachments/GrievanceFinalRulemaking.pdf#page=1 + - title: District of Columbia DHCF Non-MAGI Spend Down Notice (2023 Medically Needy Income Limit) + href: https://dhcf.dc.gov/sites/default/files/dc/sites/dhcf/documents/%2316%20Non%20MAGI%20Spend%20Down%20Notice.pdf#page=2 + - title: District of Columbia DHCF Spend Down Fact Sheet (revised September 2024) + href: https://dhcf.dc.gov/sites/default/files/dc/sites/dhcf/service_content/attachments/Spend_Down_Fact_Sheet.pdf#page=2 + - title: KFF, Medicaid Eligibility Levels for Older Adults and People with Disabilities (Non-MAGI) in 2026, Appendix Table 4 + href: https://www.kff.org/medicaid/medicaid-eligibility-levels-for-older-adults-and-people-with-disabilities-non-magi-in-2026/ + - title: New Hampshire State Plan Amendment NH-23-0029, Medically Needy Income Level (effective January 1, 2023) + href: https://www.medicaid.gov/medicaid/spa/downloads/NH-23-0029.pdf#page=7 + - title: New Hampshire State Plan Amendment NH-25-0012, Medically Needy Income Level (effective January 1, 2025) + href: https://www.medicaid.gov/medicaid/spa/downloads/NH-25-0012.pdf#page=7 + - title: New Hampshire State Plan Amendment NH-25-0019, Medically Needy Income Level (effective July 1, 2025) + href: https://www.medicaid.gov/medicaid/spa/downloads/NH-25-0019.pdf#page=7 + - title: New York DOH GIS 22 MA/11, 2023 Medicaid Levels and Other Updates + href: https://www.health.ny.gov/health_care/medicaid/publications/docs/gis/22ma11.pdf#page=1 + - title: Rhode Island 210-RICR-40-00-3, Medicaid Affordable Care Coverage Groups (version effective January 1, 2020) + href: https://rules.sos.ri.gov/Regulations/part/210-40-00-3?reg_id=10945 + - title: Rhode Island 210-RICR-40-00-3, section 3.2(A)(8), Medically Needy Income Limit + href: https://rules.sos.ri.gov/regulations/part/210-40-00-3 + - title: Rhode Island State Plan Amendment RI-21-0004, Medically Needy Income Level (effective January 1, 2021) + href: https://www.medicaid.gov/medicaid/spa/downloads/RI-21-0004.pdf#page=4 + - title: Rhode Island State Plan Amendment RI-22-0003, Medically Needy Income Level (effective January 1, 2022) + href: https://www.medicaid.gov/medicaid/spa/downloads/RI-22-0003.pdf#page=7 + - title: Rhode Island State Plan Amendment RI-23-0005, Medically Needy Income Level (effective January 1, 2023) + href: https://www.medicaid.gov/medicaid/spa/downloads/RI-23-0005.pdf#page=7 + - title: Rhode Island State Plan Amendment RI-24-0003, Medically Needy Income Level (effective January 1, 2024) + href: https://www.medicaid.gov/medicaid/spa/downloads/RI-24-0003.pdf#page=7 + - title: Rhode Island State Plan Amendment RI-25-0003, Medically Needy Income Level (effective January 1, 2025) + href: https://www.medicaid.gov/medicaid/spa/downloads/RI-25-0003.pdf#page=7 + - title: Rhode Island State Plan Amendment RI-26-0001, Medically Needy Income Level (effective January 1, 2026) + href: https://www.medicaid.gov/medicaid/spa/downloads/RI-26-0001.pdf#page=7 AK: 2018-01-01: -.inf @@ -23,8 +67,17 @@ CO: 2018-01-01: -.inf CT: 2018-01-01: 523 + 2022-07-01: 653 + 2024-01-01: 700 + 2024-03-01: 723 + 2025-03-01: 835 + 2026-03-01: 851 DC: 2018-01-01: 652 + 2023-01-01: 780.58 + 2024-01-01: 809.08 + 2025-01-01: 837.19 + 2026-01-01: 856.58 DE: 2018-01-01: -.inf FL: @@ -37,8 +90,6 @@ IA: 2018-01-01: 483 ID: 2018-01-01: -.inf -IL: - 2018-01-01: 1_012 IN: 2018-01-01: -.inf KS: @@ -55,8 +106,6 @@ ME: 2018-01-01: 315 MI: 2018-01-01: 1_012 -MN: - 2018-01-01: 810 MO: 2018-01-01: -.inf MS: @@ -65,12 +114,13 @@ MT: 2018-01-01: 525 NC: 2018-01-01: 242 -ND: - 2018-01-01: 840 NE: 2018-01-01: 392 NH: 2018-01-01: 591 + 2023-01-01: 888 + 2025-01-01: 916 + 2025-07-01: 939 NJ: 2018-01-01: 367 NM: @@ -79,6 +129,7 @@ NV: 2018-01-01: -.inf NY: 2018-01-01: 842 + 2022-01-01: 934 OH: 2018-01-01: -.inf OK: @@ -89,6 +140,14 @@ PA: 2018-01-01: 425 RI: 2018-01-01: 903 + 2019-01-01: 917 + 2020-01-01: 933 + 2021-01-01: 950 + 2022-01-01: 1_008 + 2023-01-01: 1_092 + 2024-01-01: 1_133 + 2025-01-01: 1_167 + 2026-01-01: 1_200 SC: 2018-01-01: -.inf SD: @@ -97,14 +156,10 @@ TN: 2018-01-01: 241 TX: 2018-01-01: 104 -UT: - 2018-01-01: 1_012 VA: 2018-01-01: 493 VT: 2018-01-01: 1_041 -WA: - 2018-01-01: 750 WV: 2018-01-01: 200 WI: diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/ssi_rate.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/ssi_rate.yaml new file mode 100644 index 00000000000..d53e8a792ee --- /dev/null +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/ssi_rate.yaml @@ -0,0 +1,22 @@ +description: States set the medically needy income limit at this share of the Supplemental Security Income federal benefit rate under the Medicaid program. States not listed, or with a share of zero, use the dollar limits. +metadata: + unit: /1 + period: year + label: Medicaid medically needy income limit as a share of the SSI federal benefit rate + breakdown: + - state_code + reference: + - title: "CMS approval of Kansas State Plan Amendment KS-25-0019, medically needy income disregard to the SSI federal benefit rate #page 2,46" + href: https://www.medicaid.gov/medicaid/spa/downloads/KS-25-0019.pdf#page=2 + - title: Kansas Medical Assistance Standards, KEESM Appendix F-8 (January 2026), Income Standards for Independent Living + href: https://www.kancare.ks.gov/home/showpublisheddocument/6204/639013856776770000 + - title: Washington Administrative Code 182-519-0050(5) - Monthly income and countable resource standards for medically needy (MN) + href: https://app.leg.wa.gov/WAC/default.aspx?cite=182-519-0050 + - title: Washington State Register 12-20-001, amending WAC 182-519-0050 + href: https://lawfilesext.leg.wa.gov/law/wsr/2012/20/12-20-001.htm + +KS: + 2018-01-01: 0 + 2025-07-01: 1 +WA: + 2018-01-01: 1 diff --git a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/is_medically_needy_for_medicaid.yaml b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/is_medically_needy_for_medicaid.yaml index 4c889ee6e99..a735f81df04 100644 --- a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/is_medically_needy_for_medicaid.yaml +++ b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/is_medically_needy_for_medicaid.yaml @@ -50,3 +50,115 @@ state_code: MA output: is_medically_needy_for_medicaid: false + +- name: Case 3, Arkansas senior qualifies after medical spenddown. + period: 2026 + input: + age: 70 + is_adult_for_medicaid: false + is_optional_senior_or_disabled_for_medicaid: false + is_ssi_recipient_for_medicaid: false + ssi_countable_income: 14_160 + medicaid_medically_needy_medical_expenses: 13_000 + ssi_countable_resources: 1_500 + state_code: AR + output: + # Limit 108 x 12 = 1,296. 14,160 is over it; 14,160 - 13,000 = 1,160 is not. + is_in_medicaid_medically_needy_category: true + is_medically_needy_for_medicaid: true + +- name: Case 4, Iowa senior qualifies after medical spenddown. + period: 2026 + input: + age: 70 + is_adult_for_medicaid: false + is_optional_senior_or_disabled_for_medicaid: false + is_ssi_recipient_for_medicaid: false + ssi_countable_income: 14_160 + medicaid_medically_needy_medical_expenses: 9_000 + ssi_countable_resources: 8_000 + state_code: IA + output: + # Limit 483 x 12 = 5,796. 14,160 - 9,000 = 5,160; assets 8,000 are under 10,000. + is_in_medicaid_medically_needy_category: true + is_medically_needy_for_medicaid: true + +- name: Case 5, New Jersey senior qualifies after medical spenddown. + period: 2026 + input: + age: 70 + is_adult_for_medicaid: false + is_optional_senior_or_disabled_for_medicaid: false + is_ssi_recipient_for_medicaid: false + ssi_countable_income: 14_160 + medicaid_medically_needy_medical_expenses: 10_000 + ssi_countable_resources: 3_500 + state_code: NJ + output: + # Limit 367 x 12 = 4,404. 14,160 - 10,000 = 4,160; assets 3,500 are under 4,000. + is_in_medicaid_medically_needy_category: true + is_medically_needy_for_medicaid: true + +- name: Case 6, Illinois senior qualifies after medical spenddown. + period: 2026 + input: + age: 70 + is_adult_for_medicaid: false + is_optional_senior_or_disabled_for_medicaid: false + is_ssi_recipient_for_medicaid: false + ssi_countable_income: 20_000 + medicaid_medically_needy_medical_expenses: 5_000 + ssi_countable_resources: 10_000 + state_code: IL + output: + # Limit 15,960 (100% FPG). 20,000 - 5,000 = 15,000; assets 10,000 are under 17,500. + is_in_medicaid_medically_needy_category: true + is_medically_needy_for_medicaid: true + +- name: Case 7, North Dakota senior qualifies after medical spenddown. + period: 2026 + input: + age: 70 + is_adult_for_medicaid: false + is_optional_senior_or_disabled_for_medicaid: false + is_ssi_recipient_for_medicaid: false + ssi_countable_income: 18_000 + medicaid_medically_needy_medical_expenses: 4_000 + ssi_countable_resources: 2_500 + state_code: ND + output: + # Limit 0.9 x 15,960 = 14,364. 18,000 - 4,000 = 14,000; assets 2,500 are under 3,000. + is_in_medicaid_medically_needy_category: true + is_medically_needy_for_medicaid: true + +- name: Case 8, California senior with assets under the reinstated 2026 limit qualifies. + period: 2026 + input: + age: 70 + is_adult_for_medicaid: false + is_optional_senior_or_disabled_for_medicaid: false + is_ssi_recipient_for_medicaid: false + ssi_countable_income: 9_000 + medicaid_medically_needy_medical_expenses: 2_000 + ssi_countable_resources: 120_000 + state_code: CA + output: + # Limit 600 x 12 = 7,200. 9,000 - 2,000 = 7,000; assets 120,000 are under 130,000. + is_in_medicaid_medically_needy_category: true + is_medically_needy_for_medicaid: true + +- name: Case 9, New York senior with assets under the 2026 resource level qualifies. + period: 2026 + input: + age: 70 + is_adult_for_medicaid: false + is_optional_senior_or_disabled_for_medicaid: false + is_ssi_recipient_for_medicaid: false + ssi_countable_income: 25_000 + medicaid_medically_needy_medical_expenses: 5_000 + ssi_countable_resources: 30_000 + state_code: NY + output: + # Limit 1.38 x 15,960 = 22,024.80. 25,000 - 5,000 = 20,000; assets 30,000 are under 33,038. + is_in_medicaid_medically_needy_category: true + is_medically_needy_for_medicaid: true diff --git a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_income_limit.yaml b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_income_limit.yaml new file mode 100644 index 00000000000..2f6c1a11737 --- /dev/null +++ b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_income_limit.yaml @@ -0,0 +1,207 @@ +- name: Case 1, Connecticut uses its March 2026 dollar limit from 2027. + period: 2027 + absolute_error_margin: 0.01 + input: + age: 70 + state_code: CT + output: + # 851 x 12 = 10,212. + medicaid_medically_needy_income_limit: 10_212 + +- name: Case 2, District of Columbia couple uses its 2026 dollar limit. + period: 2026 + absolute_error_margin: 0.01 + input: + people: + person1: + age: 70 + person2: + age: 68 + marital_units: + marital_unit: + members: [person1, person2] + tax_units: + tax_unit: + members: [person1, person2] + households: + household: + members: [person1, person2] + state_code: DC + output: + # 901.67 x 12 = 10,820.04. + medicaid_medically_needy_income_limit: [10_820.04, 10_820.04] + +- name: Case 3, Kansas uses its dollar limit before July 2025. + period: 2025 + absolute_error_margin: 0.01 + input: + age: 70 + state_code: KS + output: + # 475 x 12 = 5,700. + medicaid_medically_needy_income_limit: 5_700 + +- name: Case 4, Kansas couple uses the SSI couple rate from July 2025. + period: 2026 + absolute_error_margin: 0.01 + input: + people: + person1: + age: 70 + person2: + age: 68 + marital_units: + marital_unit: + members: [person1, person2] + tax_units: + tax_unit: + members: [person1, person2] + households: + household: + members: [person1, person2] + state_code: KS + output: + # 1,491 x 12 = 17,892. + medicaid_medically_needy_income_limit: [17_892, 17_892] + +- name: Case 5, Minnesota uses 100 percent of the poverty guideline. + period: 2026 + absolute_error_margin: 0.01 + input: + age: 70 + state_code: MN + output: + # 1.00 x 15,960 = 15,960. + medicaid_medically_needy_income_limit: 15_960 + +- name: Case 6, New Hampshire uses its July 2025 dollar limit. + period: 2026 + absolute_error_margin: 0.01 + input: + age: 70 + state_code: NH + output: + # 939 x 12 = 11,268. + medicaid_medically_needy_income_limit: 11_268 + +- name: Case 7, New York couple uses 138 percent of the poverty guideline. + period: 2026 + absolute_error_margin: 0.01 + input: + people: + person1: + age: 70 + person2: + age: 68 + marital_units: + marital_unit: + members: [person1, person2] + tax_units: + tax_unit: + members: [person1, person2] + households: + household: + members: [person1, person2] + state_code: NY + output: + # 1.38 x 21,640 = 29,863.20. + medicaid_medically_needy_income_limit: [29_863.2, 29_863.2] + +- name: Case 8, Rhode Island uses its 2026 dollar limit. + period: 2026 + absolute_error_margin: 0.01 + input: + age: 70 + state_code: RI + output: + # 1,200 x 12 = 14,400. + medicaid_medically_needy_income_limit: 14_400 + +- name: Case 9, Utah couple uses 100 percent of the two-person poverty guideline. + period: 2026 + absolute_error_margin: 0.01 + input: + people: + person1: + age: 70 + person2: + age: 68 + marital_units: + marital_unit: + members: [person1, person2] + tax_units: + tax_unit: + members: [person1, person2] + households: + household: + members: [person1, person2] + state_code: UT + output: + # 1.00 x 21,640 = 21,640. + medicaid_medically_needy_income_limit: [21_640, 21_640] + +- name: Case 10, Washington couple uses the one-person SSI rate. + period: 2026 + absolute_error_margin: 0.01 + input: + people: + person1: + age: 70 + person2: + age: 68 + marital_units: + marital_unit: + members: [person1, person2] + tax_units: + tax_unit: + members: [person1, person2] + households: + household: + members: [person1, person2] + state_code: WA + output: + # 994 x 12 = 11,928. + medicaid_medically_needy_income_limit: [11_928, 11_928] + +- name: Case 11, Wisconsin uses 100 percent of the poverty guideline. + period: 2026 + absolute_error_margin: 0.01 + input: + age: 70 + state_code: WI + output: + # 1.00 x 15,960 = 15,960. + medicaid_medically_needy_income_limit: 15_960 + +- name: Case 12, Illinois couple uses 100 percent of the two-person poverty guideline. + period: 2026 + absolute_error_margin: 0.01 + input: + people: + person1: + age: 70 + person2: + age: 68 + marital_units: + marital_unit: + members: [person1, person2] + tax_units: + tax_unit: + members: [person1, person2] + households: + household: + members: [person1, person2] + state_code: IL + output: + # 1.00 x 21,640 = 21,640. + medicaid_medically_needy_income_limit: [21_640, 21_640] + +- name: Case 13, North Dakota uses 90 percent of the poverty guideline. + period: 2026 + absolute_error_margin: 0.01 + input: + age: 70 + state_code: ND + output: + # 0.9 x 15,960 = 14,364. + medicaid_medically_needy_income_limit: 14_364 diff --git a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_medical_expenses.yaml b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_medical_expenses.yaml index 4cf3c9c0b0f..dd7d9a1821c 100644 --- a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_medical_expenses.yaml +++ b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_medical_expenses.yaml @@ -28,17 +28,19 @@ is_optional_senior_or_disabled_for_medicaid: false # Isolate spenddown from the separate SSI-recipient Medicaid pathway. is_ssi_recipient_for_medicaid: false - employment_income: 27_020 + employment_income: 35_020 ssi_countable_resources: 1_000 state_code: KS health_insurance_premiums: 2_000 pre_tax_health_insurance_premiums: 4_000 medicare_enrolled: false output: - # (27,020 - 4,000 - 12 * (20 + 65)) / 2 = 11,000. + # (35,020 - 4,000 - 12 * (20 + 65)) / 2 = 15,000. + # 15,000 - 2,000 = 13,000 is over the 2026 limit of 12 * 994 = 11,928; + # deducting the 4,000 pretax premium again would pass at 9,000. is_ssi_aged_blind_disabled: true - ssi_earned_income: 23_020 - ssi_countable_income: 11_000 + ssi_earned_income: 31_020 + ssi_countable_income: 15_000 medicaid_medically_needy_medical_expenses: 2_000 is_ssi_recipient_for_medicaid: false is_medically_needy_for_medicaid: false diff --git a/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/medically_needy/is_medically_needy_for_medicaid.py b/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/medically_needy/is_medically_needy_for_medicaid.py index cbf50d31400..e9068c67706 100644 --- a/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/medically_needy/is_medically_needy_for_medicaid.py +++ b/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/medically_needy/is_medically_needy_for_medicaid.py @@ -30,11 +30,7 @@ def formula(person, period, parameters): mn = ma.eligibility.categories.medically_needy is_joint = person.tax_unit("tax_unit_is_joint", period) state = person.household("state_code_str", period) - income_limit = MONTHS_IN_YEAR * where( - is_joint, - mn.limit.income.couple[state], - mn.limit.income.individual[state], - ) + income_limit = person("medicaid_medically_needy_income_limit", period) asset_limit = where( is_joint, mn.limit.assets.couple[state], diff --git a/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_income_limit.py b/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_income_limit.py new file mode 100644 index 00000000000..5b2f823e17c --- /dev/null +++ b/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_income_limit.py @@ -0,0 +1,46 @@ +from policyengine_us.model_api import * +from policyengine_us.variables.gov.hhs.tax_unit_fpg import fpg + + +class medicaid_medically_needy_income_limit(Variable): + value_type = float + entity = Person + label = "Medicaid medically needy income limit" + documentation = ( + "Annual medically needy income limit for an individual or a married " + "couple. States set it as a dollar amount, a share of the federal " + "poverty guideline, or a share of the SSI federal benefit rate." + ) + unit = USD + definition_period = YEAR + reference = ( + "https://www.ecfr.gov/current/title-42/section-435.811", + "https://www.ecfr.gov/current/title-42/section-435.602", + ) + + def formula(person, period, parameters): + p = parameters( + period + ).gov.hhs.medicaid.eligibility.categories.medically_needy.limit.income + state = person.household("state_code_str", period) + # SSI financial responsibility rules (42 CFR 435.602): the unit is + # the individual or the married couple, not the tax filing unit. + is_couple = person.marital_unit.nb_persons() == 2 + # Washington applies its one-person limit to a couple. + same_limit = p.couple_uses_individual_limit[state].astype(bool) + uses_couple_limit = is_couple & ~same_limit + dollar_limit = where(uses_couple_limit, p.couple[state], p.individual[state]) + state_group = person.household("state_group_str", period) + unit_fpg = fpg(where(uses_couple_limit, 2, 1), state_group, period, parameters) + ssi = parameters(period).gov.ssa.ssi.amount + fbr = where(uses_couple_limit, ssi.couple, ssi.individual) + fpg_rate = p.fpg_rate[state] + ssi_rate = p.ssi_rate[state] + return select( + [fpg_rate > 0, ssi_rate > 0], + [ + fpg_rate * unit_fpg, + ssi_rate * fbr * MONTHS_IN_YEAR, + ], + default=dollar_limit * MONTHS_IN_YEAR, + ) From 55d67322b26069a445aa960d56244c6355b7e624 Mon Sep 17 00:00:00 2001 From: Ziming Date: Mon, 26 Oct 2026 16:54:59 -0400 Subject: [PATCH 2/9] Apply local review: pin dated limits, test limit boundaries, fix references - Year-keyed cases pin every dated CT, DC, NH, RI, NY, MN, ND and WI income limit; cases sit exactly at the IL, ND, CA and NY limits, with CA one dollar over, CA 2024 without a limit, and couples at the NY, CA and IL couple asset limits. - NJ and CA cases use incomes above the optional ABD pathway. - Disabled adults in AR, IA, IL, ND and NJ are in a medically needy category. - Arkansas spend down in cents (108.33 / 216.66, DHS quick reference). - Fix NY GIS 22 MA/11 and RI 210-RICR-40-00-3 titles, the RI section, the KS F-8 page; cite 305 ILCS 5/5-2 and Welf. & Inst. Code 14005.62. Co-Authored-By: Claude Opus 5.5 --- .../medically_needy/limit/assets/couple.yaml | 4 +- .../limit/assets/individual.yaml | 4 +- .../medically_needy/limit/income/couple.yaml | 12 +- .../income/couple_uses_individual_limit.yaml | 2 +- .../limit/income/fpg_rate.yaml | 4 +- .../limit/income/individual.yaml | 12 +- .../limit/income/ssi_rate.yaml | 2 +- ..._in_medicaid_medically_needy_category.yaml | 41 +++ .../is_medically_needy_for_medicaid.yaml | 198 +++++++++++-- ...medicaid_medically_needy_income_limit.yaml | 271 ++++++++++++++++-- .../medicaid_medically_needy_income_limit.py | 5 - 11 files changed, 494 insertions(+), 61 deletions(-) diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/assets/couple.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/assets/couple.yaml index c58b38bcbc0..9dfb6fb3630 100644 --- a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/assets/couple.yaml +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/assets/couple.yaml @@ -8,6 +8,8 @@ metadata: reference: - title: "Medicaid Financial Eligibility for Seniors and People with Disabilities: Findings from a 50-State Survey | KFF" 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 Welfare and Institutions Code 14005.62(a), (c), (d) + href: https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=WIC§ionNum=14005.62 - title: "California DHCS All County Welfare Directors Letter 21-31, Asset Limit Changes for Non-MAGI Medi-Cal (Phase I) #page 2-4" href: https://www.dhcs.ca.gov/services/medi-cal/eligibility/letters/Documents/21-31.pdf#page=2 - title: "California DHCS All County Welfare Directors Letter 22-25, Elimination of Asset Limits for Non-MAGI Medi-Cal Programs #page 1-2" @@ -16,7 +18,7 @@ metadata: href: https://www.dhcs.ca.gov/services/medi-cal/eligibility/letters/Documents/25-14.pdf#page=1 - title: Illinois Department of Human Services Policy Manual PM 07-02-01 - Asset Limits href: https://www.dhs.state.il.us/page.aspx?Item=14876 - - title: New York DOH GIS 22 MA/11, 2023 Medicaid Levels and Other Updates + - title: New York DOH GIS 22 MA/11, Increase of Medicaid Medically Needy Income Level to 138% of the Federal Poverty Level href: https://www.health.ny.gov/health_care/medicaid/publications/docs/gis/22ma11.pdf#page=2 - title: New York DOH GIS 23 MA/02, Attachment 1, 2023 Income and Resource Standards href: https://www.health.ny.gov/health_care/medicaid/publications/docs/gis/23ma02_att1.pdf#page=2 diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/assets/individual.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/assets/individual.yaml index ff51210eb6b..c49a71f390b 100644 --- a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/assets/individual.yaml +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/assets/individual.yaml @@ -8,6 +8,8 @@ metadata: reference: - title: "Medicaid Financial Eligibility for Seniors and People with Disabilities: Findings from a 50-State Survey | KFF" 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 Welfare and Institutions Code 14005.62(a), (c), (d) + href: https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=WIC§ionNum=14005.62 - title: "California DHCS All County Welfare Directors Letter 21-31, Asset Limit Changes for Non-MAGI Medi-Cal (Phase I) #page 2-4" href: https://www.dhcs.ca.gov/services/medi-cal/eligibility/letters/Documents/21-31.pdf#page=2 - title: "California DHCS All County Welfare Directors Letter 22-25, Elimination of Asset Limits for Non-MAGI Medi-Cal Programs #page 1-2" @@ -16,7 +18,7 @@ metadata: href: https://www.dhcs.ca.gov/services/medi-cal/eligibility/letters/Documents/25-14.pdf#page=1 - title: Illinois Department of Human Services Policy Manual PM 07-02-01 - Asset Limits href: https://www.dhs.state.il.us/page.aspx?Item=14876 - - title: New York DOH GIS 22 MA/11, 2023 Medicaid Levels and Other Updates + - title: New York DOH GIS 22 MA/11, Increase of Medicaid Medically Needy Income Level to 138% of the Federal Poverty Level href: https://www.health.ny.gov/health_care/medicaid/publications/docs/gis/22ma11.pdf#page=2 - title: New York DOH GIS 23 MA/02, Attachment 1, 2023 Income and Resource Standards href: https://www.health.ny.gov/health_care/medicaid/publications/docs/gis/23ma02_att1.pdf#page=2 diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/couple.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/couple.yaml index 06603c1f8db..98d1181ad7e 100644 --- a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/couple.yaml +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/couple.yaml @@ -1,4 +1,4 @@ -description: Maximum income for a couple to qualify for Medicaid under the 'medically needy' pathway. States whose limit is a share of the poverty guideline or the SSI federal benefit rate (fpg_rate, ssi_rate) are omitted here from the date that rule applies. +description: States limit income for a couple to this monthly amount under the Medicaid medically needy pathway; from the date a state's fpg_rate or ssi_rate is positive, the formula uses that rate instead. metadata: label: Medicaid medically needy pathway for couples income limit breakdown: @@ -6,6 +6,8 @@ metadata: unit: currency-USD period: month reference: + - title: Arkansas DHS Division of County Operations, Health Care Eligibility Quick Reference (January 2025), AABD Adult Spend Down + href: https://humanservices.arkansas.gov/wp-content/uploads/Quick-Reference.pdf#page=1 - title: "Medicaid Financial Eligibility for Seniors and People with Disabilities: Findings from a 50-State Survey | KFF" 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: Connecticut State Plan Amendment CT-22-0031, Medically Needy Income Level (effective July 1, 2022) @@ -34,11 +36,11 @@ metadata: href: https://www.medicaid.gov/medicaid/spa/downloads/NH-25-0012.pdf#page=7 - title: New Hampshire State Plan Amendment NH-25-0019, Medically Needy Income Level (effective July 1, 2025) href: https://www.medicaid.gov/medicaid/spa/downloads/NH-25-0019.pdf#page=7 - - title: New York DOH GIS 22 MA/11, 2023 Medicaid Levels and Other Updates + - title: New York DOH GIS 22 MA/11, Increase of Medicaid Medically Needy Income Level to 138% of the Federal Poverty Level href: https://www.health.ny.gov/health_care/medicaid/publications/docs/gis/22ma11.pdf#page=1 - - title: Rhode Island 210-RICR-40-00-3, Medicaid Affordable Care Coverage Groups (version effective January 1, 2020) + - title: Rhode Island 210-RICR-40-00-3, Medicaid Integrated Health Care Coverage, SSI Financial Eligibility Determinations (version effective January 1, 2020) href: https://rules.sos.ri.gov/Regulations/part/210-40-00-3?reg_id=10945 - - title: Rhode Island 210-RICR-40-00-3, section 3.2(A)(8), Medically Needy Income Limit + - title: Rhode Island 210-RICR-40-00-3, section 3.2.8(A)(8), Medically Needy Income Limit href: https://rules.sos.ri.gov/regulations/part/210-40-00-3 - title: Rhode Island State Plan Amendment RI-21-0004, Medically Needy Income Level (effective January 1, 2021) href: https://www.medicaid.gov/medicaid/spa/downloads/RI-21-0004.pdf#page=4 @@ -58,7 +60,7 @@ AK: AL: 2018-01-01: -.inf AR: - 2018-01-01: 217 + 2018-01-01: 216.66 AZ: 2018-01-01: -.inf CA: diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/couple_uses_individual_limit.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/couple_uses_individual_limit.yaml index ca50470a3d5..f77c9f8f5ea 100644 --- a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/couple_uses_individual_limit.yaml +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/couple_uses_individual_limit.yaml @@ -1,4 +1,4 @@ -description: The state applies its individual medically needy income limit to a couple, if this is true. +description: States apply the one-person medically needy income limit to a married couple under the Medicaid program, if this is true. metadata: unit: bool period: year diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/fpg_rate.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/fpg_rate.yaml index 999d34492a8..35e3524b029 100644 --- a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/fpg_rate.yaml +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/fpg_rate.yaml @@ -6,6 +6,8 @@ metadata: breakdown: - state_code reference: + - title: Illinois Public Aid Code, 305 ILCS 5/5-2(2)(a)(ii) - Classes of persons eligible + href: https://www.ilga.gov/Documents/legislation/ilcs/documents/030500050K5-2.htm - title: Illinois Department of Human Services Policy Manual PM 15-06-02-a - Community Standard href: https://www.dhs.state.il.us/page.aspx?item=16507 - title: Illinois Department of Human Services Policy Manual PM 15-06-02-c - Standard for a client living with a spouse @@ -28,7 +30,7 @@ metadata: href: https://www.nd.gov/dhs/policymanuals/51003/Content/ML/2023/ML%203702%20Federal%20Poverty%20Level%20Updates%2004-01-2023.pdf#page=6 - title: North Dakota State Plan Amendment ND-23-0034 (effective January 1, 2024) href: https://www.medicaid.gov/medicaid/spa/downloads/ND-23-0034.pdf#page=2 - - title: New York DOH GIS 22 MA/11, 2023 Medicaid Levels and Other Updates + - title: New York DOH GIS 22 MA/11, Increase of Medicaid Medically Needy Income Level to 138% of the Federal Poverty Level href: https://www.health.ny.gov/health_care/medicaid/publications/docs/gis/22ma11.pdf#page=1 - title: New York State Plan Amendment NY-23-0001 (effective January 1, 2023) href: https://www.medicaid.gov/medicaid/spa/downloads/NY-23-0001.pdf#page=5 diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/individual.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/individual.yaml index dbb1f78cb85..3755f3f6a79 100644 --- a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/individual.yaml +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/individual.yaml @@ -1,4 +1,4 @@ -description: Maximum income for an individual to qualify for Medicaid under the 'medically needy' pathway. States whose limit is a share of the poverty guideline or the SSI federal benefit rate (fpg_rate, ssi_rate) are omitted here from the date that rule applies. +description: States limit income for an individual to this monthly amount under the Medicaid medically needy pathway; from the date a state's fpg_rate or ssi_rate is positive, the formula uses that rate instead. metadata: label: Medicaid medically needy pathway for individuals income limit breakdown: @@ -6,6 +6,8 @@ metadata: unit: currency-USD period: month reference: + - title: Arkansas DHS Division of County Operations, Health Care Eligibility Quick Reference (January 2025), AABD Adult Spend Down + href: https://humanservices.arkansas.gov/wp-content/uploads/Quick-Reference.pdf#page=1 - title: "Medicaid Financial Eligibility for Seniors and People with Disabilities: Findings from a 50-State Survey | KFF" 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: Connecticut State Plan Amendment CT-22-0031, Medically Needy Income Level (effective July 1, 2022) @@ -34,11 +36,11 @@ metadata: href: https://www.medicaid.gov/medicaid/spa/downloads/NH-25-0012.pdf#page=7 - title: New Hampshire State Plan Amendment NH-25-0019, Medically Needy Income Level (effective July 1, 2025) href: https://www.medicaid.gov/medicaid/spa/downloads/NH-25-0019.pdf#page=7 - - title: New York DOH GIS 22 MA/11, 2023 Medicaid Levels and Other Updates + - title: New York DOH GIS 22 MA/11, Increase of Medicaid Medically Needy Income Level to 138% of the Federal Poverty Level href: https://www.health.ny.gov/health_care/medicaid/publications/docs/gis/22ma11.pdf#page=1 - - title: Rhode Island 210-RICR-40-00-3, Medicaid Affordable Care Coverage Groups (version effective January 1, 2020) + - title: Rhode Island 210-RICR-40-00-3, Medicaid Integrated Health Care Coverage, SSI Financial Eligibility Determinations (version effective January 1, 2020) href: https://rules.sos.ri.gov/Regulations/part/210-40-00-3?reg_id=10945 - - title: Rhode Island 210-RICR-40-00-3, section 3.2(A)(8), Medically Needy Income Limit + - title: Rhode Island 210-RICR-40-00-3, section 3.2.8(A)(8), Medically Needy Income Limit href: https://rules.sos.ri.gov/regulations/part/210-40-00-3 - title: Rhode Island State Plan Amendment RI-21-0004, Medically Needy Income Level (effective January 1, 2021) href: https://www.medicaid.gov/medicaid/spa/downloads/RI-21-0004.pdf#page=4 @@ -58,7 +60,7 @@ AK: AL: 2018-01-01: -.inf AR: - 2018-01-01: 108 + 2018-01-01: 108.33 AZ: 2018-01-01: -.inf CA: diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/ssi_rate.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/ssi_rate.yaml index d53e8a792ee..eb3784d907f 100644 --- a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/ssi_rate.yaml +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/ssi_rate.yaml @@ -9,7 +9,7 @@ metadata: - title: "CMS approval of Kansas State Plan Amendment KS-25-0019, medically needy income disregard to the SSI federal benefit rate #page 2,46" href: https://www.medicaid.gov/medicaid/spa/downloads/KS-25-0019.pdf#page=2 - title: Kansas Medical Assistance Standards, KEESM Appendix F-8 (January 2026), Income Standards for Independent Living - href: https://www.kancare.ks.gov/home/showpublisheddocument/6204/639013856776770000 + href: https://www.kancare.ks.gov/home/showpublisheddocument/6204/639013856776770000#page=3 - title: Washington Administrative Code 182-519-0050(5) - Monthly income and countable resource standards for medically needy (MN) href: https://app.leg.wa.gov/WAC/default.aspx?cite=182-519-0050 - title: Washington State Register 12-20-001, amending WAC 182-519-0050 diff --git a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/is_in_medicaid_medically_needy_category.yaml b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/is_in_medicaid_medically_needy_category.yaml index 001b939bc35..32e41686e95 100644 --- a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/is_in_medicaid_medically_needy_category.yaml +++ b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/is_in_medicaid_medically_needy_category.yaml @@ -13,3 +13,44 @@ state_code: MA output: is_in_medicaid_medically_needy_category: false + +- name: Disabled adults in Arkansas, Iowa, Illinois, North Dakota and New Jersey are in a medically needy category. + period: 2026 + input: + people: + person1: + age: 50 + meets_ssi_disability_criteria: true + person2: + age: 50 + meets_ssi_disability_criteria: true + person3: + age: 50 + meets_ssi_disability_criteria: true + person4: + age: 50 + meets_ssi_disability_criteria: true + person5: + age: 50 + meets_ssi_disability_criteria: true + households: + household1: + members: [person1] + state_code: AR + household2: + members: [person2] + state_code: IA + household3: + members: [person3] + state_code: IL + household4: + members: [person4] + state_code: ND + household5: + members: [person5] + state_code: NJ + output: + # Iowa 441-75.8(2)"c" (SSI-related persons), the NJ fact sheet (blind or + # disabled), NDAC 75-02-02.1-26(1) (aged, blind and disabled groups), the + # AR AABD spend down and IL PM 15-06-02-c cover disabled people. + is_in_medicaid_medically_needy_category: [true, true, true, true, true] diff --git a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/is_medically_needy_for_medicaid.yaml b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/is_medically_needy_for_medicaid.yaml index a735f81df04..caebe8f22c2 100644 --- a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/is_medically_needy_for_medicaid.yaml +++ b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/is_medically_needy_for_medicaid.yaml @@ -63,7 +63,7 @@ ssi_countable_resources: 1_500 state_code: AR output: - # Limit 108 x 12 = 1,296. 14,160 is over it; 14,160 - 13,000 = 1,160 is not. + # Limit 108.33 x 12 = 1,299.96. 14,160 is over it; 14,160 - 13,000 = 1,160 is not. is_in_medicaid_medically_needy_category: true is_medically_needy_for_medicaid: true @@ -83,19 +83,20 @@ is_in_medicaid_medically_needy_category: true is_medically_needy_for_medicaid: true -- name: Case 5, New Jersey senior qualifies after medical spenddown. +- name: Case 5, New Jersey senior above the optional aged, blind and disabled limit qualifies after medical spenddown. period: 2026 input: age: 70 is_adult_for_medicaid: false is_optional_senior_or_disabled_for_medicaid: false is_ssi_recipient_for_medicaid: false - ssi_countable_income: 14_160 - medicaid_medically_needy_medical_expenses: 10_000 - ssi_countable_resources: 3_500 + ssi_countable_income: 18_000 + medicaid_medically_needy_medical_expenses: 14_000 + ssi_countable_resources: 4_000 state_code: NJ output: - # Limit 367 x 12 = 4,404. 14,160 - 10,000 = 4,160; assets 3,500 are under 4,000. + # 18,000 is over NJ's 100% FPL optional limit (15,960) and the SSI rate (11,928). + # Limit 367 x 12 = 4,404; 18,000 - 14,000 = 4,000. Assets 4,000 equal the limit. is_in_medicaid_medically_needy_category: true is_medically_needy_for_medicaid: true @@ -108,10 +109,10 @@ is_ssi_recipient_for_medicaid: false ssi_countable_income: 20_000 medicaid_medically_needy_medical_expenses: 5_000 - ssi_countable_resources: 10_000 + ssi_countable_resources: 17_500 state_code: IL output: - # Limit 15,960 (100% FPG). 20,000 - 5,000 = 15,000; assets 10,000 are under 17,500. + # Limit 15,960 (100% FPG). 20,000 - 5,000 = 15,000; assets 17,500 equal the limit. is_in_medicaid_medically_needy_category: true is_medically_needy_for_medicaid: true @@ -122,32 +123,35 @@ is_adult_for_medicaid: false is_optional_senior_or_disabled_for_medicaid: false is_ssi_recipient_for_medicaid: false - ssi_countable_income: 18_000 + ssi_countable_income: 18_364 medicaid_medically_needy_medical_expenses: 4_000 ssi_countable_resources: 2_500 state_code: ND output: - # Limit 0.9 x 15,960 = 14,364. 18,000 - 4,000 = 14,000; assets 2,500 are under 3,000. + # Limit 0.9 x 15,960 = 14,364. 18,364 - 4,000 = 14,364, equal to the limit; + # assets 2,500 are under 3,000. is_in_medicaid_medically_needy_category: true is_medically_needy_for_medicaid: true -- name: Case 8, California senior with assets under the reinstated 2026 limit qualifies. +- name: Case 8, California senior with assets exactly at the reinstated 2026 limit qualifies. period: 2026 input: age: 70 is_adult_for_medicaid: false is_optional_senior_or_disabled_for_medicaid: false is_ssi_recipient_for_medicaid: false - ssi_countable_income: 9_000 - medicaid_medically_needy_medical_expenses: 2_000 - ssi_countable_resources: 120_000 + ssi_countable_income: 26_400 + medicaid_medically_needy_medical_expenses: 19_500 + ssi_countable_resources: 130_000 state_code: CA output: - # Limit 600 x 12 = 7,200. 9,000 - 2,000 = 7,000; assets 120,000 are under 130,000. + # 26,400 is over the Aged and Disabled FPL limit (138% FPL, 22,024.80) and the + # SSI and SSP payment level. Limit 600 x 12 = 7,200; 26,400 - 19,500 = 6,900. + # Assets equal the 130,000 limit. is_in_medicaid_medically_needy_category: true is_medically_needy_for_medicaid: true -- name: Case 9, New York senior with assets under the 2026 resource level qualifies. +- name: Case 9, New York senior with assets at the 2026 resource level qualifies. period: 2026 input: age: 70 @@ -156,9 +160,167 @@ is_ssi_recipient_for_medicaid: false ssi_countable_income: 25_000 medicaid_medically_needy_medical_expenses: 5_000 - ssi_countable_resources: 30_000 + ssi_countable_resources: 33_038 state_code: NY output: - # Limit 1.38 x 15,960 = 22,024.80. 25,000 - 5,000 = 20,000; assets 30,000 are under 33,038. + # Limit 1.38 x 15,960 = 22,024.80. 25,000 - 5,000 = 20,000; assets 33,038 equal + # the 2026 resource level. is_in_medicaid_medically_needy_category: true is_medically_needy_for_medicaid: true + +- name: Case 10, California senior one dollar over the reinstated 2026 asset limit is ineligible. + period: 2026 + input: + age: 70 + is_adult_for_medicaid: false + is_optional_senior_or_disabled_for_medicaid: false + is_ssi_recipient_for_medicaid: false + ssi_countable_income: 26_400 + medicaid_medically_needy_medical_expenses: 19_500 + ssi_countable_resources: 130_001 + state_code: CA + output: + # Income passes (6,900 <= 7,200); assets 130,001 exceed 130,000. + is_medically_needy_for_medicaid: false + +- name: Case 11, California senior with large assets qualifies in 2024, when non-MAGI asset limits did not apply. + period: 2024 + input: + age: 70 + is_adult_for_medicaid: false + is_optional_senior_or_disabled_for_medicaid: false + is_ssi_recipient_for_medicaid: false + ssi_countable_income: 26_400 + medicaid_medically_needy_medical_expenses: 19_500 + ssi_countable_resources: 1_000_000 + state_code: CA + output: + # ACWDL 22-25: no asset limit from January 1, 2024. Limit 600 x 12 = 7,200; + # 26,400 - 19,500 = 6,900. + is_medically_needy_for_medicaid: true + +- name: Case 12, New York senior with resources exactly at each year's level qualifies. + period: 2026 + input: + people: + person1: + age: {2022: 70, 2023: 71, 2024: 72, 2025: 73, 2026: 74} + is_adult_for_medicaid: {2022: false, 2023: false, 2024: false, 2025: false, 2026: false} + is_optional_senior_or_disabled_for_medicaid: {2022: false, 2023: false, 2024: false, 2025: false, 2026: false} + is_ssi_recipient_for_medicaid: {2022: false, 2023: false, 2024: false, 2025: false, 2026: false} + ssi_countable_income: {2022: 25_000, 2023: 25_000, 2024: 25_000, 2025: 25_000, 2026: 25_000} + medicaid_medically_needy_medical_expenses: {2022: 15_000, 2023: 5_000, 2024: 5_000, 2025: 5_000, 2026: 5_000} + ssi_countable_resources: {2022: 16_800, 2023: 30_182, 2024: 31_175, 2025: 32_396, 2026: 33_038} + households: + household: + members: [person1] + state_code: {2022: NY, 2023: NY, 2024: NY, 2025: NY, 2026: NY} + output: + # 2022: 25,000 - 15,000 = 10,000 <= 934 x 12 = 11,208. + # 2023-2026: 20,000 <= 1.38 x FPG (20,120.40, 20,782.80, 21,597, 22,024.80). + # Resources equal each year's level (GIS 22 MA/11 p2; the 2023-2026 GIS + # attachments). + is_medically_needy_for_medicaid: + 2022: true + 2023: true + 2024: true + 2025: true + 2026: true + +- name: Case 13, New York, California and Illinois couples with resources exactly at the 2026 couple limits qualify. + period: 2026 + input: + people: + person1: + age: 70 + is_tax_unit_head: true + is_adult_for_medicaid: false + is_optional_senior_or_disabled_for_medicaid: false + is_ssi_recipient_for_medicaid: false + ssi_countable_income: 20_000 + medicaid_medically_needy_medical_expenses: 6_000 + ssi_countable_resources: 22_398 + person2: + age: 68 + is_tax_unit_spouse: true + is_adult_for_medicaid: false + is_optional_senior_or_disabled_for_medicaid: false + is_ssi_recipient_for_medicaid: false + ssi_countable_income: 20_000 + medicaid_medically_needy_medical_expenses: 6_000 + ssi_countable_resources: 22_398 + person3: + age: 72 + is_tax_unit_head: true + is_adult_for_medicaid: false + is_optional_senior_or_disabled_for_medicaid: false + is_ssi_recipient_for_medicaid: false + ssi_countable_income: 18_000 + medicaid_medically_needy_medical_expenses: 12_500 + ssi_countable_resources: 97_500 + person4: + age: 70 + is_tax_unit_spouse: true + is_adult_for_medicaid: false + is_optional_senior_or_disabled_for_medicaid: false + is_ssi_recipient_for_medicaid: false + ssi_countable_income: 18_000 + medicaid_medically_needy_medical_expenses: 12_500 + ssi_countable_resources: 97_500 + person5: + age: 71 + is_tax_unit_head: true + is_adult_for_medicaid: false + is_optional_senior_or_disabled_for_medicaid: false + is_ssi_recipient_for_medicaid: false + ssi_countable_income: 14_000 + medicaid_medically_needy_medical_expenses: 3_500 + ssi_countable_resources: 8_750 + person6: + age: 69 + is_tax_unit_spouse: true + is_adult_for_medicaid: false + is_optional_senior_or_disabled_for_medicaid: false + is_ssi_recipient_for_medicaid: false + ssi_countable_income: 14_000 + medicaid_medically_needy_medical_expenses: 3_500 + ssi_countable_resources: 8_750 + marital_units: + marital_unit1: + members: [person1, person2] + marital_unit2: + members: [person3, person4] + marital_unit3: + members: [person5, person6] + tax_units: + tax_unit1: + members: [person1, person2] + tax_unit_is_joint: true + tax_unit2: + members: [person3, person4] + tax_unit_is_joint: true + tax_unit3: + members: [person5, person6] + tax_unit_is_joint: true + spm_units: + spm_unit1: + members: [person1, person2] + spm_unit2: + members: [person3, person4] + spm_unit3: + members: [person5, person6] + households: + household1: + members: [person1, person2] + state_code: NY + household2: + members: [person3, person4] + state_code: CA + household3: + members: [person5, person6] + state_code: IL + output: + # NY: 40,000 - 12,000 = 28,000 <= 1.38 x 21,640 = 29,863.20; assets 44,796. + # CA: 36,000 - 25,000 = 11,000 <= 934 x 12 = 11,208; assets 195,000. + # IL: 28,000 - 7,000 = 21,000 <= 21,640; assets 17,500 (PM 07-02-01). + is_medically_needy_for_medicaid: [true, true, true, true, true, true] diff --git a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_income_limit.yaml b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_income_limit.yaml index 2f6c1a11737..2df42a91a6b 100644 --- a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_income_limit.yaml +++ b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_income_limit.yaml @@ -1,14 +1,41 @@ -- name: Case 1, Connecticut uses its March 2026 dollar limit from 2027. +- name: Case 1, Connecticut couple and individual dollar limits from 2023 to 2027. period: 2027 absolute_error_margin: 0.01 input: - age: 70 - state_code: CT + people: + person1: + age: 70 + person2: + age: 68 + person3: + age: 74 + marital_units: + marital_unit1: + members: [person1, person2] + marital_unit2: + members: [person3] + tax_units: + tax_unit1: + members: [person1, person2] + tax_unit2: + members: [person3] + households: + household: + members: [person1, person2, person3] + state_code: {2023: CT, 2024: CT, 2025: CT, 2026: CT, 2027: CT} output: - # 851 x 12 = 10,212. - medicaid_medically_needy_income_limit: 10_212 + # Outputs are [couple, couple, individual]. The annual variable reads the + # amount in force on January 1, times 12: 2023 879 / 653 (2022-07-01); + # 2024 946 / 700 (2024-01-01); 2025 980 / 723 (2024-03-01); + # 2026 1,128 / 835 (2025-03-01); 2027 1,153 / 851 (2026-03-01). + medicaid_medically_needy_income_limit: + 2023: [10_548, 10_548, 7_836] + 2024: [11_352, 11_352, 8_400] + 2025: [11_760, 11_760, 8_676] + 2026: [13_536, 13_536, 10_020] + 2027: [13_836, 13_836, 10_212] -- name: Case 2, District of Columbia couple uses its 2026 dollar limit. +- name: Case 2, District of Columbia couple and individual dollar limits from 2023 to 2026. period: 2026 absolute_error_margin: 0.01 input: @@ -17,21 +44,32 @@ age: 70 person2: age: 68 + person3: + age: 74 marital_units: - marital_unit: + marital_unit1: members: [person1, person2] + marital_unit2: + members: [person3] tax_units: - tax_unit: + tax_unit1: members: [person1, person2] + tax_unit2: + members: [person3] households: household: - members: [person1, person2] - state_code: DC + members: [person1, person2, person3] + state_code: {2023: DC, 2024: DC, 2025: DC, 2026: DC} output: - # 901.67 x 12 = 10,820.04. - medicaid_medically_needy_income_limit: [10_820.04, 10_820.04] + # Outputs are [couple, couple, individual]: 821.67 / 780.58, 851.67 / 809.08, + # 881.25 / 837.19 and 901.67 / 856.58, each times 12. + medicaid_medically_needy_income_limit: + 2023: [9_860.04, 9_860.04, 9_366.96] + 2024: [10_220.04, 10_220.04, 9_708.96] + 2025: [10_575, 10_575, 10_046.28] + 2026: [10_820.04, 10_820.04, 10_278.96] -- name: Case 3, Kansas uses its dollar limit before July 2025. +- name: Case 3, Kansas uses its 475-dollar limit for 2025; the July 2025 switch to the SSI rate applies from 2026 in this annual variable. period: 2025 absolute_error_margin: 0.01 input: @@ -41,6 +79,7 @@ # 475 x 12 = 5,700. medicaid_medically_needy_income_limit: 5_700 + - name: Case 4, Kansas couple uses the SSI couple rate from July 2025. period: 2026 absolute_error_margin: 0.01 @@ -64,6 +103,7 @@ # 1,491 x 12 = 17,892. medicaid_medically_needy_income_limit: [17_892, 17_892] + - name: Case 5, Minnesota uses 100 percent of the poverty guideline. period: 2026 absolute_error_margin: 0.01 @@ -74,15 +114,40 @@ # 1.00 x 15,960 = 15,960. medicaid_medically_needy_income_limit: 15_960 -- name: Case 6, New Hampshire uses its July 2025 dollar limit. + +- name: Case 6, New Hampshire couple and individual dollar limits in 2023, 2025 and 2026. period: 2026 absolute_error_margin: 0.01 input: - age: 70 - state_code: NH + people: + person1: + age: 70 + person2: + age: 68 + person3: + age: 74 + marital_units: + marital_unit1: + members: [person1, person2] + marital_unit2: + members: [person3] + tax_units: + tax_unit1: + members: [person1, person2] + tax_unit2: + members: [person3] + households: + household: + members: [person1, person2, person3] + state_code: {2023: NH, 2025: NH, 2026: NH} output: - # 939 x 12 = 11,268. - medicaid_medically_needy_income_limit: 11_268 + # Outputs are [couple, couple, individual]: 1,033 / 888 (2023-01-01), + # 1,066 / 916 (2025-01-01) and 1,093 / 939 (2025-07-01, first read in 2026), + # each times 12. + medicaid_medically_needy_income_limit: + 2023: [12_396, 12_396, 10_656] + 2025: [12_792, 12_792, 10_992] + 2026: [13_116, 13_116, 11_268] - name: Case 7, New York couple uses 138 percent of the poverty guideline. period: 2026 @@ -107,15 +172,44 @@ # 1.38 x 21,640 = 29,863.20. medicaid_medically_needy_income_limit: [29_863.2, 29_863.2] -- name: Case 8, Rhode Island uses its 2026 dollar limit. + +- name: Case 8, Rhode Island couple and individual dollar limits from 2019 to 2026. period: 2026 absolute_error_margin: 0.01 input: - age: 70 - state_code: RI + people: + person1: + age: 70 + person2: + age: 68 + person3: + age: 74 + marital_units: + marital_unit1: + members: [person1, person2] + marital_unit2: + members: [person3] + tax_units: + tax_unit1: + members: [person1, person2] + tax_unit2: + members: [person3] + households: + household: + members: [person1, person2, person3] + state_code: {2019: RI, 2020: RI, 2021: RI, 2022: RI, 2023: RI, 2024: RI, 2025: RI, 2026: RI} output: - # 1,200 x 12 = 14,400. - medicaid_medically_needy_income_limit: 14_400 + # Outputs are [couple, couple, individual]: the MNIL updated each January 1, + # times 12 (958 / 917 in 2019 up to 1,242 / 1,200 in 2026). + medicaid_medically_needy_income_limit: + 2019: [11_496, 11_496, 11_004] + 2020: [11_700, 11_700, 11_196] + 2021: [11_904, 11_904, 11_400] + 2022: [12_600, 12_600, 12_096] + 2023: [13_596, 13_596, 13_104] + 2024: [14_100, 14_100, 13_596] + 2025: [14_496, 14_496, 14_004] + 2026: [14_904, 14_904, 14_400] - name: Case 9, Utah couple uses 100 percent of the two-person poverty guideline. period: 2026 @@ -140,6 +234,7 @@ # 1.00 x 21,640 = 21,640. medicaid_medically_needy_income_limit: [21_640, 21_640] + - name: Case 10, Washington couple uses the one-person SSI rate. period: 2026 absolute_error_margin: 0.01 @@ -163,6 +258,7 @@ # 994 x 12 = 11,928. medicaid_medically_needy_income_limit: [11_928, 11_928] + - name: Case 11, Wisconsin uses 100 percent of the poverty guideline. period: 2026 absolute_error_margin: 0.01 @@ -173,6 +269,7 @@ # 1.00 x 15,960 = 15,960. medicaid_medically_needy_income_limit: 15_960 + - name: Case 12, Illinois couple uses 100 percent of the two-person poverty guideline. period: 2026 absolute_error_margin: 0.01 @@ -196,6 +293,7 @@ # 1.00 x 21,640 = 21,640. medicaid_medically_needy_income_limit: [21_640, 21_640] + - name: Case 13, North Dakota uses 90 percent of the poverty guideline. period: 2026 absolute_error_margin: 0.01 @@ -205,3 +303,130 @@ output: # 0.9 x 15,960 = 14,364. medicaid_medically_needy_income_limit: 14_364 + +- name: Case 14, New York uses its dollar limit in 2022 and 138 percent of the poverty guideline from 2023. + period: 2023 + absolute_error_margin: 0.01 + input: + people: + person1: + age: 70 + person2: + age: 68 + person3: + age: 74 + marital_units: + marital_unit1: + members: [person1, person2] + marital_unit2: + members: [person3] + tax_units: + tax_unit1: + members: [person1, person2] + tax_unit2: + members: [person3] + households: + household: + members: [person1, person2, person3] + state_code: {2022: NY, 2023: NY} + output: + # Outputs are [couple, couple, individual]. 2022: 1,367 / 934 times 12. + # 2023: 1.38 x 19,720 and 1.38 x 14,580. + medicaid_medically_needy_income_limit: + 2022: [16_404, 16_404, 11_208] + 2023: [27_213.6, 27_213.6, 20_120.4] + +- name: Case 15, Minnesota uses 80 percent of the poverty guideline in 2019 and 81 percent in 2020. + period: 2020 + absolute_error_margin: 0.01 + input: + people: + person1: + age: 70 + person2: + age: 68 + person3: + age: 74 + marital_units: + marital_unit1: + members: [person1, person2] + marital_unit2: + members: [person3] + tax_units: + tax_unit1: + members: [person1, person2] + tax_unit2: + members: [person3] + households: + household: + members: [person1, person2, person3] + state_code: {2019: MN, 2020: MN} + output: + # Outputs are [couple, couple, individual]. 2019: 0.8 x 16,910 and + # 0.8 x 12,490. The June 2019 rate of 0.81 is first read in 2020: + # 0.81 x 17,240 and 0.81 x 12,760. + medicaid_medically_needy_income_limit: + 2019: [13_528, 13_528, 9_992] + 2020: [13_964.4, 13_964.4, 10_335.6] + +- name: Case 16, North Dakota uses 83 percent of the poverty guideline in 2023. + period: 2023 + absolute_error_margin: 0.01 + input: + people: + person1: + age: 70 + person2: + age: 68 + person3: + age: 74 + marital_units: + marital_unit1: + members: [person1, person2] + marital_unit2: + members: [person3] + tax_units: + tax_unit1: + members: [person1, person2] + tax_unit2: + members: [person3] + households: + household: + members: [person1, person2, person3] + state_code: {2023: ND} + output: + # Outputs are [couple, couple, individual]: 0.83 x 19,720 and 0.83 x 14,580. + medicaid_medically_needy_income_limit: + 2023: [16_367.6, 16_367.6, 12_101.4] + +- name: Case 17, Wisconsin uses its dollar limit in 2019 and 100 percent of the poverty guideline from 2020. + period: 2020 + absolute_error_margin: 0.01 + input: + people: + person1: + age: 70 + person2: + age: 68 + person3: + age: 74 + marital_units: + marital_unit1: + members: [person1, person2] + marital_unit2: + members: [person3] + tax_units: + tax_unit1: + members: [person1, person2] + tax_unit2: + members: [person3] + households: + household: + members: [person1, person2, person3] + state_code: {2019: WI, 2020: WI} + output: + # Outputs are [couple, couple, individual]. 2019: 592 for one or two + # people, times 12. The September 2019 rate is first read in 2020. + medicaid_medically_needy_income_limit: + 2019: [7_104, 7_104, 7_104] + 2020: [17_240, 17_240, 12_760] diff --git a/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_income_limit.py b/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_income_limit.py index 5b2f823e17c..c40af6acf41 100644 --- a/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_income_limit.py +++ b/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_income_limit.py @@ -6,11 +6,6 @@ class medicaid_medically_needy_income_limit(Variable): value_type = float entity = Person label = "Medicaid medically needy income limit" - documentation = ( - "Annual medically needy income limit for an individual or a married " - "couple. States set it as a dollar amount, a share of the federal " - "poverty guideline, or a share of the SSI federal benefit rate." - ) unit = USD definition_period = YEAR reference = ( From 3097223aeb8bbf95d34b5d1218b518c45113aaf9 Mon Sep 17 00:00:00 2001 From: Ziming Date: Mon, 26 Oct 2026 17:25:50 -0400 Subject: [PATCH 3/9] Encode Vermont's medically needy protected income level, 2018-2026 The PIL outside Chittenden County, the same for one and two people, each January 1 (HBEE 8.06(b), 29.14; DCF B17-26; DVHA charts 2020-2026). No 2019 PIL was found, so 2018's value stays in force through 2019. The higher Chittenden PIL is not modeled. Co-Authored-By: Claude Opus 5.5 --- .../medicaid-medically-needy-limits.fixed.md | 2 +- .../medically_needy/limit/income/couple.yaml | 31 ++++++++++++++ .../limit/income/individual.yaml | 31 ++++++++++++++ .../is_medically_needy_for_medicaid.yaml | 31 ++++++++++++++ ...medicaid_medically_needy_income_limit.yaml | 40 +++++++++++++++++++ 5 files changed, 134 insertions(+), 1 deletion(-) diff --git a/changelog.d/medicaid-medically-needy-limits.fixed.md b/changelog.d/medicaid-medically-needy-limits.fixed.md index 3494371ba71..48e30e0ab9a 100644 --- a/changelog.d/medicaid-medically-needy-limits.fixed.md +++ b/changelog.d/medicaid-medically-needy-limits.fixed.md @@ -1 +1 @@ -Turned on the Medicaid medically needy pathway for aged, blind and disabled people in Arkansas, Iowa, Illinois, New Jersey and North Dakota, and updated medically needy income and asset limits in 13 states, tying them to the poverty guideline or the SSI federal benefit rate where state rules do. +Turned on the Medicaid medically needy pathway for aged, blind and disabled people in Arkansas, Iowa, Illinois, New Jersey and North Dakota, and updated medically needy income and asset limits in 14 states, including Vermont's protected income level, tying them to the poverty guideline or the SSI federal benefit rate where state rules do. diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/couple.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/couple.yaml index 98d1181ad7e..7790f38e39c 100644 --- a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/couple.yaml +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/couple.yaml @@ -54,6 +54,26 @@ metadata: href: https://www.medicaid.gov/medicaid/spa/downloads/RI-25-0003.pdf#page=7 - title: Rhode Island State Plan Amendment RI-26-0001, Medically Needy Income Level (effective January 1, 2026) href: https://www.medicaid.gov/medicaid/spa/downloads/RI-26-0001.pdf#page=7 + - title: Vermont Health Benefits Eligibility and Enrollment Rule, Part 2, section 8.06 - Medically-needy coverage group + href: https://humanservices.vermont.gov/sites/ahsnew/files/documents/HBEE-Part-2-Eligibility-Standards.pdf#page=19 + - title: "Vermont Health Benefits Eligibility and Enrollment Rule, Part 5, section 29.14 - Determination of countable income #page 51-52" + href: https://humanservices.vermont.gov/sites/ahsnew/files/documents/HBEE-Part-5-Financial-Methodologies.pdf#page=51 + - title: Vermont DCF Bulletin 17-26, P-2420 Eligibility maximums for MABD, effective 1/1/18 + href: https://outside.vermont.gov/dept/DCF/Shared%20Documents/ESD/Rules-Adopted/B17-26.pdf#page=3 + - title: Vermont DVHA 2020 MABD PIL FPL Income Chart, effective 1/1/2020 + href: https://dvha.vermont.gov/sites/dvha/files/doc_library/2020%20MABD%20PIL%20Chart%20FINAL.pdf + - title: Vermont DVHA 2021 Standards Change for Healthcare + href: https://dvha.vermont.gov/sites/dvha/files/doc_library/2021%20Standards%20Change%20for%20Healthcare%20Updated%201.14.21.pdf#page=1 + - title: Vermont DVHA 2022 Standards Change for Healthcare + href: https://dvha.vermont.gov/sites/dvha/files/doc_library/2022%20Standards%20Change%20for%20Healthcare%20Draft%20FINAL%20V.2%20corrected.pdf#page=1 + - title: Vermont DVHA 2023 Standards Change for Healthcare + href: https://dvha.vermont.gov/sites/dvha/files/documents/2023%20Standards%20Change%20for%20Healthcare%20FINAL%20%28with%2010-1-23%20DR%20Numbers%29%20%28003%29.pdf#page=1 + - title: Vermont DVHA 2024 Standards Change for Healthcare + href: https://dvha.vermont.gov/sites/dvha/files/documents/2024%20Standards%20Change%20for%20Healthcare%20FINAL%20Corrected%2012.19.pdf#page=1 + - title: Vermont DVHA 2025 Standards Change for Healthcare + href: https://dvha.vermont.gov/sites/dvha/files/documents/2025%20Standards%20Change%20for%20Healthcare%20FINAL.pdf#page=1 + - title: Vermont DVHA 2026 Standards Change for Healthcare + href: https://dvha.vermont.gov/sites/dvha/files/documents/Standards_Change_for_Healthcare_2026.pdf#page=1 AK: 2018-01-01: -.inf @@ -161,7 +181,18 @@ TX: VA: 2018-01-01: 659 VT: + # The protected income level (PIL) outside Chittenden County, the same for + # one and two people (HBEE 8.06(b), 29.14). The higher PIL inside Chittenden + # County is not modeled. No 2019 PIL was found, so 2018's value stays in + # force through 2019. 2018-01-01: 1_041 + 2020-01-01: 1_091 + 2021-01-01: 1_100 + 2022-01-01: 1_166 + 2023-01-01: 1_258 + 2024-01-01: 1_300 + 2025-01-01: 1_333 + 2026-01-01: 1_375 WV: 2018-01-01: 275 WI: diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/individual.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/individual.yaml index 3755f3f6a79..876d9dfa73b 100644 --- a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/individual.yaml +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/individual.yaml @@ -54,6 +54,26 @@ metadata: href: https://www.medicaid.gov/medicaid/spa/downloads/RI-25-0003.pdf#page=7 - title: Rhode Island State Plan Amendment RI-26-0001, Medically Needy Income Level (effective January 1, 2026) href: https://www.medicaid.gov/medicaid/spa/downloads/RI-26-0001.pdf#page=7 + - title: Vermont Health Benefits Eligibility and Enrollment Rule, Part 2, section 8.06 - Medically-needy coverage group + href: https://humanservices.vermont.gov/sites/ahsnew/files/documents/HBEE-Part-2-Eligibility-Standards.pdf#page=19 + - title: "Vermont Health Benefits Eligibility and Enrollment Rule, Part 5, section 29.14 - Determination of countable income #page 51-52" + href: https://humanservices.vermont.gov/sites/ahsnew/files/documents/HBEE-Part-5-Financial-Methodologies.pdf#page=51 + - title: Vermont DCF Bulletin 17-26, P-2420 Eligibility maximums for MABD, effective 1/1/18 + href: https://outside.vermont.gov/dept/DCF/Shared%20Documents/ESD/Rules-Adopted/B17-26.pdf#page=3 + - title: Vermont DVHA 2020 MABD PIL FPL Income Chart, effective 1/1/2020 + href: https://dvha.vermont.gov/sites/dvha/files/doc_library/2020%20MABD%20PIL%20Chart%20FINAL.pdf + - title: Vermont DVHA 2021 Standards Change for Healthcare + href: https://dvha.vermont.gov/sites/dvha/files/doc_library/2021%20Standards%20Change%20for%20Healthcare%20Updated%201.14.21.pdf#page=1 + - title: Vermont DVHA 2022 Standards Change for Healthcare + href: https://dvha.vermont.gov/sites/dvha/files/doc_library/2022%20Standards%20Change%20for%20Healthcare%20Draft%20FINAL%20V.2%20corrected.pdf#page=1 + - title: Vermont DVHA 2023 Standards Change for Healthcare + href: https://dvha.vermont.gov/sites/dvha/files/documents/2023%20Standards%20Change%20for%20Healthcare%20FINAL%20%28with%2010-1-23%20DR%20Numbers%29%20%28003%29.pdf#page=1 + - title: Vermont DVHA 2024 Standards Change for Healthcare + href: https://dvha.vermont.gov/sites/dvha/files/documents/2024%20Standards%20Change%20for%20Healthcare%20FINAL%20Corrected%2012.19.pdf#page=1 + - title: Vermont DVHA 2025 Standards Change for Healthcare + href: https://dvha.vermont.gov/sites/dvha/files/documents/2025%20Standards%20Change%20for%20Healthcare%20FINAL.pdf#page=1 + - title: Vermont DVHA 2026 Standards Change for Healthcare + href: https://dvha.vermont.gov/sites/dvha/files/documents/Standards_Change_for_Healthcare_2026.pdf#page=1 AK: 2018-01-01: -.inf @@ -161,7 +181,18 @@ TX: VA: 2018-01-01: 493 VT: + # The protected income level (PIL) outside Chittenden County, the same for + # one and two people (HBEE 8.06(b), 29.14). The higher PIL inside Chittenden + # County is not modeled. No 2019 PIL was found, so 2018's value stays in + # force through 2019. 2018-01-01: 1_041 + 2020-01-01: 1_091 + 2021-01-01: 1_100 + 2022-01-01: 1_166 + 2023-01-01: 1_258 + 2024-01-01: 1_300 + 2025-01-01: 1_333 + 2026-01-01: 1_375 WV: 2018-01-01: 200 WI: diff --git a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/is_medically_needy_for_medicaid.yaml b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/is_medically_needy_for_medicaid.yaml index caebe8f22c2..41c4f6cecd1 100644 --- a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/is_medically_needy_for_medicaid.yaml +++ b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/is_medically_needy_for_medicaid.yaml @@ -324,3 +324,34 @@ # CA: 36,000 - 25,000 = 11,000 <= 934 x 12 = 11,208; assets 195,000. # IL: 28,000 - 7,000 = 21,000 <= 21,640; assets 17,500 (PM 07-02-01). is_medically_needy_for_medicaid: [true, true, true, true, true, true] + +- name: Case 14, Vermont senior with income after medical expenses at the 2026 protected income level qualifies. + period: 2026 + input: + age: 70 + is_adult_for_medicaid: false + is_optional_senior_or_disabled_for_medicaid: false + is_ssi_recipient_for_medicaid: false + ssi_countable_income: 20_000 + medicaid_medically_needy_medical_expenses: 3_500 + ssi_countable_resources: 1_500 + state_code: VT + output: + # HBEE 8.06(b): income at or below the PIL. 1,375 x 12 = 16,500; + # 20,000 - 3,500 = 16,500, equal to the limit. + is_medically_needy_for_medicaid: true + +- name: Case 15, Vermont senior with income after medical expenses one dollar a month over the 2026 protected income level is ineligible. + period: 2026 + input: + age: 70 + is_adult_for_medicaid: false + is_optional_senior_or_disabled_for_medicaid: false + is_ssi_recipient_for_medicaid: false + ssi_countable_income: 20_000 + medicaid_medically_needy_medical_expenses: 3_488 + ssi_countable_resources: 1_500 + state_code: VT + output: + # 20,000 - 3,488 = 16,512, or 1,376 a month, over 1,375. + is_medically_needy_for_medicaid: false diff --git a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_income_limit.yaml b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_income_limit.yaml index 2df42a91a6b..c42c21cc37a 100644 --- a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_income_limit.yaml +++ b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_income_limit.yaml @@ -430,3 +430,43 @@ medicaid_medically_needy_income_limit: 2019: [7_104, 7_104, 7_104] 2020: [17_240, 17_240, 12_760] + +- name: Case 18, Vermont uses its protected income level outside Chittenden County from 2018 to 2026. + period: 2026 + absolute_error_margin: 0.01 + input: + people: + person1: + age: 70 + person2: + age: 68 + person3: + age: 74 + marital_units: + marital_unit1: + members: [person1, person2] + marital_unit2: + members: [person3] + tax_units: + tax_unit1: + members: [person1, person2] + tax_unit2: + members: [person3] + households: + household: + members: [person1, person2, person3] + state_code: {2018: VT, 2019: VT, 2020: VT, 2021: VT, 2022: VT, 2023: VT, 2024: VT, 2025: VT, 2026: VT} + output: + # Outputs are [couple, couple, individual]. The PIL is the same for one and + # two people, effective each January 1, times 12: 1,041 (2018, kept in + # 2019), 1,091, 1,100, 1,166, 1,258, 1,300, 1,333 and 1,375. + medicaid_medically_needy_income_limit: + 2018: [12_492, 12_492, 12_492] + 2019: [12_492, 12_492, 12_492] + 2020: [13_092, 13_092, 13_092] + 2021: [13_200, 13_200, 13_200] + 2022: [13_992, 13_992, 13_992] + 2023: [15_096, 15_096, 15_096] + 2024: [15_600, 15_600, 15_600] + 2025: [15_996, 15_996, 15_996] + 2026: [16_500, 16_500, 16_500] From 4d2fb9d24c8f09035b002d2a62bc05b288c13c99 Mon Sep 17 00:00:00 2001 From: Ziming Date: Mon, 26 Oct 2026 17:26:33 -0400 Subject: [PATCH 4/9] Cite the Arkansas policy manual for the medically needy income levels Co-Authored-By: Claude Opus 5.5 --- .../categories/medically_needy/limit/income/couple.yaml | 2 ++ .../categories/medically_needy/limit/income/individual.yaml | 2 ++ 2 files changed, 4 insertions(+) diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/couple.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/couple.yaml index 7790f38e39c..29cd31db478 100644 --- a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/couple.yaml +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/couple.yaml @@ -8,6 +8,8 @@ metadata: reference: - title: Arkansas DHS Division of County Operations, Health Care Eligibility Quick Reference (January 2025), AABD Adult Spend Down href: https://humanservices.arkansas.gov/wp-content/uploads/Quick-Reference.pdf#page=1 + - title: Arkansas DHS Medical Services Policy Manual (September 2026), O-710 Medically Needy Income Levels + href: https://humanservices.arkansas.gov/wp-content/uploads/MS-Policy-9.26-New.pdf#page=435 - title: "Medicaid Financial Eligibility for Seniors and People with Disabilities: Findings from a 50-State Survey | KFF" 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: Connecticut State Plan Amendment CT-22-0031, Medically Needy Income Level (effective July 1, 2022) diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/individual.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/individual.yaml index 876d9dfa73b..275f9e95ef9 100644 --- a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/individual.yaml +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/individual.yaml @@ -8,6 +8,8 @@ metadata: reference: - title: Arkansas DHS Division of County Operations, Health Care Eligibility Quick Reference (January 2025), AABD Adult Spend Down href: https://humanservices.arkansas.gov/wp-content/uploads/Quick-Reference.pdf#page=1 + - title: Arkansas DHS Medical Services Policy Manual (September 2026), O-710 Medically Needy Income Levels + href: https://humanservices.arkansas.gov/wp-content/uploads/MS-Policy-9.26-New.pdf#page=435 - title: "Medicaid Financial Eligibility for Seniors and People with Disabilities: Findings from a 50-State Survey | KFF" 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: Connecticut State Plan Amendment CT-22-0031, Medically Needy Income Level (effective July 1, 2022) From 7ff36144ad22172f5e0d32f284dba89251d5118d Mon Sep 17 00:00:00 2001 From: Ziming Date: Mon, 26 Oct 2026 20:06:55 -0400 Subject: [PATCH 5/9] Switch off ABD medically needy in AZ, ID, IN, NM and NV; archive NJ link KFF 2018 and 2026 list no medically needy program for aged, blind or disabled people in these five states; the flags had been swapped with AR, IL, IA, NJ and ND. Their -inf limits meant no result changes. The NJ DMAHS fact sheet now 404s, so cite the 2026-05-14 Wayback copy. Co-Authored-By: Claude Opus 5.5 --- .../medicaid-medically-needy-limits.fixed.md | 2 +- .../medically_needy/categories/disabled.yaml | 17 +++++++++++------ .../medically_needy/categories/senior.yaml | 17 +++++++++++------ ...s_in_medicaid_medically_needy_category.yaml | 18 ++++++++++++++++++ 4 files changed, 41 insertions(+), 13 deletions(-) diff --git a/changelog.d/medicaid-medically-needy-limits.fixed.md b/changelog.d/medicaid-medically-needy-limits.fixed.md index 48e30e0ab9a..fe86f4a3d72 100644 --- a/changelog.d/medicaid-medically-needy-limits.fixed.md +++ b/changelog.d/medicaid-medically-needy-limits.fixed.md @@ -1 +1 @@ -Turned on the Medicaid medically needy pathway for aged, blind and disabled people in Arkansas, Iowa, Illinois, New Jersey and North Dakota, and updated medically needy income and asset limits in 14 states, including Vermont's protected income level, tying them to the poverty guideline or the SSI federal benefit rate where state rules do. +Turned on the Medicaid medically needy pathway for aged, blind and disabled people in Arkansas, Iowa, Illinois, New Jersey and North Dakota, turned it off in Arizona, Idaho, Indiana, New Mexico and Nevada, which have no such program, and updated medically needy income and asset limits in 14 states, including Vermont's protected income level, tying them to the poverty guideline or the SSI federal benefit rate where state rules do. diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/categories/disabled.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/categories/disabled.yaml index f074b02c968..5b83ab01de3 100644 --- a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/categories/disabled.yaml +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/categories/disabled.yaml @@ -16,7 +16,7 @@ metadata: - title: Illinois Department of Human Services Policy Manual PM 15-08-00 - Spenddown href: https://www.dhs.state.il.us/page.aspx?item=16536 - title: New Jersey DMAHS, Medically Needy Segment fact sheet - href: https://www.nj.gov/humanservices/dmahs/clients/medicaid/medically_needy_fact_sheet.pdf#page=1 + href: https://web.archive.org/web/20260514003440id_/https://www.nj.gov/humanservices/dmahs/clients/medicaid/medically_needy_fact_sheet.pdf#page=1 - title: North Dakota Non-ACA Medicaid Manual 510-05-85-40 - Medically needy income levels href: https://www.nd.gov/dhs/policymanuals/51005/510_05_85_40.htm - title: North Dakota Administrative Code 75-02-02.1-26(1) - Asset limits, medically needy aged, blind, and disabled @@ -29,7 +29,8 @@ AL: AR: 2015-01-01: true AZ: - 2015-01-01: true + # No medically needy pathway for aged, blind or disabled people (KFF 2018, 2026). + 2015-01-01: false CA: 2015-01-01: true CO: @@ -49,11 +50,13 @@ HI: IA: 2015-01-01: true ID: - 2015-01-01: true + # No medically needy pathway for aged, blind or disabled people (KFF 2018, 2026). + 2015-01-01: false IL: 2015-01-01: true IN: - 2015-01-01: true + # No medically needy pathway for aged, blind or disabled people (KFF 2018, 2026). + 2015-01-01: false KS: 2015-01-01: true KY: @@ -87,9 +90,11 @@ NH: NJ: 2015-01-01: true NM: - 2015-01-01: true + # No medically needy pathway for aged, blind or disabled people (KFF 2018, 2026). + 2015-01-01: false NV: - 2015-01-01: true + # No medically needy pathway for aged, blind or disabled people (KFF 2018, 2026). + 2015-01-01: false NY: 2015-01-01: true OH: diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/categories/senior.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/categories/senior.yaml index 34e55264c8f..65a4049496a 100644 --- a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/categories/senior.yaml +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/categories/senior.yaml @@ -16,7 +16,7 @@ metadata: - title: Illinois Department of Human Services Policy Manual PM 15-08-00 - Spenddown href: https://www.dhs.state.il.us/page.aspx?item=16536 - title: New Jersey DMAHS, Medically Needy Segment fact sheet - href: https://www.nj.gov/humanservices/dmahs/clients/medicaid/medically_needy_fact_sheet.pdf#page=1 + href: https://web.archive.org/web/20260514003440id_/https://www.nj.gov/humanservices/dmahs/clients/medicaid/medically_needy_fact_sheet.pdf#page=1 - title: North Dakota Non-ACA Medicaid Manual 510-05-85-40 - Medically needy income levels href: https://www.nd.gov/dhs/policymanuals/51005/510_05_85_40.htm - title: North Dakota Administrative Code 75-02-02.1-26(1) - Asset limits, medically needy aged, blind, and disabled @@ -29,7 +29,8 @@ AL: AR: 2015-01-01: true AZ: - 2015-01-01: true + # No medically needy pathway for aged, blind or disabled people (KFF 2018, 2026). + 2015-01-01: false CA: 2015-01-01: true CO: @@ -49,11 +50,13 @@ HI: IA: 2015-01-01: true ID: - 2015-01-01: true + # No medically needy pathway for aged, blind or disabled people (KFF 2018, 2026). + 2015-01-01: false IL: 2015-01-01: true IN: - 2015-01-01: true + # No medically needy pathway for aged, blind or disabled people (KFF 2018, 2026). + 2015-01-01: false KS: 2015-01-01: true KY: @@ -87,9 +90,11 @@ NH: NJ: 2015-01-01: true NM: - 2015-01-01: true + # No medically needy pathway for aged, blind or disabled people (KFF 2018, 2026). + 2015-01-01: false NV: - 2015-01-01: true + # No medically needy pathway for aged, blind or disabled people (KFF 2018, 2026). + 2015-01-01: false NY: 2015-01-01: true OH: diff --git a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/is_in_medicaid_medically_needy_category.yaml b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/is_in_medicaid_medically_needy_category.yaml index 32e41686e95..707eb316a5b 100644 --- a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/is_in_medicaid_medically_needy_category.yaml +++ b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/is_in_medicaid_medically_needy_category.yaml @@ -54,3 +54,21 @@ # disabled), NDAC 75-02-02.1-26(1) (aged, blind and disabled groups), the # AR AABD spend down and IL PM 15-06-02-c cover disabled people. is_in_medicaid_medically_needy_category: [true, true, true, true, true] + +- name: Senior and disabled adult in Arizona, which has no medically needy pathway for them, are not in a medically needy category. + period: 2026 + input: + people: + person1: + age: 70 + person2: + age: 40 + meets_ssi_disability_criteria: true + households: + household: + members: [person1, person2] + state_code: AZ + output: + # KFF 2026 lists no medically needy pathway for older adults or people + # with disabilities in Arizona (likewise ID, IN, NM and NV). + is_in_medicaid_medically_needy_category: [false, false] From c1b120a6ed76235c3a485eadb88849ed90545a66 Mon Sep 17 00:00:00 2001 From: Ziming Date: Mon, 26 Oct 2026 20:52:15 -0400 Subject: [PATCH 6/9] Cite state sources for IA, NJ and KS limits; fix VT pages; number cases - Iowa 441-75.8(7) and (5)"a", the NJ fact sheet (archived) and SPA KS-25-0019 page 7 for the $475 standard, alongside KFF. - HBEE 29.14 cited from file page 50. - Number the two category cases 3 and 4, after PR 10370's Cases 1-2. Co-Authored-By: Claude Opus 5.5 --- .../medically_needy/limit/assets/couple.yaml | 4 ++++ .../medically_needy/limit/assets/individual.yaml | 4 ++++ .../medically_needy/limit/income/couple.yaml | 10 ++++++++-- .../medically_needy/limit/income/individual.yaml | 10 ++++++++-- .../is_in_medicaid_medically_needy_category.yaml | 4 ++-- 5 files changed, 26 insertions(+), 6 deletions(-) diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/assets/couple.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/assets/couple.yaml index 9dfb6fb3630..f957dc45bd3 100644 --- a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/assets/couple.yaml +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/assets/couple.yaml @@ -6,6 +6,10 @@ metadata: unit: currency-USD period: month reference: + - title: Iowa Administrative Code 441-75.8(5)"a" - Medically needy resource limit + href: https://www.legis.iowa.gov/docs/iac/chapter/441.75.pdf#page=22 + - title: New Jersey DMAHS, Medically Needy Segment fact sheet + href: https://web.archive.org/web/20260514003440id_/https://www.nj.gov/humanservices/dmahs/clients/medicaid/medically_needy_fact_sheet.pdf#page=1 - title: "Medicaid Financial Eligibility for Seniors and People with Disabilities: Findings from a 50-State Survey | KFF" 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 Welfare and Institutions Code 14005.62(a), (c), (d) diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/assets/individual.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/assets/individual.yaml index c49a71f390b..c318ddca22f 100644 --- a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/assets/individual.yaml +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/assets/individual.yaml @@ -6,6 +6,10 @@ metadata: unit: currency-USD period: month reference: + - title: Iowa Administrative Code 441-75.8(5)"a" - Medically needy resource limit + href: https://www.legis.iowa.gov/docs/iac/chapter/441.75.pdf#page=22 + - title: New Jersey DMAHS, Medically Needy Segment fact sheet + href: https://web.archive.org/web/20260514003440id_/https://www.nj.gov/humanservices/dmahs/clients/medicaid/medically_needy_fact_sheet.pdf#page=1 - title: "Medicaid Financial Eligibility for Seniors and People with Disabilities: Findings from a 50-State Survey | KFF" 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 Welfare and Institutions Code 14005.62(a), (c), (d) diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/couple.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/couple.yaml index 29cd31db478..7ed00c292ef 100644 --- a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/couple.yaml +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/couple.yaml @@ -6,6 +6,12 @@ metadata: unit: currency-USD period: month reference: + - title: Iowa Administrative Code 441-75.8(7) - Medically needy income level + href: https://www.legis.iowa.gov/docs/iac/chapter/441.75.pdf#page=24 + - title: New Jersey DMAHS, Medically Needy Segment fact sheet + href: https://web.archive.org/web/20260514003440id_/https://www.nj.gov/humanservices/dmahs/clients/medicaid/medically_needy_fact_sheet.pdf#page=1 + - title: CMS approval of Kansas State Plan Amendment KS-25-0019, medically needy income level + href: https://www.medicaid.gov/medicaid/spa/downloads/KS-25-0019.pdf#page=7 - title: Arkansas DHS Division of County Operations, Health Care Eligibility Quick Reference (January 2025), AABD Adult Spend Down href: https://humanservices.arkansas.gov/wp-content/uploads/Quick-Reference.pdf#page=1 - title: Arkansas DHS Medical Services Policy Manual (September 2026), O-710 Medically Needy Income Levels @@ -58,8 +64,8 @@ metadata: href: https://www.medicaid.gov/medicaid/spa/downloads/RI-26-0001.pdf#page=7 - title: Vermont Health Benefits Eligibility and Enrollment Rule, Part 2, section 8.06 - Medically-needy coverage group href: https://humanservices.vermont.gov/sites/ahsnew/files/documents/HBEE-Part-2-Eligibility-Standards.pdf#page=19 - - title: "Vermont Health Benefits Eligibility and Enrollment Rule, Part 5, section 29.14 - Determination of countable income #page 51-52" - href: https://humanservices.vermont.gov/sites/ahsnew/files/documents/HBEE-Part-5-Financial-Methodologies.pdf#page=51 + - title: "Vermont Health Benefits Eligibility and Enrollment Rule, Part 5, section 29.14 - Determination of countable income #page 50-52" + href: https://humanservices.vermont.gov/sites/ahsnew/files/documents/HBEE-Part-5-Financial-Methodologies.pdf#page=50 - title: Vermont DCF Bulletin 17-26, P-2420 Eligibility maximums for MABD, effective 1/1/18 href: https://outside.vermont.gov/dept/DCF/Shared%20Documents/ESD/Rules-Adopted/B17-26.pdf#page=3 - title: Vermont DVHA 2020 MABD PIL FPL Income Chart, effective 1/1/2020 diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/individual.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/individual.yaml index 275f9e95ef9..c535b4b49dc 100644 --- a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/individual.yaml +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/individual.yaml @@ -6,6 +6,12 @@ metadata: unit: currency-USD period: month reference: + - title: Iowa Administrative Code 441-75.8(7) - Medically needy income level + href: https://www.legis.iowa.gov/docs/iac/chapter/441.75.pdf#page=24 + - title: New Jersey DMAHS, Medically Needy Segment fact sheet + href: https://web.archive.org/web/20260514003440id_/https://www.nj.gov/humanservices/dmahs/clients/medicaid/medically_needy_fact_sheet.pdf#page=1 + - title: CMS approval of Kansas State Plan Amendment KS-25-0019, medically needy income level + href: https://www.medicaid.gov/medicaid/spa/downloads/KS-25-0019.pdf#page=7 - title: Arkansas DHS Division of County Operations, Health Care Eligibility Quick Reference (January 2025), AABD Adult Spend Down href: https://humanservices.arkansas.gov/wp-content/uploads/Quick-Reference.pdf#page=1 - title: Arkansas DHS Medical Services Policy Manual (September 2026), O-710 Medically Needy Income Levels @@ -58,8 +64,8 @@ metadata: href: https://www.medicaid.gov/medicaid/spa/downloads/RI-26-0001.pdf#page=7 - title: Vermont Health Benefits Eligibility and Enrollment Rule, Part 2, section 8.06 - Medically-needy coverage group href: https://humanservices.vermont.gov/sites/ahsnew/files/documents/HBEE-Part-2-Eligibility-Standards.pdf#page=19 - - title: "Vermont Health Benefits Eligibility and Enrollment Rule, Part 5, section 29.14 - Determination of countable income #page 51-52" - href: https://humanservices.vermont.gov/sites/ahsnew/files/documents/HBEE-Part-5-Financial-Methodologies.pdf#page=51 + - title: "Vermont Health Benefits Eligibility and Enrollment Rule, Part 5, section 29.14 - Determination of countable income #page 50-52" + href: https://humanservices.vermont.gov/sites/ahsnew/files/documents/HBEE-Part-5-Financial-Methodologies.pdf#page=50 - title: Vermont DCF Bulletin 17-26, P-2420 Eligibility maximums for MABD, effective 1/1/18 href: https://outside.vermont.gov/dept/DCF/Shared%20Documents/ESD/Rules-Adopted/B17-26.pdf#page=3 - title: Vermont DVHA 2020 MABD PIL FPL Income Chart, effective 1/1/2020 diff --git a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/is_in_medicaid_medically_needy_category.yaml b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/is_in_medicaid_medically_needy_category.yaml index 707eb316a5b..75097873646 100644 --- a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/is_in_medicaid_medically_needy_category.yaml +++ b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/is_in_medicaid_medically_needy_category.yaml @@ -14,7 +14,7 @@ output: is_in_medicaid_medically_needy_category: false -- name: Disabled adults in Arkansas, Iowa, Illinois, North Dakota and New Jersey are in a medically needy category. +- name: Case 3, disabled adults in Arkansas, Iowa, Illinois, North Dakota and New Jersey are in a medically needy category. period: 2026 input: people: @@ -55,7 +55,7 @@ # AR AABD spend down and IL PM 15-06-02-c cover disabled people. is_in_medicaid_medically_needy_category: [true, true, true, true, true] -- name: Senior and disabled adult in Arizona, which has no medically needy pathway for them, are not in a medically needy category. +- name: Case 4, a senior and a disabled adult in Arizona, which has no medically needy pathway for them, are not in a medically needy category. period: 2026 input: people: From 33d10a5f09bb7c69d2ecd6a11b0ad283a371a31c Mon Sep 17 00:00:00 2001 From: Ziming Date: Thu, 29 Oct 2026 14:33:46 -0400 Subject: [PATCH 7/9] Apply review: whole-dollar NY, ND and IL limits, DC 2019-2022, tests and references Co-Authored-By: Claude Opus 5.5 --- .../medicaid-medically-needy-limits.fixed.md | 2 +- .../medically_needy/categories/disabled.yaml | 5 + .../medically_needy/categories/senior.yaml | 5 + .../medically_needy/limit/assets/couple.yaml | 6 + .../limit/assets/individual.yaml | 6 + .../medically_needy/limit/income/couple.yaml | 14 +- .../limit/income/fpg_rate.yaml | 9 +- .../limit/income/individual.yaml | 13 +- .../limit/income/rounds_down_monthly.yaml | 15 ++ .../limit/income/rounds_up_monthly.yaml | 21 +++ .../limit/income/ssi_rate.yaml | 3 +- .../is_medically_needy_for_medicaid.yaml | 63 ++++++++ ...medicaid_medically_needy_income_limit.yaml | 134 +++++++++++++++--- .../medicaid_medically_needy_income_limit.py | 20 ++- 14 files changed, 292 insertions(+), 24 deletions(-) create mode 100644 policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/rounds_down_monthly.yaml create mode 100644 policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/rounds_up_monthly.yaml diff --git a/changelog.d/medicaid-medically-needy-limits.fixed.md b/changelog.d/medicaid-medically-needy-limits.fixed.md index fe86f4a3d72..4fe7b33107e 100644 --- a/changelog.d/medicaid-medically-needy-limits.fixed.md +++ b/changelog.d/medicaid-medically-needy-limits.fixed.md @@ -1 +1 @@ -Turned on the Medicaid medically needy pathway for aged, blind and disabled people in Arkansas, Iowa, Illinois, New Jersey and North Dakota, turned it off in Arizona, Idaho, Indiana, New Mexico and Nevada, which have no such program, and updated medically needy income and asset limits in 14 states, including Vermont's protected income level, tying them to the poverty guideline or the SSI federal benefit rate where state rules do. +Turned on the Medicaid medically needy pathway for aged, blind and disabled people in Arkansas, Iowa, Illinois, New Jersey and North Dakota, turned it off in Arizona, Idaho, Indiana, New Mexico and Nevada, which have no such program, and updated medically needy income and asset limits in 14 states and DC, including Vermont's protected income level and DC's 2019-2022 levels, tying them to the poverty guideline or the SSI federal benefit rate where state rules do, with New York and North Dakota rounding the monthly level up to the dollar and Illinois dropping the cents. diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/categories/disabled.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/categories/disabled.yaml index 5b83ab01de3..af0ab731519 100644 --- a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/categories/disabled.yaml +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/categories/disabled.yaml @@ -1,4 +1,5 @@ description: Whether people with disabilities can qualify for Medicaid under the 'medically needy' pathway. +# NOTE: Like every other state's, the AR, IA, IL, ND and NJ switches date from 2015-01-01, while their income and asset limits start in 2018, so 2015-2017 use the 2018 limits. metadata: label: Medicaid medically needy pathway for people with disabilities breakdown: @@ -17,6 +18,10 @@ metadata: href: https://www.dhs.state.il.us/page.aspx?item=16536 - title: New Jersey DMAHS, Medically Needy Segment fact sheet href: https://web.archive.org/web/20260514003440id_/https://www.nj.gov/humanservices/dmahs/clients/medicaid/medically_needy_fact_sheet.pdf#page=1 + - title: N.J.A.C. 10:70-1.2 - Purpose of the Medically Needy Manual + href: https://www.law.cornell.edu/regulations/new-jersey/N-J-A-C-10-70-1-2 + - title: N.J.A.C. 10:70-5.1 - Resource eligibility limits + href: https://www.law.cornell.edu/regulations/new-jersey/N-J-A-C-10-70-5-1 - title: North Dakota Non-ACA Medicaid Manual 510-05-85-40 - Medically needy income levels href: https://www.nd.gov/dhs/policymanuals/51005/510_05_85_40.htm - title: North Dakota Administrative Code 75-02-02.1-26(1) - Asset limits, medically needy aged, blind, and disabled diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/categories/senior.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/categories/senior.yaml index 65a4049496a..b1d55e332d7 100644 --- a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/categories/senior.yaml +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/categories/senior.yaml @@ -1,4 +1,5 @@ description: Whether seniors can qualify for Medicaid under the 'medically needy' pathway. +# NOTE: Like every other state's, the AR, IA, IL, ND and NJ switches date from 2015-01-01, while their income and asset limits start in 2018, so 2015-2017 use the 2018 limits. metadata: label: Medicaid medically needy pathway for seniors breakdown: @@ -17,6 +18,10 @@ metadata: href: https://www.dhs.state.il.us/page.aspx?item=16536 - title: New Jersey DMAHS, Medically Needy Segment fact sheet href: https://web.archive.org/web/20260514003440id_/https://www.nj.gov/humanservices/dmahs/clients/medicaid/medically_needy_fact_sheet.pdf#page=1 + - title: N.J.A.C. 10:70-1.2 - Purpose of the Medically Needy Manual + href: https://www.law.cornell.edu/regulations/new-jersey/N-J-A-C-10-70-1-2 + - title: N.J.A.C. 10:70-5.1 - Resource eligibility limits + href: https://www.law.cornell.edu/regulations/new-jersey/N-J-A-C-10-70-5-1 - title: North Dakota Non-ACA Medicaid Manual 510-05-85-40 - Medically needy income levels href: https://www.nd.gov/dhs/policymanuals/51005/510_05_85_40.htm - title: North Dakota Administrative Code 75-02-02.1-26(1) - Asset limits, medically needy aged, blind, and disabled diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/assets/couple.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/assets/couple.yaml index f957dc45bd3..dc218d5281d 100644 --- a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/assets/couple.yaml +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/assets/couple.yaml @@ -10,6 +10,10 @@ metadata: href: https://www.legis.iowa.gov/docs/iac/chapter/441.75.pdf#page=22 - title: New Jersey DMAHS, Medically Needy Segment fact sheet href: https://web.archive.org/web/20260514003440id_/https://www.nj.gov/humanservices/dmahs/clients/medicaid/medically_needy_fact_sheet.pdf#page=1 + - title: N.J.A.C. 10:70-1.2 - Purpose of the Medically Needy Manual + href: https://www.law.cornell.edu/regulations/new-jersey/N-J-A-C-10-70-1-2 + - title: N.J.A.C. 10:70-5.1 - Resource eligibility limits + href: https://www.law.cornell.edu/regulations/new-jersey/N-J-A-C-10-70-5-1 - title: "Medicaid Financial Eligibility for Seniors and People with Disabilities: Findings from a 50-State Survey | KFF" 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 Welfare and Institutions Code 14005.62(a), (c), (d) @@ -22,6 +26,8 @@ metadata: href: https://www.dhcs.ca.gov/services/medi-cal/eligibility/letters/Documents/25-14.pdf#page=1 - title: Illinois Department of Human Services Policy Manual PM 07-02-01 - Asset Limits href: https://www.dhs.state.il.us/page.aspx?Item=14876 + - title: New York DOH GIS 22 MA/01, Attachment I, 2022 SSI-Related Medicaid Income and Resource Levels + href: https://www.health.ny.gov/health_care/medicaid/publications/docs/gis/22ma01_att1.pdf#page=2 - title: New York DOH GIS 22 MA/11, Increase of Medicaid Medically Needy Income Level to 138% of the Federal Poverty Level href: https://www.health.ny.gov/health_care/medicaid/publications/docs/gis/22ma11.pdf#page=2 - title: New York DOH GIS 23 MA/02, Attachment 1, 2023 Income and Resource Standards diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/assets/individual.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/assets/individual.yaml index c318ddca22f..671d6701178 100644 --- a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/assets/individual.yaml +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/assets/individual.yaml @@ -10,6 +10,10 @@ metadata: href: https://www.legis.iowa.gov/docs/iac/chapter/441.75.pdf#page=22 - title: New Jersey DMAHS, Medically Needy Segment fact sheet href: https://web.archive.org/web/20260514003440id_/https://www.nj.gov/humanservices/dmahs/clients/medicaid/medically_needy_fact_sheet.pdf#page=1 + - title: N.J.A.C. 10:70-1.2 - Purpose of the Medically Needy Manual + href: https://www.law.cornell.edu/regulations/new-jersey/N-J-A-C-10-70-1-2 + - title: N.J.A.C. 10:70-5.1 - Resource eligibility limits + href: https://www.law.cornell.edu/regulations/new-jersey/N-J-A-C-10-70-5-1 - title: "Medicaid Financial Eligibility for Seniors and People with Disabilities: Findings from a 50-State Survey | KFF" 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 Welfare and Institutions Code 14005.62(a), (c), (d) @@ -22,6 +26,8 @@ metadata: href: https://www.dhcs.ca.gov/services/medi-cal/eligibility/letters/Documents/25-14.pdf#page=1 - title: Illinois Department of Human Services Policy Manual PM 07-02-01 - Asset Limits href: https://www.dhs.state.il.us/page.aspx?Item=14876 + - title: New York DOH GIS 22 MA/01, Attachment I, 2022 SSI-Related Medicaid Income and Resource Levels + href: https://www.health.ny.gov/health_care/medicaid/publications/docs/gis/22ma01_att1.pdf#page=2 - title: New York DOH GIS 22 MA/11, Increase of Medicaid Medically Needy Income Level to 138% of the Federal Poverty Level href: https://www.health.ny.gov/health_care/medicaid/publications/docs/gis/22ma11.pdf#page=2 - title: New York DOH GIS 23 MA/02, Attachment 1, 2023 Income and Resource Standards diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/couple.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/couple.yaml index 7ed00c292ef..71f7af89140 100644 --- a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/couple.yaml +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/couple.yaml @@ -1,4 +1,5 @@ -description: States limit income for a couple to this monthly amount under the Medicaid medically needy pathway; from the date a state's fpg_rate or ssi_rate is positive, the formula uses that rate instead. +description: States limit monthly income for a couple to this amount under the Medicaid medically needy program. +# NOTE: From the date a state's fpg_rate or ssi_rate is positive, the formula uses that rate instead of this amount. IL, MN, ND, UT and WA use a rate from 2018 and have no dollar entry. metadata: label: Medicaid medically needy pathway for couples income limit breakdown: @@ -10,6 +11,10 @@ metadata: href: https://www.legis.iowa.gov/docs/iac/chapter/441.75.pdf#page=24 - title: New Jersey DMAHS, Medically Needy Segment fact sheet href: https://web.archive.org/web/20260514003440id_/https://www.nj.gov/humanservices/dmahs/clients/medicaid/medically_needy_fact_sheet.pdf#page=1 + - title: N.J.A.C. 10:70-1.2 - Purpose of the Medically Needy Manual + href: https://www.law.cornell.edu/regulations/new-jersey/N-J-A-C-10-70-1-2 + - title: N.J.A.C. 10:70-5.1 - Resource eligibility limits + href: https://www.law.cornell.edu/regulations/new-jersey/N-J-A-C-10-70-5-1 - title: CMS approval of Kansas State Plan Amendment KS-25-0019, medically needy income level href: https://www.medicaid.gov/medicaid/spa/downloads/KS-25-0019.pdf#page=7 - title: Arkansas DHS Division of County Operations, Health Care Eligibility Quick Reference (January 2025), AABD Adult Spend Down @@ -44,6 +49,8 @@ metadata: href: https://www.medicaid.gov/medicaid/spa/downloads/NH-25-0012.pdf#page=7 - title: New Hampshire State Plan Amendment NH-25-0019, Medically Needy Income Level (effective July 1, 2025) href: https://www.medicaid.gov/medicaid/spa/downloads/NH-25-0019.pdf#page=7 + - title: New York DOH GIS 22 MA/01, Attachment I, 2022 SSI-Related Medicaid Income and Resource Levels + href: https://www.health.ny.gov/health_care/medicaid/publications/docs/gis/22ma01_att1.pdf#page=2 - title: New York DOH GIS 22 MA/11, Increase of Medicaid Medically Needy Income Level to 138% of the Federal Poverty Level href: https://www.health.ny.gov/health_care/medicaid/publications/docs/gis/22ma11.pdf#page=1 - title: Rhode Island 210-RICR-40-00-3, Medicaid Integrated Health Care Coverage, SSI Financial Eligibility Determinations (version effective January 1, 2020) @@ -104,6 +111,11 @@ CT: 2026-03-01: 1_153 DC: 2018-01-01: 652 + # NOTE: KFF 2018 reports DC's own $652 for couples; the 29 DCMR 901.1 method applies from 2019. + 2019-01-01: 704.58 + 2020-01-01: 718.33 + 2021-01-01: 725.83 + 2022-01-01: 762.92 2023-01-01: 821.67 2024-01-01: 851.67 2025-01-01: 881.25 diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/fpg_rate.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/fpg_rate.yaml index 35e3524b029..6a95b4ffdcc 100644 --- a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/fpg_rate.yaml +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/fpg_rate.yaml @@ -1,4 +1,5 @@ -description: States set the medically needy income limit at this share of the federal poverty guideline for a household of one or two under the Medicaid program. States not listed, or with a share of zero, use the dollar limits. +description: States set the medically needy income limit at this share of the federal poverty guideline for a household of one or two under the Medicaid program. +# NOTE: States not listed, or with a share of zero, use the dollar limits in individual.yaml and couple.yaml. metadata: unit: /1 period: year @@ -30,6 +31,10 @@ metadata: href: https://www.nd.gov/dhs/policymanuals/51003/Content/ML/2023/ML%203702%20Federal%20Poverty%20Level%20Updates%2004-01-2023.pdf#page=6 - title: North Dakota State Plan Amendment ND-23-0034 (effective January 1, 2024) href: https://www.medicaid.gov/medicaid/spa/downloads/ND-23-0034.pdf#page=2 + - title: North Dakota Manual Letter 3776, ACA Medically Needy (effective January 1, 2024) + href: https://www.nd.gov/dhs/policymanuals/51003/Content/ML/2023/ML%203776%20-ACA%20Med%20Needy.pdf#page=1 + - title: North Dakota Non-ACA Medicaid Manual 510-05-85-40 (archived, ML 3896), 90% of poverty from April 1, 2024 + href: https://www.nd.gov/dhs/policymanuals/51005/Archived%20Documents/2025/3896/510_05_85_40.htm - title: New York DOH GIS 22 MA/11, Increase of Medicaid Medically Needy Income Level to 138% of the Federal Poverty Level href: https://www.health.ny.gov/health_care/medicaid/publications/docs/gis/22ma11.pdf#page=1 - title: New York State Plan Amendment NY-23-0001 (effective January 1, 2023) @@ -41,7 +46,7 @@ metadata: - title: Wisconsin Statutes 49.47(4)(c)1 href: https://docs.legis.wisconsin.gov/statutes/statutes/49/iv/47/4/c - title: Wisconsin DHS Operations Memo 19-26, SSI-Related Medicaid Medically Needy Income Limit Increase - href: https://www.dhs.wisconsin.gov/dms/memos/ops/dms-ops-2019-26.pdf#page=2 + href: https://web.archive.org/web/20251031224345id_/https://www.dhs.wisconsin.gov/dms/memos/ops/dms-ops-2019-26.pdf#page=2 - title: Wisconsin Medicaid Eligibility Handbook (EBD) 39.4.1 - Elderly, Blind, or Disabled Assets and Income Table href: https://www.emhandbooks.wisconsin.gov/meh-ebd/policy_files/39/39.4.htm diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/individual.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/individual.yaml index c535b4b49dc..e57ea1c221a 100644 --- a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/individual.yaml +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/individual.yaml @@ -1,4 +1,5 @@ -description: States limit income for an individual to this monthly amount under the Medicaid medically needy pathway; from the date a state's fpg_rate or ssi_rate is positive, the formula uses that rate instead. +description: States limit monthly income for an individual to this amount under the Medicaid medically needy program. +# NOTE: From the date a state's fpg_rate or ssi_rate is positive, the formula uses that rate instead of this amount. IL, MN, ND, UT and WA use a rate from 2018 and have no dollar entry. metadata: label: Medicaid medically needy pathway for individuals income limit breakdown: @@ -10,6 +11,10 @@ metadata: href: https://www.legis.iowa.gov/docs/iac/chapter/441.75.pdf#page=24 - title: New Jersey DMAHS, Medically Needy Segment fact sheet href: https://web.archive.org/web/20260514003440id_/https://www.nj.gov/humanservices/dmahs/clients/medicaid/medically_needy_fact_sheet.pdf#page=1 + - title: N.J.A.C. 10:70-1.2 - Purpose of the Medically Needy Manual + href: https://www.law.cornell.edu/regulations/new-jersey/N-J-A-C-10-70-1-2 + - title: N.J.A.C. 10:70-5.1 - Resource eligibility limits + href: https://www.law.cornell.edu/regulations/new-jersey/N-J-A-C-10-70-5-1 - title: CMS approval of Kansas State Plan Amendment KS-25-0019, medically needy income level href: https://www.medicaid.gov/medicaid/spa/downloads/KS-25-0019.pdf#page=7 - title: Arkansas DHS Division of County Operations, Health Care Eligibility Quick Reference (January 2025), AABD Adult Spend Down @@ -44,6 +49,8 @@ metadata: href: https://www.medicaid.gov/medicaid/spa/downloads/NH-25-0012.pdf#page=7 - title: New Hampshire State Plan Amendment NH-25-0019, Medically Needy Income Level (effective July 1, 2025) href: https://www.medicaid.gov/medicaid/spa/downloads/NH-25-0019.pdf#page=7 + - title: New York DOH GIS 22 MA/01, Attachment I, 2022 SSI-Related Medicaid Income and Resource Levels + href: https://www.health.ny.gov/health_care/medicaid/publications/docs/gis/22ma01_att1.pdf#page=2 - title: New York DOH GIS 22 MA/11, Increase of Medicaid Medically Needy Income Level to 138% of the Federal Poverty Level href: https://www.health.ny.gov/health_care/medicaid/publications/docs/gis/22ma11.pdf#page=1 - title: Rhode Island 210-RICR-40-00-3, Medicaid Integrated Health Care Coverage, SSI Financial Eligibility Determinations (version effective January 1, 2020) @@ -104,6 +111,10 @@ CT: 2026-03-01: 851 DC: 2018-01-01: 652 + 2019-01-01: 669.35 + 2020-01-01: 682.42 + 2021-01-01: 689.54 + 2022-01-01: 724.77 2023-01-01: 780.58 2024-01-01: 809.08 2025-01-01: 837.19 diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/rounds_down_monthly.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/rounds_down_monthly.yaml new file mode 100644 index 00000000000..02c9236b4fa --- /dev/null +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/rounds_down_monthly.yaml @@ -0,0 +1,15 @@ +description: States round the monthly medically needy income limit down to a whole dollar under the Medicaid program, if this is true. +metadata: + unit: bool + period: year + label: Medicaid medically needy income limit rounded down to a whole dollar + breakdown: + - state_code + reference: + - title: Illinois DHS Workers' Action Guide WAG 25-03-02(2), AABD 100% FPL monthly income standards ($1,803 for two in 2026) + href: https://www.dhs.state.il.us/page.aspx?item=21741 + +IL: + # IDHS tables drop the cents for one and two people from 2023; KFF 2018 does not. + 2018-01-01: false + 2023-01-01: true diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/rounds_up_monthly.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/rounds_up_monthly.yaml new file mode 100644 index 00000000000..50e188d6a67 --- /dev/null +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/rounds_up_monthly.yaml @@ -0,0 +1,21 @@ +description: States round the monthly medically needy income limit up to the next whole dollar under the Medicaid program, if this is true. +metadata: + unit: bool + period: year + label: Medicaid medically needy income limit rounded up to a whole dollar + breakdown: + - state_code + reference: + - title: New York DOH GIS 26 MA/05, Attachment I, SSI-Related Medicaid Income Level $1,836 / $2,489 (138% FPL) + href: https://www.health.ny.gov/health_care/medicaid/publications/docs/gis/26ma05_att1.pdf#page=2 + - title: New York DOH GIS 25 MA/03, Attachment I, SSI-Related Medicaid Income Level $1,800 / $2,433 (138% FPL) + href: https://www.health.ny.gov/health_care/medicaid/publications/docs/gis/25ma03_att1.pdf#page=2 + - title: North Dakota Manual Letter 3702, medically needy income levels $1,009 / $1,364 (83% FPL) + href: https://www.nd.gov/dhs/policymanuals/51003/Content/ML/2023/ML%203702%20Federal%20Poverty%20Level%20Updates%2004-01-2023.pdf#page=6 + - title: North Dakota Non-ACA Medicaid Manual 510-05-85-40 (archived, ML 3896), medically needy income level $1,130 (90% FPL) + href: https://www.nd.gov/dhs/policymanuals/51005/Archived%20Documents/2025/3896/510_05_85_40.htm + +ND: + 2018-01-01: true +NY: + 2018-01-01: true diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/ssi_rate.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/ssi_rate.yaml index eb3784d907f..4240fcfd4ec 100644 --- a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/ssi_rate.yaml +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/ssi_rate.yaml @@ -1,4 +1,5 @@ -description: States set the medically needy income limit at this share of the Supplemental Security Income federal benefit rate under the Medicaid program. States not listed, or with a share of zero, use the dollar limits. +description: States set the medically needy income limit at this share of the Supplemental Security Income federal benefit rate under the Medicaid program. +# NOTE: States not listed, or with a share of zero, use the dollar limits in individual.yaml and couple.yaml. metadata: unit: /1 period: year diff --git a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/is_medically_needy_for_medicaid.yaml b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/is_medically_needy_for_medicaid.yaml index 4da0f2cdaa5..7274ca89020 100644 --- a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/is_medically_needy_for_medicaid.yaml +++ b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/is_medically_needy_for_medicaid.yaml @@ -637,3 +637,66 @@ output: # 20,000 - 3,488 = 16,512, or 1,376 a month, over 1,375. is_medically_needy_for_medicaid: false + +- name: Case 24, Illinois senior with assets at the 17,500 limit qualifies in 2024. + period: 2024 + input: + age: 70 + is_adult_for_medicaid: false + is_optional_senior_or_disabled_for_medicaid: false + is_ssi_recipient_for_medicaid: false + ssi_countable_income: 20_000 + medicaid_medically_needy_medical_expenses: 6_000 + ssi_countable_resources: 17_500 + state_code: IL + output: + # Limit 15,060 (100% FPG, 2024). 20,000 - 6,000 = 14,000; assets 17,500 equal + # the limit from 2023-05-12, first read in 2024 (PM 07-02-01). + is_in_medicaid_medically_needy_category: true + is_medically_needy_for_medicaid: true + +- name: Case 25, New York senior at the published 1,836 monthly level qualifies in 2026. + period: 2026 + input: + age: 70 + is_adult_for_medicaid: false + is_optional_senior_or_disabled_for_medicaid: false + is_ssi_recipient_for_medicaid: false + ssi_countable_income: 22_032 + medicaid_medically_needy_medical_expenses: 0 + ssi_countable_resources: 1_000 + state_code: NY + output: + # GIS 26 MA/05: 1,836 x 12 = 22,032 (138% FPL is 1,835.40, rounded up). + is_medically_needy_for_medicaid: true + +- name: Case 26, New York senior one dollar a year above the published level does not qualify in 2026. + period: 2026 + input: + age: 70 + is_adult_for_medicaid: false + is_optional_senior_or_disabled_for_medicaid: false + is_ssi_recipient_for_medicaid: false + ssi_countable_income: 22_033 + medicaid_medically_needy_medical_expenses: 0 + ssi_countable_resources: 1_000 + state_code: NY + output: + # 22,033 is above the published 22,032 (1,836 x 12). + is_medically_needy_for_medicaid: false + +- name: Case 27, Illinois couple above the published 1,803 monthly level does not qualify in 2026. + period: 2026 + input: + people: + person1: {age: 70, is_tax_unit_head: true, is_adult_for_medicaid: false, is_optional_senior_or_disabled_for_medicaid: false, is_ssi_recipient_for_medicaid: false, ssi_countable_income: 21_640, medicaid_medically_needy_medical_expenses: 0, ssi_countable_resources: 1_000} + person2: {age: 68, is_tax_unit_spouse: true, is_adult_for_medicaid: false, is_optional_senior_or_disabled_for_medicaid: false, is_ssi_recipient_for_medicaid: false, ssi_countable_income: 0, medicaid_medically_needy_medical_expenses: 0, ssi_countable_resources: 0} + marital_units: + marital_unit: {members: [person1, person2]} + tax_units: + tax_unit: {members: [person1, person2]} + households: + household: {members: [person1, person2], state_code: IL} + output: + # WAG 25-03-02(2): 1,803 x 12 = 21,636 (21,640 / 12 = 1,803.33, cents dropped). + is_medically_needy_for_medicaid: [false, false] diff --git a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_income_limit.yaml b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_income_limit.yaml index c42c21cc37a..a9f1b197349 100644 --- a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_income_limit.yaml +++ b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_income_limit.yaml @@ -79,7 +79,6 @@ # 475 x 12 = 5,700. medicaid_medically_needy_income_limit: 5_700 - - name: Case 4, Kansas couple uses the SSI couple rate from July 2025. period: 2026 absolute_error_margin: 0.01 @@ -103,7 +102,6 @@ # 1,491 x 12 = 17,892. medicaid_medically_needy_income_limit: [17_892, 17_892] - - name: Case 5, Minnesota uses 100 percent of the poverty guideline. period: 2026 absolute_error_margin: 0.01 @@ -114,7 +112,6 @@ # 1.00 x 15,960 = 15,960. medicaid_medically_needy_income_limit: 15_960 - - name: Case 6, New Hampshire couple and individual dollar limits in 2023, 2025 and 2026. period: 2026 absolute_error_margin: 0.01 @@ -169,9 +166,9 @@ members: [person1, person2] state_code: NY output: - # 1.38 x 21,640 = 29,863.20. - medicaid_medically_needy_income_limit: [29_863.2, 29_863.2] - + # 1.38 x 21,640 / 12 = 2,488.60, rounded up to 2,489 (GIS 26 MA/05): + # 2,489 x 12 = 29,868. + medicaid_medically_needy_income_limit: [29_868, 29_868] - name: Case 8, Rhode Island couple and individual dollar limits from 2019 to 2026. period: 2026 @@ -234,7 +231,6 @@ # 1.00 x 21,640 = 21,640. medicaid_medically_needy_income_limit: [21_640, 21_640] - - name: Case 10, Washington couple uses the one-person SSI rate. period: 2026 absolute_error_margin: 0.01 @@ -258,7 +254,6 @@ # 994 x 12 = 11,928. medicaid_medically_needy_income_limit: [11_928, 11_928] - - name: Case 11, Wisconsin uses 100 percent of the poverty guideline. period: 2026 absolute_error_margin: 0.01 @@ -269,7 +264,6 @@ # 1.00 x 15,960 = 15,960. medicaid_medically_needy_income_limit: 15_960 - - name: Case 12, Illinois couple uses 100 percent of the two-person poverty guideline. period: 2026 absolute_error_margin: 0.01 @@ -290,9 +284,9 @@ members: [person1, person2] state_code: IL output: - # 1.00 x 21,640 = 21,640. - medicaid_medically_needy_income_limit: [21_640, 21_640] - + # 21,640 / 12 = 1,803.33, with the cents dropped (WAG 25-03-02(2)): + # 1,803 x 12 = 21,636. + medicaid_medically_needy_income_limit: [21_636, 21_636] - name: Case 13, North Dakota uses 90 percent of the poverty guideline. period: 2026 @@ -331,10 +325,11 @@ state_code: {2022: NY, 2023: NY} output: # Outputs are [couple, couple, individual]. 2022: 1,367 / 934 times 12. - # 2023: 1.38 x 19,720 and 1.38 x 14,580. + # 2023: 1.38 x 19,720 / 12 = 2,267.80 and 1.38 x 14,580 / 12 = 1,676.70, + # rounded up to 2,268 and 1,677 a month. medicaid_medically_needy_income_limit: 2022: [16_404, 16_404, 11_208] - 2023: [27_213.6, 27_213.6, 20_120.4] + 2023: [27_216, 27_216, 20_124] - name: Case 15, Minnesota uses 80 percent of the poverty guideline in 2019 and 81 percent in 2020. period: 2020 @@ -395,9 +390,11 @@ members: [person1, person2, person3] state_code: {2023: ND} output: - # Outputs are [couple, couple, individual]: 0.83 x 19,720 and 0.83 x 14,580. + # Outputs are [couple, couple, individual]: 0.83 x 19,720 / 12 = 1,363.97 + # and 0.83 x 14,580 / 12 = 1,008.45, rounded up to 1,364 and 1,009 a month + # (ML 3702). medicaid_medically_needy_income_limit: - 2023: [16_367.6, 16_367.6, 12_101.4] + 2023: [16_368, 16_368, 12_108] - name: Case 17, Wisconsin uses its dollar limit in 2019 and 100 percent of the poverty guideline from 2020. period: 2020 @@ -470,3 +467,108 @@ 2024: [15_600, 15_600, 15_600] 2025: [15_996, 15_996, 15_996] 2026: [16_500, 16_500, 16_500] + +- name: Case 19, Arkansas, Iowa and New Jersey couple and individual dollar limits in 2026. + period: 2026 + absolute_error_margin: 0.01 + input: + people: + person1: {age: 70} + person2: {age: 68} + person3: {age: 74} + person4: {age: 70} + person5: {age: 68} + person6: {age: 74} + person7: {age: 70} + person8: {age: 68} + person9: {age: 74} + marital_units: + marital_unit1: {members: [person1, person2]} + marital_unit2: {members: [person3]} + marital_unit3: {members: [person4, person5]} + marital_unit4: {members: [person6]} + marital_unit5: {members: [person7, person8]} + marital_unit6: {members: [person9]} + tax_units: + tax_unit1: {members: [person1, person2]} + tax_unit2: {members: [person3]} + tax_unit3: {members: [person4, person5]} + tax_unit4: {members: [person6]} + tax_unit5: {members: [person7, person8]} + tax_unit6: {members: [person9]} + households: + household1: {members: [person1, person2, person3], state_code: AR} + household2: {members: [person4, person5, person6], state_code: IA} + household3: {members: [person7, person8, person9], state_code: NJ} + output: + # AR: 216.66 / 108.33 x 12; IA: 483 / 483 x 12; NJ: 434 / 367 x 12. + medicaid_medically_needy_income_limit: [2_599.92, 2_599.92, 1_299.96, 5_796, 5_796, 5_796, 5_208, 5_208, 4_404] + +- name: Case 20, North Dakota uses 90 percent of the poverty guideline from 2024 and Minnesota 100 percent from 2023. + period: 2024 + absolute_error_margin: 0.01 + input: + people: + person1: {age: 70} + person2: {age: 70} + marital_units: + marital_unit1: {members: [person1]} + marital_unit2: {members: [person2]} + tax_units: + tax_unit1: {members: [person1]} + tax_unit2: {members: [person2]} + households: + household1: {members: [person1], state_code: {2023: MN, 2024: MN}} + household2: {members: [person2], state_code: {2023: ND, 2024: ND}} + output: + # [MN, ND]. 2023: 100% and 83% of 14,580 (ND 1,008.45 rounds up to 1,009 a month). + # 2024: 100% and 90% of 15,060 (ND 1,129.50 rounds up to 1,130, ML 3896). + medicaid_medically_needy_income_limit: + 2023: [14_580, 12_108] + 2024: [15_060, 13_560] + +- name: Case 21, aged parent claimed as a dependent on a married child's joint return uses the individual limit. + period: 2026 + absolute_error_margin: 0.01 + input: + people: + person1: {age: 50, is_tax_unit_head: true} + person2: {age: 48, is_tax_unit_spouse: true} + person3: {age: 78, is_tax_unit_dependent: true} + marital_units: + marital_unit1: {members: [person1, person2]} + marital_unit2: {members: [person3]} + tax_units: + tax_unit: {members: [person1, person2, person3]} + households: + household: {members: [person1, person2, person3], state_code: NY} + output: + # 42 CFR 435.602: the unit is the individual or married couple, not the tax unit. + # person3 is unmarried: 1.38 x 15,960 / 12 = 1,835.40, rounded up to 1,836, x 12. + medicaid_medically_needy_income_limit: [29_868, 29_868, 22_032] + +- name: Case 22, District of Columbia couple and individual limits from 2019 to 2022 follow 29 DCMR 901.1. + period: 2022 + absolute_error_margin: 0.01 + input: + people: + person1: {age: 70} + person2: {age: 68} + person3: {age: 74} + marital_units: + marital_unit1: {members: [person1, person2]} + marital_unit2: {members: [person3]} + tax_units: + tax_unit1: {members: [person1, person2]} + tax_unit2: {members: [person3]} + households: + household: + members: [person1, person2, person3] + state_code: {2019: DC, 2020: DC, 2021: DC, 2022: DC} + output: + # Couple: 50% of the two-person guideline / 12; individual: 95% of that. + medicaid_medically_needy_income_limit: + 2019: [8_454.96, 8_454.96, 8_032.2] + 2020: [8_619.96, 8_619.96, 8_189.04] + 2021: [8_709.96, 8_709.96, 8_274.48] + 2022: [9_155.04, 9_155.04, 8_697.24] diff --git a/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_income_limit.py b/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_income_limit.py index c40af6acf41..274cb767e2a 100644 --- a/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_income_limit.py +++ b/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_income_limit.py @@ -21,7 +21,7 @@ def formula(person, period, parameters): # SSI financial responsibility rules (42 CFR 435.602): the unit is # the individual or the married couple, not the tax filing unit. is_couple = person.marital_unit.nb_persons() == 2 - # Washington applies its one-person limit to a couple. + # Some states apply the one-person limit to a couple. same_limit = p.couple_uses_individual_limit[state].astype(bool) uses_couple_limit = is_couple & ~same_limit dollar_limit = where(uses_couple_limit, p.couple[state], p.individual[state]) @@ -31,10 +31,26 @@ def formula(person, period, parameters): fbr = where(uses_couple_limit, ssi.couple, ssi.individual) fpg_rate = p.fpg_rate[state] ssi_rate = p.ssi_rate[state] + fpg_limit = fpg_rate * unit_fpg + # Some states publish the monthly level in whole dollars. Fix the + # monthly amount at cent precision first, so floating-point noise + # cannot move an exact whole dollar (as in medicaid_income_level). + fpg_monthly = np.round(fpg_limit / MONTHS_IN_YEAR, 2) + fpg_limit = select( + [ + p.rounds_up_monthly[state].astype(bool), + p.rounds_down_monthly[state].astype(bool), + ], + [ + np.ceil(fpg_monthly) * MONTHS_IN_YEAR, + np.floor(fpg_monthly) * MONTHS_IN_YEAR, + ], + default=fpg_limit, + ) return select( [fpg_rate > 0, ssi_rate > 0], [ - fpg_rate * unit_fpg, + fpg_limit, ssi_rate * fbr * MONTHS_IN_YEAR, ], default=dollar_limit * MONTHS_IN_YEAR, From 0f8b603643e23993ebaa3fbb850fa2e25f843319 Mon Sep 17 00:00:00 2001 From: Ziming Date: Thu, 29 Oct 2026 17:42:49 -0400 Subject: [PATCH 8/9] Move the Illinois rounding flag to a scalar parameter; review test and comments Co-Authored-By: Claude Opus 5.5 --- .../income/{ => il}/rounds_down_monthly.yaml | 15 +++++------ .../is_medically_needy_for_medicaid.yaml | 8 +++--- ...medicaid_medically_needy_income_limit.yaml | 26 +++++++++++++++++++ .../medicaid_medically_needy_income_limit.py | 4 ++- 4 files changed, 39 insertions(+), 14 deletions(-) rename policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/{ => il}/rounds_down_monthly.yaml (59%) diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/rounds_down_monthly.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/il/rounds_down_monthly.yaml similarity index 59% rename from policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/rounds_down_monthly.yaml rename to policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/il/rounds_down_monthly.yaml index 02c9236b4fa..dcab04882e6 100644 --- a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/rounds_down_monthly.yaml +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/il/rounds_down_monthly.yaml @@ -1,15 +1,12 @@ -description: States round the monthly medically needy income limit down to a whole dollar under the Medicaid program, if this is true. +description: Illinois rounds the monthly medically needy income limit down to a whole dollar under the Medicaid program, if this is true. +values: + # IDHS tables drop the cents for one and two people from 2023; KFF 2018 does not. + 2018-01-01: false + 2023-01-01: true metadata: unit: bool period: year - label: Medicaid medically needy income limit rounded down to a whole dollar - breakdown: - - state_code + label: Illinois Medicaid medically needy income limit rounded down to a whole dollar reference: - title: Illinois DHS Workers' Action Guide WAG 25-03-02(2), AABD 100% FPL monthly income standards ($1,803 for two in 2026) href: https://www.dhs.state.il.us/page.aspx?item=21741 - -IL: - # IDHS tables drop the cents for one and two people from 2023; KFF 2018 does not. - 2018-01-01: false - 2023-01-01: true diff --git a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/is_medically_needy_for_medicaid.yaml b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/is_medically_needy_for_medicaid.yaml index 7274ca89020..a197c79fd71 100644 --- a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/is_medically_needy_for_medicaid.yaml +++ b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/is_medically_needy_for_medicaid.yaml @@ -445,7 +445,7 @@ ssi_countable_resources: 33_038 state_code: NY output: - # Limit 1.38 x 15,960 = 22,024.80. 25,000 - 5,000 = 20,000; assets 33,038 equal + # Limit 1,836 x 12 = 22,032 (GIS 26 MA/05). 25,000 - 5,000 = 20,000; assets 33,038 equal # the 2026 resource level. is_in_medicaid_medically_needy_category: true is_medically_needy_for_medicaid: true @@ -499,7 +499,7 @@ state_code: {2022: NY, 2023: NY, 2024: NY, 2025: NY, 2026: NY} output: # 2022: 25,000 - 15,000 = 10,000 <= 934 x 12 = 11,208. - # 2023-2026: 20,000 <= 1.38 x FPG (20,120.40, 20,782.80, 21,597, 22,024.80). + # 2023-2026: 20,000 <= 12 x 1,677, 1,732, 1,800 and 1,836 (20,124, 20,784, 21,600, 22,032). # Resources equal each year's level (GIS 22 MA/11 p2; the 2023-2026 GIS # attachments). is_medically_needy_for_medicaid: @@ -602,9 +602,9 @@ members: [person5, person6] state_code: IL output: - # NY: 40,000 - 12,000 = 28,000 <= 1.38 x 21,640 = 29,863.20; assets 44,796. + # NY: 40,000 - 12,000 = 28,000 <= 2,489 x 12 = 29,868; assets 44,796. # CA: 36,000 - 25,000 = 11,000 <= 934 x 12 = 11,208; assets 195,000. - # IL: 28,000 - 7,000 = 21,000 <= 21,640; assets 17,500 (PM 07-02-01). + # IL: 28,000 - 7,000 = 21,000 <= 1,803 x 12 = 21,636; assets 17,500 (PM 07-02-01). is_medically_needy_for_medicaid: [true, true, true, true, true, true] - name: Case 22, Vermont senior with income after medical expenses at the 2026 protected income level qualifies. diff --git a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_income_limit.yaml b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_income_limit.yaml index a9f1b197349..c1ea8172c80 100644 --- a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_income_limit.yaml +++ b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_income_limit.yaml @@ -572,3 +572,29 @@ 2020: [8_619.96, 8_619.96, 8_189.04] 2021: [8_709.96, 8_709.96, 8_274.48] 2022: [9_155.04, 9_155.04, 8_697.24] + +- name: Case 23, Illinois keeps the cents in 2022 and drops them from 2023. + period: 2023 + absolute_error_margin: 0.01 + input: + people: + person1: {age: 70} + person2: {age: 68} + person3: {age: 74} + marital_units: + marital_unit1: {members: [person1, person2]} + marital_unit2: {members: [person3]} + tax_units: + tax_unit1: {members: [person1, person2]} + tax_unit2: {members: [person3]} + households: + household: + members: [person1, person2, person3] + state_code: {2022: IL, 2023: IL} + output: + # Outputs are [couple, couple, individual]. 2022: 18,310 and 13,590 (1,132.50 a + # month, not rounded). 2023: 19,720 / 12 = 1,643.33, cents dropped, 1,643 x 12; + # 14,580 / 12 = 1,215 exactly. + medicaid_medically_needy_income_limit: + 2022: [18_310, 18_310, 13_590] + 2023: [19_716, 19_716, 14_580] diff --git a/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_income_limit.py b/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_income_limit.py index 274cb767e2a..64e892ff38e 100644 --- a/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_income_limit.py +++ b/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_income_limit.py @@ -36,10 +36,12 @@ def formula(person, period, parameters): # monthly amount at cent precision first, so floating-point noise # cannot move an exact whole dollar (as in medicaid_income_level). fpg_monthly = np.round(fpg_limit / MONTHS_IN_YEAR, 2) + # Illinois is the only state that drops the cents. + rounds_down = (state == "IL") & p.il.rounds_down_monthly fpg_limit = select( [ p.rounds_up_monthly[state].astype(bool), - p.rounds_down_monthly[state].astype(bool), + rounds_down, ], [ np.ceil(fpg_monthly) * MONTHS_IN_YEAR, From bdb48a7b2c28d05d3b7995882a2d1f8bc5d7b864 Mon Sep 17 00:00:00 2001 From: Ziming Date: Fri, 30 Oct 2026 10:47:48 -0400 Subject: [PATCH 9/9] Round Illinois medically needy limits to the nearest dollar through 2024 KFF 2018 and the IDHS 2019-2024 tables round the monthly level to the nearest dollar; the 2025 and 2026 tables drop the cents. Add the scalar il/rounds_to_nearest_monthly flag and move il/rounds_down_monthly to 2025. Co-Authored-By: Claude Opus 5.5 --- .../medicaid-medically-needy-limits.fixed.md | 2 +- .../limit/income/il/rounds_down_monthly.yaml | 6 ++++-- .../income/il/rounds_to_nearest_monthly.yaml | 17 +++++++++++++++++ .../medicaid_medically_needy_income_limit.yaml | 16 ++++++++-------- .../medicaid_medically_needy_income_limit.py | 10 ++++++++-- 5 files changed, 38 insertions(+), 13 deletions(-) create mode 100644 policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/il/rounds_to_nearest_monthly.yaml diff --git a/changelog.d/medicaid-medically-needy-limits.fixed.md b/changelog.d/medicaid-medically-needy-limits.fixed.md index 4fe7b33107e..10cf60e5fef 100644 --- a/changelog.d/medicaid-medically-needy-limits.fixed.md +++ b/changelog.d/medicaid-medically-needy-limits.fixed.md @@ -1 +1 @@ -Turned on the Medicaid medically needy pathway for aged, blind and disabled people in Arkansas, Iowa, Illinois, New Jersey and North Dakota, turned it off in Arizona, Idaho, Indiana, New Mexico and Nevada, which have no such program, and updated medically needy income and asset limits in 14 states and DC, including Vermont's protected income level and DC's 2019-2022 levels, tying them to the poverty guideline or the SSI federal benefit rate where state rules do, with New York and North Dakota rounding the monthly level up to the dollar and Illinois dropping the cents. +Turned on the Medicaid medically needy pathway for aged, blind and disabled people in Arkansas, Iowa, Illinois, New Jersey and North Dakota, turned it off in Arizona, Idaho, Indiana, New Mexico and Nevada, which have no such program, and updated medically needy income and asset limits in 14 states and DC, including Vermont's protected income level and DC's 2019-2022 levels, tying them to the poverty guideline or the SSI federal benefit rate where state rules do, with New York and North Dakota rounding the monthly level up to the dollar and Illinois rounding it to the nearest dollar through 2024 and dropping the cents from 2025. diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/il/rounds_down_monthly.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/il/rounds_down_monthly.yaml index dcab04882e6..2c3f8f7613c 100644 --- a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/il/rounds_down_monthly.yaml +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/il/rounds_down_monthly.yaml @@ -1,8 +1,8 @@ description: Illinois rounds the monthly medically needy income limit down to a whole dollar under the Medicaid program, if this is true. values: - # IDHS tables drop the cents for one and two people from 2023; KFF 2018 does not. + # IDHS tables drop the cents from 2025 ($1,762 for $1,762.50 for two; $2,220 for $2,220.83 for three). 2018-01-01: false - 2023-01-01: true + 2025-01-01: true metadata: unit: bool period: year @@ -10,3 +10,5 @@ metadata: reference: - title: Illinois DHS Workers' Action Guide WAG 25-03-02(2), AABD 100% FPL monthly income standards ($1,803 for two in 2026) href: https://www.dhs.state.il.us/page.aspx?item=21741 + - title: Illinois DHS WAG 25-03-02(2), 2025 Monthly Income Standards, AABD 100% FPL ($1,762 for two) (archived May 15, 2025) + href: https://web.archive.org/web/20250515155649/https://www.dhs.state.il.us/page.aspx?item=21741 diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/il/rounds_to_nearest_monthly.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/il/rounds_to_nearest_monthly.yaml new file mode 100644 index 00000000000..6a16b28bcce --- /dev/null +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/il/rounds_to_nearest_monthly.yaml @@ -0,0 +1,17 @@ +description: Illinois rounds the monthly medically needy income limit to the nearest whole dollar under the Medicaid program, if this is true. +values: + # KFF 2018 ($1,012 / $1,372) and IDHS 2019-2024 tables round to the nearest dollar + # ($1,133 / $1,526 in 2022; $2,072 for $2,071.67 for three in 2023). + 2018-01-01: true + 2025-01-01: false +metadata: + unit: bool + period: year + label: Illinois Medicaid medically needy income limit rounded to the nearest whole dollar + reference: + - title: "KFF, Medicaid Financial Eligibility for Seniors and People with Disabilities: Findings from a 50-State Survey, Appendix Table 3 (2018), Illinois $1,012 / $1,372" + 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: Illinois DHS WAG 25-03-02(2), 2022 Income Standards, AABD 100% FPL ($1,133 / $1,526) (archived September 28, 2022) + href: https://web.archive.org/web/20220928154002/https://www.dhs.state.il.us/page.aspx?item=21741 + - title: Illinois DHS WAG 25-03-02(2), 2024 Monthly Income Standards, AABD 100% FPL ($1,255 / $1,703) (archived July 15, 2024) + href: https://web.archive.org/web/20240715015033/https://www.dhs.state.il.us/page.aspx?item=21741 diff --git a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_income_limit.yaml b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_income_limit.yaml index c1ea8172c80..99b5c2e2c34 100644 --- a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_income_limit.yaml +++ b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_income_limit.yaml @@ -573,8 +573,8 @@ 2021: [8_709.96, 8_709.96, 8_274.48] 2022: [9_155.04, 9_155.04, 8_697.24] -- name: Case 23, Illinois keeps the cents in 2022 and drops them from 2023. - period: 2023 +- name: Case 23, Illinois rounds to the nearest dollar in 2022 and drops the cents in 2025. + period: 2025 absolute_error_margin: 0.01 input: people: @@ -590,11 +590,11 @@ households: household: members: [person1, person2, person3] - state_code: {2022: IL, 2023: IL} + state_code: {2022: IL, 2025: IL} output: - # Outputs are [couple, couple, individual]. 2022: 18,310 and 13,590 (1,132.50 a - # month, not rounded). 2023: 19,720 / 12 = 1,643.33, cents dropped, 1,643 x 12; - # 14,580 / 12 = 1,215 exactly. + # Outputs are [couple, couple, individual]. WAG 25-03-02(2), AABD 100% FPL. + # 2022: 18,310 / 12 = 1,525.83 to 1,526; 13,590 / 12 = 1,132.50 to 1,133. + # 2025: 21,150 / 12 = 1,762.50, cents dropped, 1,762; 15,650 / 12 = 1,304.17 to 1,304. medicaid_medically_needy_income_limit: - 2022: [18_310, 18_310, 13_590] - 2023: [19_716, 19_716, 14_580] + 2022: [18_312, 18_312, 13_596] + 2025: [21_144, 21_144, 15_648] diff --git a/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_income_limit.py b/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_income_limit.py index 64e892ff38e..dd644e12c12 100644 --- a/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_income_limit.py +++ b/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_income_limit.py @@ -36,16 +36,22 @@ def formula(person, period, parameters): # monthly amount at cent precision first, so floating-point noise # cannot move an exact whole dollar (as in medicaid_income_level). fpg_monthly = np.round(fpg_limit / MONTHS_IN_YEAR, 2) - # Illinois is the only state that drops the cents. - rounds_down = (state == "IL") & p.il.rounds_down_monthly + # Illinois rounds to the nearest dollar before 2025, then drops the cents. + in_il = state == "IL" + rounds_down = in_il & p.il.rounds_down_monthly + # Half a dollar rounds up ($1,132.50 to $1,133 in 2022); np.round + # would round it to the even dollar. + rounds_to_nearest = in_il & p.il.rounds_to_nearest_monthly fpg_limit = select( [ p.rounds_up_monthly[state].astype(bool), rounds_down, + rounds_to_nearest, ], [ np.ceil(fpg_monthly) * MONTHS_IN_YEAR, np.floor(fpg_monthly) * MONTHS_IN_YEAR, + np.floor(fpg_monthly + 0.5) * MONTHS_IN_YEAR, ], default=fpg_limit, )