Update Medicaid medically needy limits and switch on AR, IA, IL, NJ and ND

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, 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.

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:
@@ -7,15 +8,34 @@ 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://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
+      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
-AZ:
   2015-01-01: true
+AZ:
+  # No medically needy pathway for aged, blind or disabled people (KFF 2018, 2026).
+  2015-01-01: false
 CA:
   2015-01-01: true
 CO:
@@ -33,13 +53,15 @@ GA:
 HI:
   2015-01-01: true
 IA:
-  2015-01-01: false
-ID:
   2015-01-01: true
-IL:
+ID:
+  # No medically needy pathway for aged, blind or disabled people (KFF 2018, 2026).
   2015-01-01: false
-IN:
+IL:
   2015-01-01: true
+IN:
+  # No medically needy pathway for aged, blind or disabled people (KFF 2018, 2026).
+  2015-01-01: false
 KS:
   2015-01-01: true
 KY:
@@ -65,17 +87,19 @@ 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
-NM:
   2015-01-01: true
+NM:
+  # 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:

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:
@@ -7,15 +8,34 @@ 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://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
+      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
-AZ:
   2015-01-01: true
+AZ:
+  # No medically needy pathway for aged, blind or disabled people (KFF 2018, 2026).
+  2015-01-01: false
 CA:
   2015-01-01: true
 CO:
@@ -33,13 +53,15 @@ GA:
 HI:
   2015-01-01: true
 IA:
-  2015-01-01: false
-ID:
   2015-01-01: true
-IL:
+ID:
+  # No medically needy pathway for aged, blind or disabled people (KFF 2018, 2026).
   2015-01-01: false
-IN:
+IL:
   2015-01-01: true
+IN:
+  # No medically needy pathway for aged, blind or disabled people (KFF 2018, 2026).
+  2015-01-01: false
 KS:
   2015-01-01: true
 KY:
@@ -65,17 +87,19 @@ 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
-NM:
   2015-01-01: true
+NM:
+  # 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:

policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/assets/couple.yaml

@@ -6,8 +6,38 @@ 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: 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)
+      href: https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=WIC&sectionNum=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"
+      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/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
+      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 +49,9 @@ 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 +72,7 @@ ID:
   2018-01-01: -.inf
 IL:
   2018-01-01: 3_000
+  2023-05-12: 17_500
 IN:
   2018-01-01: -.inf
 KS:
@@ -79,6 +113,11 @@ 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:

policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/assets/individual.yaml

@@ -6,8 +6,38 @@ 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: 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)
+      href: https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=WIC&sectionNum=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"
+      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/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
+      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 +49,9 @@ 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 +72,7 @@ ID:
   2018-01-01: -.inf
 IL:
   2018-01-01: 2_000
+  2023-05-12: 17_500
 IN:
   2018-01-01: -.inf
 KS:
@@ -79,6 +113,11 @@ 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: