diff --git a/changelog.d/fix-ri-pregnancy-medicaid-pathways.fixed.md b/changelog.d/fix-ri-pregnancy-medicaid-pathways.fixed.md new file mode 100644 index 00000000000..ded10d458f6 --- /dev/null +++ b/changelog.d/fix-ri-pregnancy-medicaid-pathways.fixed.md @@ -0,0 +1 @@ +Correct Rhode Island pregnancy Medicaid and CHIP routing for people with third-party health coverage, and preserve full postpartum Medicaid based on qualifying pregnancy eligibility through the last day of the month in which the 12-month postpartum period ends, including after income changes or another pregnancy. Fixes #10390. diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/pregnant/income_limit.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/pregnant/income_limit.yaml index a416c7e4519..2d29f612385 100644 --- a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/pregnant/income_limit.yaml +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/pregnant/income_limit.yaml @@ -27,6 +27,16 @@ metadata: href: https://medicaid.nv.gov/Downloads/provider/web_announcement_3748_20251020.pdf - title: "West Virginia Medicaid State Plan Amendment WV-19-0004, approval letter and S14 Pregnant Women #page 3,14" href: https://www.medicaid.gov/State-resource-center/Medicaid-State-Plan-Amendments/Downloads/WV/WV-19-0004.pdf#page=3 + - title: 210-RICR-30-00-1 § 1.6(A)(2)(a) (version effective August 17, 2025) + href: https://risos-apa-production-public.s3.amazonaws.com/EOHHS/REG_13314_20250728104245127.pdf#page=5 + - title: "Rhode Island 1115 expenditure authorities (December 23, 2013 to December 31, 2018), Budget Population 6b" + href: https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/ri/Comprehensive-Demonstration/ri-global-consumer-choice-compact-expnditure-auth-12232013-12312018.pdf#page=2 + - title: "Rhode Island 1115 amendment approval (March 21, 2024; 2019 to 2024), Budget Population 6b" + href: https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/ri-comphnsve-dmnstrtn-aprvl.pdf#page=11 + - title: "Rhode Island 1115 temporary extension (December 12, 2024; through June 30, 2025), Budget Population 6b" + href: https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/ri-comphnsve-dmnstrtn-tmp-extn-amndmnt.pdf#page=6 + - title: "Rhode Island 1115 approval (November 28, 2025; 2026 to 2030), Budget Population 6b #page 3,15" + href: https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/ri-comp-demo-appvl-11282025.pdf#page=3 AK: 2018-01-01: 2.05 2024-02-01: 2.30 @@ -113,8 +123,12 @@ OR: PA: 2018-01-01: 2.20 RI: + # The higher Medicaid ceiling for insured pregnant people is applied in the + # financial-criteria formula using Rhode Island's CHIP pregnancy ceiling. + # The insured route rests on 1115 Budget Population 6b since 2013 (185-250% + # FPL before MAGI, 190-253% after) and on 210-RICR-30-00-1 § 1.6(A)(2)(a)(2) + # from August 17, 2025. 2018-01-01: 1.95 - 2023-01-01: 2.58 SC: 2018-01-01: 1.99 SD: diff --git a/policyengine_us/parameters/gov/states/ri/eohhs/medicaid/postpartum_coverage_months.yaml b/policyengine_us/parameters/gov/states/ri/eohhs/medicaid/postpartum_coverage_months.yaml new file mode 100644 index 00000000000..a1295803df7 --- /dev/null +++ b/policyengine_us/parameters/gov/states/ri/eohhs/medicaid/postpartum_coverage_months.yaml @@ -0,0 +1,13 @@ +description: Rhode Island provides full Medicaid through the last day of the month in which a postpartum period of this many months, beginning on the last day of pregnancy, ends, including when federal funding is unavailable. +values: + 0000-01-01: 0 + 2022-10-01: 12 +metadata: + unit: month + period: month + label: Rhode Island postpartum Medicaid continuation months + reference: + - title: R.I. Gen. Laws § 42-12.3-3(g) + href: https://webserver.rilegislature.gov/Statutes/TITLE42/42-12.3/42-12.3-3.htm + - title: Rhode Island Medicaid State Plan Amendment RI-22-0024, section B (12-month period begins on the last day of pregnancy) + href: https://www.medicaid.gov/medicaid/spa/downloads/RI-22-0024.pdf#page=7 diff --git a/policyengine_us/parameters/gov/states/ri/eohhs/medicaid/third_party_coverage.yaml b/policyengine_us/parameters/gov/states/ri/eohhs/medicaid/third_party_coverage.yaml new file mode 100644 index 00000000000..bb4e2031818 --- /dev/null +++ b/policyengine_us/parameters/gov/states/ri/eohhs/medicaid/third_party_coverage.yaml @@ -0,0 +1,22 @@ +description: Rhode Island uses these coverage sources as third-party liability insurance under the Medicaid program. +values: + 0000-01-01: + - has_esi + - has_marketplace_health_coverage_at_interview + - has_non_marketplace_direct_purchase_health_coverage_at_interview + - medicare_enrolled + - has_tricare_health_coverage_at_interview + - has_champva_health_coverage_at_interview +metadata: + unit: list + period: year + label: Rhode Island Medicaid third-party liability coverage sources + reference: + - title: "210-RICR-30-00-1 §§ 1.6(A)(2)(a)(2), 1.9(B)(1) (version effective August 17, 2025) #page 5,19" + href: https://risos-apa-production-public.s3.amazonaws.com/EOHHS/REG_13314_20250728104245127.pdf#page=5 + - title: Rhode Island EOHHS, Third Party Liability + href: https://eohhs.ri.gov/providers-partners/billing-and-claims/third-party-liability + - title: TRICARE, Other Health Insurance FAQ + href: https://tricare.mil/FAQs/General/GEN_OHI_TRICARE + - title: VA, CHAMPVA benefits + href: https://www.va.gov/resources/champva-care/ diff --git a/policyengine_us/tests/policy/baseline/gov/hhs/chip/is_chip_eligible_standard_pregnant_person.yaml b/policyengine_us/tests/policy/baseline/gov/hhs/chip/is_chip_eligible_standard_pregnant_person.yaml index 9ab01a18487..92d02cde7ea 100644 --- a/policyengine_us/tests/policy/baseline/gov/hhs/chip/is_chip_eligible_standard_pregnant_person.yaml +++ b/policyengine_us/tests/policy/baseline/gov/hhs/chip/is_chip_eligible_standard_pregnant_person.yaml @@ -788,3 +788,231 @@ state_code: MO output: is_chip_eligible_standard_pregnant_person: false + +# 210-RICR-30-00-1 § 1.6(A)(2)(b)(1)-(2) requires the absence of +# third-party insurance for standard pregnancy CHIP in Rhode Island. +# https://risos-apa-production-public.s3.amazonaws.com/EOHHS/REG_13314_20250728104245127.pdf#page=5 +# Supply Medicaid ineligibility here to exercise the CHIP insurance gate +# independently; the Medicaid integration cases test the insured pathway. +- name: Case 28, Rhode Island standard pregnancy CHIP excludes third-party coverage independently of Medicaid eligibility. + period: 2024 + input: + people: + person1: + age: 30 + is_pregnant: true + immigration_status: CITIZEN + is_medicaid_eligible: false + medicaid_household_size: 2 + medicaid_income_level: 2.3 + has_esi: true + person2: + age: 30 + is_pregnant: true + immigration_status: CITIZEN + is_medicaid_eligible: false + medicaid_household_size: 2 + medicaid_income_level: 2.3 + has_marketplace_health_coverage_at_interview: true + person3: + age: 30 + is_pregnant: true + immigration_status: CITIZEN + is_medicaid_eligible: false + medicaid_household_size: 2 + medicaid_income_level: 2.3 + has_non_marketplace_direct_purchase_health_coverage_at_interview: true + person4: + age: 30 + is_pregnant: true + immigration_status: CITIZEN + is_medicaid_eligible: false + medicaid_household_size: 2 + medicaid_income_level: 2.3 + medicare_enrolled: true + person5: + age: 30 + is_pregnant: true + immigration_status: CITIZEN + is_medicaid_eligible: false + medicaid_household_size: 2 + medicaid_income_level: 2.3 + has_tricare_health_coverage_at_interview: true + person6: + age: 30 + is_pregnant: true + immigration_status: CITIZEN + is_medicaid_eligible: false + medicaid_household_size: 2 + medicaid_income_level: 2.3 + has_champva_health_coverage_at_interview: true + person7: + age: 30 + is_pregnant: true + immigration_status: CITIZEN + is_medicaid_eligible: false + medicaid_household_size: 2 + medicaid_income_level: 2.3 + households: + household: + members: [person1, person2, person3, person4, person5, person6, person7] + state_code: RI + output: + is_chip_eligible_standard_pregnant_person: [false, false, false, false, false, false, true] + +# RI-22-0025 CS27 continues the separate CHIP program through the postpartum +# period; the full Medicaid benefit scope does not create duplicate enrollment. +# https://www.medicaid.gov/CHIP/Downloads/RI-22-0025.pdf#page=4 +# R.I. Gen. Laws § 42-12.3-3(g) preserves the entitlement "without regard to the +# availability of federal financial participation". +# https://webserver.rilegislature.gov/Statutes/TITLE42/42-12.3/42-12.3-3.htm +- name: Case 29, Rhode Island retains pregnancy CHIP despite later income, insurance, pregnancy or immigration changes. + period: 2024 + input: + people: + person1: + age: 30 + is_pregnant: false + immigration_status: CITIZEN + has_esi: false + ri_pregnancy_coverage: CHIP + ri_pregnancy_end_date: "2023-03-07" + medicaid_household_size: 2 + medicaid_income_level: 4 + person2: + age: 30 + is_pregnant: true + immigration_status: CITIZEN + has_esi: true + ri_pregnancy_coverage: CHIP + ri_pregnancy_end_date: "2023-03-07" + medicaid_household_size: 2 + medicaid_income_level: 4 + person3: + age: 30 + is_pregnant: false + immigration_status: UNDOCUMENTED + has_esi: true + ri_pregnancy_coverage: CHIP + ri_pregnancy_end_date: "2023-03-07" + medicaid_household_size: 2 + medicaid_income_level: 4 + person4: + age: 30 + is_pregnant: true + immigration_status: UNDOCUMENTED + has_esi: false + ri_pregnancy_coverage: CHIP + ri_pregnancy_end_date: "2023-03-07" + medicaid_household_size: 2 + medicaid_income_level: 4 + person5: + age: 30 + is_pregnant: false + immigration_status: CITIZEN + has_esi: false + ri_pregnancy_coverage: CHIP + ri_pregnancy_end_date: "2022-11-27" + medicaid_household_size: 2 + medicaid_income_level: 4 + households: + household: + members: [person1, person2, person3, person4, person5] + state_code: RI + output: + is_chip_eligible_standard_pregnant_person: [true, true, true, true, false] + medicaid_enrolled: [false, false, false, false, false] + chip_enrolled: [true, true, true, true, false] + +# 210-RICR-30-00-1 § 1.6(A)(2)(b)(1) and (c) place a new pregnancy in the +# CHIP band in CHIP, and 42 U.S.C. 1397jj(b)(1)(C) bars CHIP only for people +# eligible under Title XIX, which the state-funded continuation is not. +# https://risos-apa-production-public.s3.amazonaws.com/EOHHS/REG_13314_20250728104245127.pdf#page=5 +# https://www.law.cornell.edu/uscode/text/42/1397jj#b_1_C +- name: Case 30, a new Rhode Island pregnancy in the CHIP band moves a state-funded continuation to CHIP. + period: 2024 + input: + people: + person1: + age: 30 + immigration_status: CITIZEN + is_pregnant: true + ri_pregnancy_coverage: RITE_START + ri_pregnancy_end_date: "2023-03-07" + medicaid_household_size: 2 + medicaid_income_level: 2.3 + takes_up_chip_if_eligible: true + person2: + age: 30 + immigration_status: UNDOCUMENTED + is_pregnant: true + ri_pregnancy_coverage: FCEP + ri_pregnancy_end_date: "2023-03-07" + medicaid_household_size: 2 + medicaid_income_level: 2.0 + takes_up_chip_if_eligible: true + person3: + age: 30 + immigration_status: CITIZEN + is_pregnant: true + ri_pregnancy_coverage: RITE_START + ri_pregnancy_end_date: "2023-03-07" + medicaid_household_size: 2 + medicaid_income_level: 2.3 + takes_up_chip_if_eligible: false + person4: + age: 30 + immigration_status: CITIZEN + is_pregnant: true + ri_pregnancy_coverage: MEDICAID + ri_pregnancy_end_date: "2023-03-07" + medicaid_household_size: 2 + medicaid_income_level: 2.3 + takes_up_chip_if_eligible: true + households: + household: + members: [person1, person2, person3, person4] + state_code: RI + output: + is_medicaid_eligible: [false, false, true, true] + is_chip_eligible_standard_pregnant_person: [true, false, false, false] + is_chip_fcep_eligible_person: [true, true, false, false] + chip_enrolled: [true, true, false, false] + +# 210-RICR-30-00-1 § 1.6(A)(2)(a)(2) and (b)(1) pair the routes: Medicaid with +# third-party insurance, CHIP without it. VA coverage, other means-tested +# coverage and the aggregate other-coverage flag are not on Rhode Island's +# third-party list, so these applicants stay in standard CHIP. +# https://risos-apa-production-public.s3.amazonaws.com/EOHHS/REG_13314_20250728104245127.pdf#page=5 +- name: Case 31, Rhode Island pregnant applicants whose only coverage is outside the third-party list stay in standard CHIP. + period: 2024 + input: + people: + person1: + age: 30 + is_pregnant: true + immigration_status: CITIZEN + medicaid_household_size: 2 + medicaid_income_level: 2.3 + has_va_health_coverage_at_interview: true + person2: + age: 30 + is_pregnant: true + immigration_status: CITIZEN + medicaid_household_size: 2 + medicaid_income_level: 2.3 + has_other_means_tested_health_coverage_at_interview: true + person3: + age: 30 + is_pregnant: true + immigration_status: CITIZEN + medicaid_household_size: 2 + medicaid_income_level: 2.3 + has_health_coverage_other_than_chip: true + households: + household: + members: [person1, person2, person3] + state_code: RI + output: + is_medicaid_eligible: [false, false, false] + is_chip_eligible_standard_pregnant_person: [true, true, true] diff --git a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/costs/medicaid_federal_share.yaml b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/costs/medicaid_federal_share.yaml index 9e6719c2830..ee57b302434 100644 --- a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/costs/medicaid_federal_share.yaml +++ b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/costs/medicaid_federal_share.yaml @@ -127,3 +127,158 @@ meets_ssi_disability_criteria: true output: medicaid_federal_share: 0.9000 + +# RIte Start/FCEP continuation for undocumented residents has no Title XIX +# Medicaid match. Separate Title XXI HSI funding is outside this cost variable. +# https://webserver.rilegislature.gov/Statutes/TITLE42/42-12.3/42-12.3-3.htm +# https://www.law.cornell.edu/uscode/text/42/1396b#v +# https://www.medicaid.gov/CHIP/Downloads/RI-22-0026.pdf#page=2 +# January 2024 uses Rhode Island's regular FY2024 FMAP of 55.01%. +- name: Rhode Island RIte Start and FCEP continuation has no Title XIX match for undocumented residents while a Medicaid citizen retains regular FMAP. + period: 2024 + input: + people: + person1: + age: 30 + immigration_status: UNDOCUMENTED + ri_pregnancy_coverage: FCEP + ri_pregnancy_end_date: "2023-03-07" + medicaid_household_size: 2 + medicaid_income_level: 4 + takes_up_medicaid_if_eligible: true + medicaid_cost: 1_000 + person2: + age: 30 + immigration_status: UNDOCUMENTED + ri_pregnancy_coverage: RITE_START + ri_pregnancy_end_date: "2023-03-07" + medicaid_household_size: 2 + medicaid_income_level: 4 + takes_up_medicaid_if_eligible: true + medicaid_cost: 1_000 + person3: + age: 30 + immigration_status: CITIZEN + ri_pregnancy_coverage: MEDICAID + ri_pregnancy_end_date: "2023-03-07" + medicaid_household_size: 2 + medicaid_income_level: 4 + takes_up_medicaid_if_eligible: true + medicaid_cost: 1_000 + households: + household: + members: [person1, person2, person3] + state_code: RI + output: + is_medicaid_eligible: [true, true, true] + medicaid_enrolled: [true, true, true] + medicaid_federal_share: [0, 0, 0.5501] + medicaid_federal_cost: [0, 0, 550.1] + +# R.I. Gen. Laws § 42-12.3-3(b) limits RIte Start to people not eligible under +# Title XIX or XXI, so its postpartum continuation has no Title XIX match even +# for a citizen. Only a Medicaid pregnancy keeps the pregnancy group, and at +# 400% FPL this citizen meets no other Medicaid group. +# https://webserver.rilegislature.gov/Statutes/TITLE42/42-12.3/42-12.3-3.htm +- name: Rhode Island RIte Start continuation has no Title XIX match for a citizen. + period: 2024 + input: + state_code: RI + age: 30 + immigration_status: CITIZEN + ri_pregnancy_coverage: RITE_START + ri_pregnancy_end_date: "2023-03-07" + medicaid_household_size: 2 + medicaid_income_level: 4 + takes_up_medicaid_if_eligible: true + output: + medicaid_category: NONE + medicaid_enrolled: true + medicaid_federal_share: 0 + +# Only a Medicaid-covered pregnancy of someone who meets Medicaid immigration +# requirements keeps the Title XIX match in the continuation. A citizen whose +# pregnancy was covered by CHIP and who now takes up Medicaid instead, and an +# undocumented resident whose pregnancy was covered by Medicaid, both get 0. +- name: Rhode Island CHIP-history and Medicaid-history-without-status continuations have no Title XIX match. + period: 2024 + input: + people: + person1: + age: 30 + immigration_status: CITIZEN + ri_pregnancy_coverage: CHIP + ri_pregnancy_end_date: "2023-03-07" + medicaid_household_size: 2 + medicaid_income_level: 4 + takes_up_medicaid_if_eligible: true + takes_up_chip_if_eligible: false + person2: + age: 30 + immigration_status: UNDOCUMENTED + ri_pregnancy_coverage: MEDICAID + ri_pregnancy_end_date: "2023-03-07" + medicaid_household_size: 2 + medicaid_income_level: 4 + takes_up_medicaid_if_eligible: true + households: + household: + members: [person1, person2] + state_code: RI + output: + medicaid_enrolled: [true, true] + medicaid_federal_share: [0, 0] + +# 210-RICR-30-00-1 § 1.6(A)(2)(d)(1) extends postpartum coverage to people not +# eligible under another Medicaid eligibility category, and § 42-12.3-3(g) +# uses state-only funds only if federal financial participation is not +# available. Each person meets a federally matched group: the adult group at +# 120% FPL, the pregnancy group at 150% FPL, or SSI. +# https://risos-apa-production-public.s3.amazonaws.com/EOHHS/REG_13314_20250728104245127.pdf#page=6 +- name: Rhode Island non-Medicaid pregnancy histories keep the match of a federally matched group the person meets. + period: 2024 + input: + people: + person1: + age: 30 + immigration_status: CITIZEN + ri_pregnancy_coverage: RITE_START + ri_pregnancy_end_date: "2023-03-07" + medicaid_household_size: 2 + medicaid_income_level: 1.2 + takes_up_medicaid_if_eligible: true + person2: + age: 30 + immigration_status: CITIZEN + ri_pregnancy_coverage: FCEP + ri_pregnancy_end_date: "2023-03-07" + medicaid_household_size: 2 + medicaid_income_level: 1.2 + takes_up_medicaid_if_eligible: true + person3: + age: 30 + immigration_status: CITIZEN + is_pregnant: true + ri_pregnancy_coverage: RITE_START + ri_pregnancy_end_date: "2023-03-07" + medicaid_household_size: 2 + medicaid_income_level: 1.5 + takes_up_medicaid_if_eligible: true + person4: + age: 30 + immigration_status: CITIZEN + ri_pregnancy_coverage: CHIP + ri_pregnancy_end_date: "2023-03-07" + is_ssi_recipient_for_medicaid: true + medicaid_household_size: 2 + medicaid_income_level: 0.5 + takes_up_medicaid_if_eligible: true + takes_up_chip_if_eligible: false + households: + household: + members: [person1, person2, person3, person4] + state_code: RI + output: + medicaid_category: [ADULT, ADULT, PREGNANT, SSI_RECIPIENT] + medicaid_enrolled: [true, true, true, true] + medicaid_federal_share: [0.9, 0.9, 0.5501, 0.5501] diff --git a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/is_pregnant_for_medicaid.yaml b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/is_pregnant_for_medicaid.yaml index a64736f438e..ef53fccf73d 100644 --- a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/is_pregnant_for_medicaid.yaml +++ b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/is_pregnant_for_medicaid.yaml @@ -611,3 +611,275 @@ medicaid_income_level: 1.91 output: is_pregnant_for_medicaid: false + +# R.I. Gen. Laws § 42-12.3-3(g): from October 1, 2022, people eligible for +# Medicaid or CHIP while pregnant keep full Medicaid through the postpartum +# period. $47,000 is about 230% FPL for a household of 2 in 2024 ($20,440). +# https://webserver.rilegislature.gov/Statutes/TITLE42/42-12.3/42-12.3-3.htm +# Only a Medicaid pregnancy keeps the pregnancy group (SHO 21-007 Q6), so the +# parent, whose pregnancy CHIP covered, stays in CHIP (RI-22-0025 CS27). +- name: Case 34, Rhode Island postpartum parent with a CHIP-covered pregnancy stays in CHIP outside the pregnancy group, and the newborn is an infant. + period: 2024 + input: + people: + person1: + age: 28 + is_pregnant: false + ri_pregnancy_coverage: CHIP + ri_pregnancy_end_date: "2023-12-01" + employment_income: 47_000 + person2: + age: 0 + tax_units: + tax_unit: + members: [person1, person2] + households: + household: + members: [person1, person2] + state_code: RI + output: + is_pregnant_for_medicaid: [false, false] + medicaid_category: [NONE, INFANT] + is_medicaid_eligible: [true, true] + medicaid_enrolled: [false, true] + chip_enrolled: [true, false] + is_chip_eligible_standard_pregnant_person: [true, false] + +# While pregnant, the same income is above RI's 190% Medicaid standard (195% +# with the disregard), so an uninsured applicant is in CHIP rather than +# Medicaid (210-RICR-30-00-1 § 1.6(A)(2)(b)(1)). +- name: Case 35, Rhode Island uninsured pregnant applicant at 230 percent FPL receives CHIP. + period: 2024 + input: + people: + person1: + age: 28 + is_pregnant: true + immigration_status: CITIZEN + employment_income: 47_000 + tax_units: + tax_unit: + members: [person1] + households: + household: + members: [person1] + state_code: RI + output: + is_pregnant_for_medicaid: false + is_medicaid_eligible: false + is_chip_eligible_standard_pregnant_person: true + +# 210-RICR-30-00-1 § 1.6(A)(2)(a)(2) covers pregnant applicants with +# third-party insurance through the upper 253% standard (258% with the +# disregard). Employer, individual and Medicare/military coverage are +# independent of Medicaid enrollment, so the eligibility calculation must +# also work without a circular dependency on medicaid_enrolled. +# https://risos-apa-production-public.s3.amazonaws.com/EOHHS/REG_13314_20250728104245127.pdf#page=5 +- name: Case 36, Rhode Island pregnancy Medicaid covers applicants with each modeled third-party insurance source. + period: 2024 + input: + people: + person1: + age: 30 + is_pregnant: true + immigration_status: CITIZEN + medicaid_household_size: 2 + medicaid_income_level: 2.3 + has_esi: true + person2: + age: 30 + is_pregnant: true + immigration_status: CITIZEN + medicaid_household_size: 2 + medicaid_income_level: 2.3 + has_marketplace_health_coverage_at_interview: true + person3: + age: 30 + is_pregnant: true + immigration_status: CITIZEN + medicaid_household_size: 2 + medicaid_income_level: 2.3 + has_non_marketplace_direct_purchase_health_coverage_at_interview: true + person4: + age: 30 + is_pregnant: true + immigration_status: CITIZEN + medicaid_household_size: 2 + medicaid_income_level: 2.3 + medicare_enrolled: true + person5: + age: 30 + is_pregnant: true + immigration_status: CITIZEN + medicaid_household_size: 2 + medicaid_income_level: 2.3 + has_tricare_health_coverage_at_interview: true + person6: + age: 30 + is_pregnant: true + immigration_status: CITIZEN + medicaid_household_size: 2 + medicaid_income_level: 2.3 + has_champva_health_coverage_at_interview: true + households: + household: + members: [person1, person2, person3, person4, person5, person6] + state_code: RI + output: + is_pregnant_for_medicaid: [true, true, true, true, true, true] + is_medicaid_eligible: [true, true, true, true, true, true] + is_chip_eligible_standard_pregnant_person: [false, false, false, false, false, false] + +# The ordinary standard is 190% plus the five-point disregard; the insured +# standard is 253% plus the disregard. The same insurance does not extend +# another state's ordinary Medicaid pregnancy band. +- name: Case 37, Rhode Island pregnancy income boundaries and state controls preserve the coverage split. + period: 2024 + input: + people: + person1: + age: 30 + is_pregnant: true + medicaid_household_size: 2 + medicaid_income_level: 1.95 + person2: + age: 30 + is_pregnant: true + medicaid_household_size: 2 + medicaid_income_level: 1.96 + person3: + age: 30 + is_pregnant: true + has_esi: true + medicaid_household_size: 2 + medicaid_income_level: 2.58 + person4: + age: 30 + is_pregnant: true + has_esi: true + medicaid_household_size: 2 + medicaid_income_level: 2.59 + person5: + age: 30 + is_pregnant: false + has_esi: true + medicaid_household_size: 2 + medicaid_income_level: 2.3 + person6: + age: 30 + is_pregnant: true + has_esi: true + medicaid_household_size: 2 + medicaid_income_level: 2.3 + households: + household1: + members: [person1, person2, person3, person4, person5] + state_code: RI + household2: + members: [person6] + state_code: CO + output: + is_pregnant_for_medicaid: [true, false, true, false, false, false] + +# R.I. Gen. Laws § 42-12.3-3(g) supplies twelve months of full Medicaid +# from October 1, 2022, including people covered under Title XXI while +# pregnant. At January 1, 2024, the March 2023 pregnancies are within the +# continuation period and the November 2022 pregnancies have expired. +# Pregnancy Medicaid requires a qualifying immigration status, so the +# undocumented parents had unborn-child CHIP (FCEP) coverage while pregnant +# (210-RICR-30-00-1 § 1.6(A)(2)(a)). Their continuation is state-funded and +# outside the pregnancy group. +- name: Case 38, Rhode Island citizen and undocumented postpartum parents receive coverage within the extended period. + period: 2024 + input: + people: + person1: + age: 30 + is_pregnant: false + immigration_status: CITIZEN + count_days_postpartum: 300 + ri_pregnancy_coverage: MEDICAID + ri_pregnancy_end_date: "2023-03-07" + medicaid_household_size: 2 + medicaid_income_level: 2.3 + person2: + age: 30 + is_pregnant: false + immigration_status: CITIZEN + count_days_postpartum: 400 + ri_pregnancy_coverage: MEDICAID + ri_pregnancy_end_date: "2022-11-27" + medicaid_household_size: 2 + medicaid_income_level: 2.3 + person3: + age: 30 + is_pregnant: false + immigration_status: UNDOCUMENTED + count_days_postpartum: 300 + ri_pregnancy_coverage: FCEP + ri_pregnancy_end_date: "2023-03-07" + medicaid_household_size: 2 + medicaid_income_level: 2.3 + person4: + age: 30 + is_pregnant: false + immigration_status: UNDOCUMENTED + count_days_postpartum: 400 + ri_pregnancy_coverage: FCEP + ri_pregnancy_end_date: "2022-11-27" + medicaid_household_size: 2 + medicaid_income_level: 2.3 + households: + household: + members: [person1, person2, person3, person4] + state_code: RI + output: + is_pregnant_for_medicaid: [true, false, false, false] + is_medicaid_eligible: [true, false, true, false] + is_chip_eligible_standard_pregnant_person: [false, false, false, false] + +# The YEAR-defined formula reads January 1, so the October 2022 extension +# is reflected in 2023 annual results. The parameter retains its legal date. +- name: Case 39, Rhode Island annual postpartum eligibility reflects the October 2022 extension in 2023. + period: 2023 + input: + state_code: + 2022: RI + 2023: RI + count_days_postpartum: + 2022: 90 + 2023: 90 + ri_pregnancy_coverage: + 2022: MEDICAID + 2023: MEDICAID + ri_pregnancy_end_date: + 2022: "2021-10-03" + 2023: "2022-10-03" + medicaid_household_size: + 2022: 2 + 2023: 2 + medicaid_income_level: + 2022: 2.3 + 2023: 2.3 + output: + is_pregnant_for_medicaid: + 2022: false + 2023: true + +# The state-funded postpartum continuation does not change the citizenship +# rules for someone seeking Medicaid during pregnancy. An undocumented +# pregnant applicant instead has the existing unborn-child CHIP pathway. +- name: Case 40, Rhode Island state-funded postpartum coverage does not bypass pregnancy immigration requirements. + period: 2024 + input: + state_code: RI + age: 30 + is_pregnant: true + immigration_status: UNDOCUMENTED + medicaid_household_size: 2 + medicaid_income_level: 1.8 + output: + is_pregnant_for_medicaid: true + is_medicaid_eligible: false + is_chip_eligible_standard_pregnant_person: false + is_chip_fcep_eligible_person: true diff --git a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/is_medicaid_eligible.yaml b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/is_medicaid_eligible.yaml index 2fb92c16b1e..c48e39629ee 100644 --- a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/is_medicaid_eligible.yaml +++ b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/is_medicaid_eligible.yaml @@ -314,3 +314,128 @@ medicaid_category: SECTION_1115_MEC_ADULT is_medicaid_work_requirement_applicable_adult: true is_medicaid_eligible: true + +# R.I. Gen. Laws § 42-12.3-3(g) bases continuation on eligibility while +# pregnant, including RIte Start and Title XXI, without requiring federal funds. +# Current income does not replace that history or terminate continuation. +# https://webserver.rilegislature.gov/Statutes/TITLE42/42-12.3/42-12.3-3.htm +# Without that history, income at or below the pregnancy standard qualifies +# only within the state's day-count postpartum period (postpartum_coverage): +# person 5 is 30 days postpartum at 180% FPL, while person 3 has the same +# income 400 days after the pregnancy, beyond that period whether it is 60 or +# 365 days. +# https://www.law.cornell.edu/cfr/text/42/435.4 +- name: Case 17, Rhode Island pregnancy history preserves coverage after income rises, while without it income qualifies only within the state's day-count postpartum period. + period: 2024 + input: + people: + person1: + age: 30 + immigration_status: CITIZEN + count_days_postpartum: 300 + ri_pregnancy_coverage: MEDICAID + ri_pregnancy_end_date: "2023-03-07" + medicaid_household_size: 2 + medicaid_income_level: 4 + person2: + age: 30 + immigration_status: CITIZEN + count_days_postpartum: 300 + ri_pregnancy_coverage: NONE + ri_pregnancy_end_date: "2023-03-07" + medicaid_household_size: 2 + medicaid_income_level: 4 + person3: + age: 30 + immigration_status: UNDOCUMENTED + count_days_postpartum: 400 + ri_pregnancy_coverage: NONE + ri_pregnancy_end_date: "2022-11-27" + medicaid_household_size: 2 + medicaid_income_level: 1.8 + person4: + age: 30 + immigration_status: CITIZEN + count_days_postpartum: 300 + ri_pregnancy_coverage: NONE + ri_pregnancy_end_date: "2023-03-07" + medicaid_household_size: 2 + medicaid_income_level: 2.3 + person5: + age: 30 + immigration_status: CITIZEN + count_days_postpartum: 30 + ri_pregnancy_coverage: NONE + ri_pregnancy_end_date: "2023-12-02" + medicaid_household_size: 2 + medicaid_income_level: 1.8 + households: + household: + members: [person1, person2, person3, person4, person5] + state_code: RI + output: + is_pregnant_for_medicaid: [true, false, false, false, true] + is_medicaid_eligible: [true, false, false, false, true] + +# A new pregnancy does not end the prior pregnancy's continuation period. +# These applicants have income above both current pregnancy ceilings, and +# the state-funded entitlement also protects the undocumented applicant. +- name: Case 18, Rhode Island continuation survives a new pregnancy for citizens and undocumented residents. + period: 2024 + input: + people: + person1: + age: 30 + is_pregnant: true + immigration_status: CITIZEN + ri_pregnancy_coverage: MEDICAID + ri_pregnancy_end_date: "2023-03-07" + medicaid_household_size: 2 + medicaid_income_level: 4 + person2: + age: 30 + is_pregnant: true + immigration_status: UNDOCUMENTED + ri_pregnancy_coverage: MEDICAID + ri_pregnancy_end_date: "2023-03-07" + medicaid_household_size: 2 + medicaid_income_level: 4 + households: + household: + members: [person1, person2] + state_code: RI + output: + is_pregnant_for_medicaid: [true, true] + is_medicaid_eligible: [true, true] + +- name: Case 19, Rhode Island pregnancy history does not confer continuation outside the state. + period: 2024 + input: + age: 30 + immigration_status: CITIZEN + count_days_postpartum: 300 + ri_pregnancy_coverage: MEDICAID + ri_pregnancy_end_date: "2023-03-07" + medicaid_household_size: 2 + medicaid_income_level: 4 + state_code: CO + output: + is_pregnant_for_medicaid: false + is_medicaid_eligible: false + +# Annual results read January 1, so a pregnancy that ends on January 1 starts +# the continuation in time for that year's result. +- name: Case 20, a Rhode Island pregnancy that ends on January 1 keeps Medicaid in that year's annual result. + period: 2024 + input: + state_code: RI + age: 30 + immigration_status: CITIZEN + is_pregnant: false + ri_pregnancy_coverage: MEDICAID + ri_pregnancy_end_date: "2024-01-01" + medicaid_household_size: 2 + medicaid_income_level: 4 + output: + is_pregnant_for_medicaid: true + is_medicaid_eligible: true diff --git a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/medicaid_enrolled.yaml b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/medicaid_enrolled.yaml index 6efcba2e39e..6cd2b5e2c15 100644 --- a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/medicaid_enrolled.yaml +++ b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/medicaid_enrolled.yaml @@ -130,3 +130,45 @@ is_ca_medicaid_immigration_status_eligible: [true] is_medicaid_eligible: [true] medicaid_enrolled: [true] + +# RI-22-0025 CS27 preserves postpartum CHIP and permits voluntary disenrollment. +# Independent take-up inputs must retain a Medicaid enrollee when CHIP is declined. +# https://www.medicaid.gov/CHIP/Downloads/RI-22-0025.pdf#page=4 +- name: Case 6, Rhode Island postpartum enrollment follows independent Medicaid and CHIP take-up choices. + period: 2024 + input: + people: + person1: + age: 30 + immigration_status: CITIZEN + ri_pregnancy_coverage: CHIP + ri_pregnancy_end_date: "2023-03-07" + medicaid_household_size: 2 + medicaid_income_level: 4 + takes_up_medicaid_if_eligible: true + takes_up_chip_if_eligible: false + person2: + age: 30 + immigration_status: CITIZEN + ri_pregnancy_coverage: CHIP + ri_pregnancy_end_date: "2023-03-07" + medicaid_household_size: 2 + medicaid_income_level: 4 + takes_up_medicaid_if_eligible: true + takes_up_chip_if_eligible: true + person3: + age: 30 + immigration_status: CITIZEN + ri_pregnancy_coverage: CHIP + ri_pregnancy_end_date: "2023-03-07" + medicaid_household_size: 2 + medicaid_income_level: 4 + takes_up_medicaid_if_eligible: false + takes_up_chip_if_eligible: false + households: + household: + members: [person1, person2, person3] + state_code: RI + output: + medicaid_enrolled: [true, false, false] + chip_enrolled: [false, true, false] diff --git a/policyengine_us/tests/policy/baseline/gov/states/ri/eohhs/medicaid/ri_medicaid_postpartum_eligible.yaml b/policyengine_us/tests/policy/baseline/gov/states/ri/eohhs/medicaid/ri_medicaid_postpartum_eligible.yaml new file mode 100644 index 00000000000..9296b4e0aed --- /dev/null +++ b/policyengine_us/tests/policy/baseline/gov/states/ri/eohhs/medicaid/ri_medicaid_postpartum_eligible.yaml @@ -0,0 +1,149 @@ +# R.I. Gen. Laws § 42-12.3-3(g) continues full Medicaid for people eligible +# for RIte Start, Medicaid or CHIP while pregnant, including retroactively. +# https://webserver.rilegislature.gov/Statutes/TITLE42/42-12.3/42-12.3-3.htm +# Coverage runs through the last day of the month in which the 12-month +# postpartum period, beginning on the last day of pregnancy, ends. +# https://www.law.cornell.edu/uscode/text/42/1396a#e_16 +# CMS approved continuous postpartum coverage effective October 1, 2022. +# https://www.medicaid.gov/medicaid/spa/downloads/RI-22-0024.pdf#page=2 + +# The 12-month period that begins January 1, 2023 ends December 31, 2023. +# YEAR inputs are keyed for both years because the outputs cross a year end. +- name: Case 1, a pregnancy ending on the first of a month keeps Rhode Island coverage through the month before its anniversary. + period: 2024 + input: + state_code: + 2023: RI + 2024: RI + ri_pregnancy_coverage: + 2023: MEDICAID + 2024: MEDICAID + ri_pregnancy_end_date: + 2023: "2023-01-01" + 2024: "2023-01-01" + output: + ri_medicaid_postpartum_eligible: + 2023-12: true + 2024-01: false + +# The 12-month period that begins January 2, 2024 includes leap day and ends +# January 1, 2025, so January 2025 is covered. A 365-day count would end the +# period on December 31, 2024. +- name: Case 2, Rhode Island continuation spans a leap year without a 365-day cutoff. + period: 2025 + input: + state_code: RI + ri_pregnancy_coverage: MEDICAID + ri_pregnancy_end_date: "2024-01-02" + output: + ri_medicaid_postpartum_eligible: + 2025-01: true + 2025-02: false + +- name: Case 3, a pregnancy ending on leap day retains Rhode Island coverage through the following February. + period: 2025 + input: + state_code: RI + ri_pregnancy_coverage: MEDICAID + ri_pregnancy_end_date: "2024-02-29" + output: + ri_medicaid_postpartum_eligible: + 2025-02: true + 2025-03: false + +- name: Case 4, Rhode Island extended postpartum coverage begins in October 2022. + period: 2022 + input: + state_code: RI + ri_pregnancy_coverage: MEDICAID + ri_pregnancy_end_date: "2022-03-15" + output: + ri_medicaid_postpartum_eligible: + 2022-09: false + 2022-10: true + +# A monthly test explicitly supplies YEAR inputs for the containing year. +# People 1 and 2 have no qualifying history; person 3 has no end date; +# person 4 reports a future pregnancy end; person 5 is the positive control; +# person 6 has the same qualifying facts outside Rhode Island. +- name: Case 5, continuation requires qualifying history and a completed pregnancy with current Rhode Island residence. + period: 2024-01 + input: + people: + person1: + ri_pregnancy_coverage: + 2024: NONE + ri_pregnancy_end_date: + 2024: "2023-03-07" + person2: + ri_pregnancy_end_date: + 2024: "2023-03-07" + person3: + ri_pregnancy_coverage: + 2024: MEDICAID + person4: + ri_pregnancy_coverage: + 2024: MEDICAID + ri_pregnancy_end_date: + 2024: "2024-02-01" + person5: + ri_pregnancy_coverage: + 2024: MEDICAID + ri_pregnancy_end_date: + 2024: "2023-03-07" + person6: + ri_pregnancy_coverage: + 2024: MEDICAID + ri_pregnancy_end_date: + 2024: "2023-03-07" + households: + household1: + members: [person1, person2, person3, person4, person5] + state_code: + 2024: RI + household2: + members: [person6] + state_code: + 2024: CO + output: + ri_medicaid_postpartum_eligible: [false, false, false, false, true, false] + +- name: Case 6, each qualifying Rhode Island pregnancy coverage pathway retains postpartum benefits. + period: 2024 + input: + people: + person1: + ri_pregnancy_coverage: MEDICAID + ri_pregnancy_end_date: "2023-03-07" + person2: + ri_pregnancy_coverage: CHIP + ri_pregnancy_end_date: "2023-03-07" + person3: + ri_pregnancy_coverage: RITE_START + ri_pregnancy_end_date: "2023-03-07" + person4: + ri_pregnancy_coverage: FCEP + ri_pregnancy_end_date: "2023-03-07" + person5: + ri_pregnancy_coverage: NONE + ri_pregnancy_end_date: "2023-03-07" + households: + household: + members: [person1, person2, person3, person4, person5] + state_code: RI + output: + ri_medicaid_postpartum_eligible: + 2024-01: [true, true, true, true, false] + ri_chip_postpartum_eligible: + 2024-01: [false, true, false, false, false] + +- name: Case 7, a pregnancy ending on the first day of the evaluated month starts the continuation that month. + period: 2024 + input: + state_code: RI + ri_pregnancy_coverage: MEDICAID + ri_pregnancy_end_date: "2024-01-01" + output: + ri_medicaid_postpartum_eligible: + 2024-01: true + 2024-12: true diff --git a/policyengine_us/tests/policy/baseline/gov/states/ri/eohhs/medicaid/ri_medicaid_state_funded_postpartum_eligible.yaml b/policyengine_us/tests/policy/baseline/gov/states/ri/eohhs/medicaid/ri_medicaid_state_funded_postpartum_eligible.yaml new file mode 100644 index 00000000000..38d945e9215 --- /dev/null +++ b/policyengine_us/tests/policy/baseline/gov/states/ri/eohhs/medicaid/ri_medicaid_state_funded_postpartum_eligible.yaml @@ -0,0 +1,158 @@ +# R.I. Gen. Laws § 42-12.3-3(g) continues postpartum Medicaid with state-only +# funds when federal financial participation is not available. Only a +# Medicaid pregnancy of someone with Medicaid immigration status stays in the +# federally matched pregnancy group. +- name: Case 1, the state-funded continuation covers non-Medicaid histories and Medicaid histories without status. + period: 2024 + input: + people: + person1: + immigration_status: CITIZEN + ri_pregnancy_coverage: RITE_START + ri_pregnancy_end_date: "2023-03-07" + person2: + immigration_status: CITIZEN + ri_pregnancy_coverage: CHIP + ri_pregnancy_end_date: "2023-03-07" + person3: + immigration_status: UNDOCUMENTED + ri_pregnancy_coverage: FCEP + ri_pregnancy_end_date: "2023-03-07" + person4: + immigration_status: UNDOCUMENTED + ri_pregnancy_coverage: MEDICAID + ri_pregnancy_end_date: "2023-03-07" + person5: + immigration_status: CITIZEN + ri_pregnancy_coverage: MEDICAID + ri_pregnancy_end_date: "2023-03-07" + person6: + immigration_status: CITIZEN + ri_pregnancy_coverage: RITE_START + ri_pregnancy_end_date: "2022-11-27" + households: + household: + members: [person1, person2, person3, person4, person5, person6] + state_code: RI + output: + ri_medicaid_state_funded_postpartum_eligible: [true, true, true, true, false, false] + +# 210-RICR-30-00-1 § 1.6(A)(2)(b)(1) and (c): a new pregnancy at or below the +# 258% CHIP limit (253% plus the disregard) qualifies for Title XXI coverage. +- name: Case 2, a new pregnancy in the CHIP band ends the state-funded continuation only when CHIP is taken up. + period: 2024 + input: + people: + person1: + is_pregnant: true + ri_pregnancy_coverage: RITE_START + ri_pregnancy_end_date: "2023-03-07" + medicaid_household_size: 2 + medicaid_income_level: 2.58 + takes_up_chip_if_eligible: true + person2: + is_pregnant: true + ri_pregnancy_coverage: RITE_START + ri_pregnancy_end_date: "2023-03-07" + medicaid_household_size: 2 + medicaid_income_level: 2.59 + takes_up_chip_if_eligible: true + person3: + is_pregnant: true + ri_pregnancy_coverage: RITE_START + ri_pregnancy_end_date: "2023-03-07" + medicaid_household_size: 2 + medicaid_income_level: 2.3 + takes_up_chip_if_eligible: false + households: + household: + members: [person1, person2, person3] + state_code: RI + output: + ri_medicaid_state_funded_postpartum_eligible: [false, true, true] + +# Title XXI pregnancy coverage requires the absence of third-party insurance +# (210-RICR-30-00-1 § 1.6(A)(2)(b); 42 CFR 457.310(b)(2)), so an insured +# person who is pregnant again cannot take it up and keeps the continuation, +# which R.I. Gen. Laws § 42-12.3-3(g) provides without regard to federal +# funding. Both had unborn-child CHIP while pregnant and are within the +# continuation at January 1, 2024; only person 1 now has employer coverage. +- name: Case 3, an insured new pregnancy in the CHIP band keeps the state-funded continuation. + period: 2024 + input: + people: + person1: + age: 30 + immigration_status: UNDOCUMENTED + is_pregnant: true + has_esi: true + ri_pregnancy_coverage: FCEP + ri_pregnancy_end_date: "2023-03-07" + medicaid_household_size: 2 + medicaid_income_level: 2.3 + takes_up_chip_if_eligible: true + person2: + age: 30 + immigration_status: UNDOCUMENTED + is_pregnant: true + ri_pregnancy_coverage: FCEP + ri_pregnancy_end_date: "2023-03-07" + medicaid_household_size: 2 + medicaid_income_level: 2.3 + takes_up_chip_if_eligible: true + households: + household: + members: [person1, person2] + state_code: RI + output: + ri_medicaid_state_funded_postpartum_eligible: [true, false] + is_medicaid_eligible: [true, false] + +# 210-RICR-30-00-1 § 1.6(A)(2)(c) bases CHIP for people without CHIP +# immigration status on the unborn child, whom other coverage bars (42 CFR +# 457.310(b)(2)). R.I. Gen. Laws § 42-12.3-3(g) then keeps the continuation +# with state-only funds. The citizen takes standard CHIP, which uses Rhode +# Island's third-party list. +- name: Case 4, coverage that bars unborn-child CHIP keeps the continuation for a person without CHIP immigration status. + period: 2024 + input: + people: + person1: + age: 30 + immigration_status: UNDOCUMENTED + is_pregnant: true + has_other_means_tested_health_coverage_at_interview: true + ri_pregnancy_coverage: FCEP + ri_pregnancy_end_date: "2023-03-07" + medicaid_household_size: 2 + medicaid_income_level: 2.3 + takes_up_chip_if_eligible: true + person2: + age: 30 + immigration_status: UNDOCUMENTED + is_pregnant: true + has_health_coverage_other_than_chip: true + ri_pregnancy_coverage: RITE_START + ri_pregnancy_end_date: "2023-03-07" + medicaid_household_size: 2 + medicaid_income_level: 2.3 + takes_up_chip_if_eligible: true + person3: + age: 30 + immigration_status: CITIZEN + is_pregnant: true + has_other_means_tested_health_coverage_at_interview: true + ri_pregnancy_coverage: RITE_START + ri_pregnancy_end_date: "2023-03-07" + medicaid_household_size: 2 + medicaid_income_level: 2.3 + takes_up_chip_if_eligible: true + households: + household: + members: [person1, person2, person3] + state_code: RI + output: + ri_medicaid_state_funded_postpartum_eligible: [true, true, false] + is_medicaid_eligible: [true, true, false] + is_chip_fcep_eligible_person: [false, false, false] + chip_enrolled: [false, false, true] diff --git a/policyengine_us/variables/gov/hhs/chip/is_chip_eligible_standard_pregnant_person.py b/policyengine_us/variables/gov/hhs/chip/is_chip_eligible_standard_pregnant_person.py index f615473d3c7..dd335290618 100644 --- a/policyengine_us/variables/gov/hhs/chip/is_chip_eligible_standard_pregnant_person.py +++ b/policyengine_us/variables/gov/hhs/chip/is_chip_eligible_standard_pregnant_person.py @@ -8,7 +8,12 @@ class is_chip_eligible_standard_pregnant_person(Variable): value_type = bool entity = Person label = "Pregnant or postpartum person eligible for standard CHIP" - documentation = "Determines if a pregnant or postpartum person is eligible for the standard Children's Health Insurance Program" + documentation = ( + "Determines if a pregnant or postpartum person is eligible for the " + "standard Children's Health Insurance Program, including Rhode " + "Island's continuous postpartum coverage at the annual model's " + "January snapshot." + ) definition_period = YEAR reference = ( "https://www.ssa.gov/OP_Home/ssact/title21/2110.htm", @@ -23,6 +28,9 @@ class is_chip_eligible_standard_pregnant_person(Variable): "https://www.law.cornell.edu/cfr/text/45/155.20", "https://www.medicaid.gov/federal-policy-guidance/downloads/sho-12-002.pdf", "https://www.medicaid.gov/federal-policy-guidance/downloads/sho26001.pdf#page=28", + # 210-RICR-30-00-1 § 1.6(A)(2)(b), version effective August 17, 2025. + "https://risos-apa-production-public.s3.amazonaws.com/EOHHS/REG_13314_20250728104245127.pdf#page=5", + "https://www.medicaid.gov/CHIP/Downloads/RI-22-0025.pdf#page=4", ) def formula(person, period, parameters): @@ -62,6 +70,13 @@ def formula(person, period, parameters): has_disqualifying_coverage = person( "has_chip_disqualifying_health_coverage", period ) + # 210-RICR-30-00-1 § 1.6(A)(2)(a)(2), (b): Medicaid and CHIP use the + # same third-party list in Rhode Island. + has_disqualifying_coverage = where( + state_code == StateCode.RI, + person("ri_medicaid_has_third_party_coverage", period), + has_disqualifying_coverage, + ) return ( is_pregnant_or_postpartum @@ -70,4 +85,4 @@ def formula(person, period, parameters): & ~medicaid_eligible & income_eligible & ~has_disqualifying_coverage - ) + ) | person("ri_chip_postpartum_eligible", period.first_month) diff --git a/policyengine_us/variables/gov/hhs/medicaid/costs/medicaid_federal_share.py b/policyengine_us/variables/gov/hhs/medicaid/costs/medicaid_federal_share.py index 5e4cb63acae..b9bf95ca8d5 100644 --- a/policyengine_us/variables/gov/hhs/medicaid/costs/medicaid_federal_share.py +++ b/policyengine_us/variables/gov/hhs/medicaid/costs/medicaid_federal_share.py @@ -9,11 +9,23 @@ class medicaid_federal_share(Variable): "Federal medical assistance percentage applied to this enrollee's " "Medicaid expenditures. Uses the ACA expansion FMAP for expansion " "adults (42 U.S.C. 1396d(y)) and the state's regular FMAP for all " - "other enrollment groups (42 U.S.C. 1396d(b))." + "other enrollment groups (42 U.S.C. 1396d(b)). Rhode Island's " + "postpartum continuation receives no Title XIX match unless the " + "pregnancy was covered by Medicaid and the enrollee meets Medicaid " + "immigration requirements: RIte Start serves people not eligible " + "under Title XIX or XXI, and CHIP and FCEP pregnancies are Title XXI " + "coverage. An enrollee who also meets a federally matched group keeps " + "that group's match. Separate Title XXI health services " + "initiative funding is not included here." ) unit = "/1" definition_period = YEAR - reference = "https://www.law.cornell.edu/uscode/text/42/1396d" + reference = ( + "https://www.law.cornell.edu/uscode/text/42/1396d", + "https://webserver.rilegislature.gov/Statutes/TITLE42/42-12.3/42-12.3-3.htm", + "https://www.medicaid.gov/medicaid/spa/downloads/RI-22-0024.pdf#page=7", + "https://www.medicaid.gov/CHIP/Downloads/RI-22-0026.pdf#page=2", + ) defined_for = "medicaid_enrolled" def formula(person, period, parameters): @@ -22,11 +34,19 @@ def formula(person, period, parameters): regular_fmap = p.fmap[state] category = person("medicaid_category", period) categories = category.possible_values + federally_matched_route = (category != categories.NONE) & person( + "is_medicaid_immigration_status_eligible", period + ) + no_federal_medicaid_match = ( + person("ri_medicaid_state_funded_postpartum_eligible", period) + & ~federally_matched_route + ) return select( [ + no_federal_medicaid_match, category == categories.ADULT, category != categories.NONE, ], - [p.expansion_fmap, regular_fmap], + [0, p.expansion_fmap, regular_fmap], default=0, ) diff --git a/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/pregnant/is_pregnant_for_medicaid_fc.py b/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/pregnant/is_pregnant_for_medicaid_fc.py index 5f2fc085cf8..67546245ad7 100644 --- a/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/pregnant/is_pregnant_for_medicaid_fc.py +++ b/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/pregnant/is_pregnant_for_medicaid_fc.py @@ -20,10 +20,39 @@ class is_pregnant_for_medicaid_fc(Variable): # Medi-Cal. The section-level URL returns a version picker; this link # renders the full chapter text. "https://leginfo.legislature.ca.gov/faces/codes_displayText.xhtml?lawCode=WIC&division=9.&title=&part=3.3.&chapter=2.&article=", + # R.I. Gen. Laws § 42-12.3-3(g): people eligible for Medicaid or CHIP + # while pregnant keep full Medicaid through the postpartum period. + "https://webserver.rilegislature.gov/Statutes/TITLE42/42-12.3/42-12.3-3.htm", + # 210-RICR-30-00-1 § 1.6(A)(2)(a)(2), insured route from August 17, 2025. + "https://risos-apa-production-public.s3.amazonaws.com/EOHHS/REG_13314_20250728104245127.pdf#page=5", + # 1115 Budget Population 6b, insured pregnant women, December 23, 2013 + # to December 31, 2018. + "https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/ri/Comprehensive-Demonstration/ri-global-consumer-choice-compact-expnditure-auth-12232013-12312018.pdf#page=2", + # 1115 Budget Population 6b, 2019 to 2024 (March 21, 2024 approval). + "https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/ri-comphnsve-dmnstrtn-aprvl.pdf#page=11", + # 1115 Budget Population 6b, extended through June 30, 2025. + "https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/ri-comphnsve-dmnstrtn-tmp-extn-amndmnt.pdf#page=6", + # PDF pages 3, 15: 1115 Budget Population 6b, 2026 to 2030. + "https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/ri-comp-demo-appvl-11282025.pdf#page=3", ) def formula(person, period, parameters): ma = parameters(period).gov.hhs.medicaid.eligibility.categories.pregnant state = person.household("state_code_str", period) income_limit = ma.income_limit[state] - return medicaid_income_eligible(person, period, parameters, income_limit) + ri_higher_limit = person("ri_medicaid_has_third_party_coverage", period) + # NOTE: 210-RICR-30-00-1 § 1.6(B) gives one pregnancy row (253% FPL plus + # the disregard) for insured Medicaid and uninsured CHIP, so this reuses + # the CHIP pregnancy limit. A CHIP-only change to that parameter would + # also move Rhode Island's insured Medicaid route. + chip_income_limit = parameters(period).gov.hhs.chip.pregnant.income_limit[state] + income_limit = where(ri_higher_limit, chip_income_limit, income_limit) + # Only a Medicaid pregnancy keeps the pregnancy group (SHO 21-007 Q6). + coverage = person("ri_pregnancy_coverage", period) + ri_postpartum_eligible = person( + "ri_medicaid_postpartum_eligible", period.first_month + ) & (coverage == coverage.possible_values.MEDICAID) + return ( + medicaid_income_eligible(person, period, parameters, income_limit) + | ri_postpartum_eligible + ) diff --git a/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/pregnant/is_pregnant_for_medicaid_nfc.py b/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/pregnant/is_pregnant_for_medicaid_nfc.py index c122e30b728..8d48a65ec34 100644 --- a/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/pregnant/is_pregnant_for_medicaid_nfc.py +++ b/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/pregnant/is_pregnant_for_medicaid_nfc.py @@ -13,4 +13,15 @@ def formula(person, period, parameters): days_postpartum = person("count_days_postpartum", period) state = person.household("state_code_str", period) max_postpartum_days = ma.postpartum_coverage[state] - return is_pregnant | (days_postpartum < max_postpartum_days) + # Rhode Island's 12-month continuation adds to the state's day-count + # postpartum period (postpartum_coverage); it does not replace it. + # Only a Medicaid pregnancy keeps the pregnancy group (SHO 21-007 Q6). + coverage = person("ri_pregnancy_coverage", period) + ri_postpartum_eligible = person( + "ri_medicaid_postpartum_eligible", period.first_month + ) & (coverage == coverage.possible_values.MEDICAID) + return ( + is_pregnant + | (days_postpartum < max_postpartum_days) + | ri_postpartum_eligible + ) diff --git a/policyengine_us/variables/gov/hhs/medicaid/eligibility/is_medicaid_eligible.py b/policyengine_us/variables/gov/hhs/medicaid/eligibility/is_medicaid_eligible.py index 809e8c79883..89f9c17dee0 100644 --- a/policyengine_us/variables/gov/hhs/medicaid/eligibility/is_medicaid_eligible.py +++ b/policyengine_us/variables/gov/hhs/medicaid/eligibility/is_medicaid_eligible.py @@ -9,6 +9,7 @@ class is_medicaid_eligible(Variable): reference = ( "https://www.law.cornell.edu/uscode/text/42/1396a#a_10", "https://www.kff.org/racial-equity-and-health-policy/fact-sheet/key-facts-on-health-coverage-of-immigrants", + "https://webserver.rilegislature.gov/Statutes/TITLE42/42-12.3/42-12.3-3.htm", ) def formula(person, period, parameters): @@ -19,6 +20,9 @@ def formula(person, period, parameters): ) ca_ffyp_eligible = person("ca_ffyp_eligible", period) il_hbi_eligible = person("il_hbi_eligible", period) + ri_postpartum_eligible = person( + "ri_medicaid_state_funded_postpartum_eligible", period + ) p = parameters(period).gov.hhs.medicaid.eligibility federal_work_requirement_eligible = True @@ -51,4 +55,5 @@ def formula(person, period, parameters): ) | ca_ffyp_eligible | il_hbi_eligible + | ri_postpartum_eligible ) diff --git a/policyengine_us/variables/gov/hhs/medicaid/medicaid_enrolled.py b/policyengine_us/variables/gov/hhs/medicaid/medicaid_enrolled.py index 05b2f752609..bf864de3dc6 100644 --- a/policyengine_us/variables/gov/hhs/medicaid/medicaid_enrolled.py +++ b/policyengine_us/variables/gov/hhs/medicaid/medicaid_enrolled.py @@ -6,6 +6,15 @@ class medicaid_enrolled(Variable): entity = Person label = "Medicaid enrolled" definition_period = YEAR - reference = "https://www.law.cornell.edu/uscode/text/42/1396a" + reference = ( + "https://www.law.cornell.edu/uscode/text/42/1396a", + "https://www.medicaid.gov/CHIP/Downloads/RI-22-0025.pdf#page=4", + ) defined_for = "is_medicaid_eligible" - adds = ["takes_up_medicaid_if_eligible"] + + def formula(person, period, parameters): + takes_up = person("takes_up_medicaid_if_eligible", period) + retained_chip = person( + "ri_chip_postpartum_eligible", period.first_month + ) & person("takes_up_chip_if_eligible", period) + return takes_up & ~retained_chip diff --git a/policyengine_us/variables/gov/states/ri/eohhs/medicaid/ri_chip_postpartum_eligible.py b/policyengine_us/variables/gov/states/ri/eohhs/medicaid/ri_chip_postpartum_eligible.py new file mode 100644 index 00000000000..0918fa035d3 --- /dev/null +++ b/policyengine_us/variables/gov/states/ri/eohhs/medicaid/ri_chip_postpartum_eligible.py @@ -0,0 +1,19 @@ +from policyengine_us.model_api import * + + +class ri_chip_postpartum_eligible(Variable): + value_type = bool + entity = Person + label = "Eligible for Rhode Island postpartum CHIP continuation" + definition_period = MONTH + defined_for = StateCode.RI + reference = ( + "https://www.medicaid.gov/CHIP/Downloads/RI-22-0025.pdf#page=4", + "https://webserver.rilegislature.gov/Statutes/TITLE42/42-12.3/42-12.3-3.htm", + ) + + def formula(person, period, parameters): + coverage = person("ri_pregnancy_coverage", period.this_year) + return person("ri_medicaid_postpartum_eligible", period) & ( + coverage == coverage.possible_values.CHIP + ) diff --git a/policyengine_us/variables/gov/states/ri/eohhs/medicaid/ri_medicaid_has_third_party_coverage.py b/policyengine_us/variables/gov/states/ri/eohhs/medicaid/ri_medicaid_has_third_party_coverage.py new file mode 100644 index 00000000000..b76be3fa88b --- /dev/null +++ b/policyengine_us/variables/gov/states/ri/eohhs/medicaid/ri_medicaid_has_third_party_coverage.py @@ -0,0 +1,20 @@ +from policyengine_us.model_api import * + + +class ri_medicaid_has_third_party_coverage(Variable): + value_type = bool + entity = Person + label = "Rhode Island Medicaid third-party health coverage" + definition_period = YEAR + defined_for = StateCode.RI + reference = ( + # PDF pages 5, 19: 210-RICR-30-00-1 §§ 1.6(A)(2)(a)(2), 1.9(B)(1). + "https://risos-apa-production-public.s3.amazonaws.com/EOHHS/REG_13314_20250728104245127.pdf#page=5", + "https://eohhs.ri.gov/providers-partners/billing-and-claims/third-party-liability", + "https://tricare.mil/FAQs/General/GEN_OHI_TRICARE", + "https://www.va.gov/resources/champva-care/", + ) + + def formula(person, period, parameters): + p = parameters(period).gov.states.ri.eohhs.medicaid + return add(person, period, p.third_party_coverage) > 0 diff --git a/policyengine_us/variables/gov/states/ri/eohhs/medicaid/ri_medicaid_postpartum_eligible.py b/policyengine_us/variables/gov/states/ri/eohhs/medicaid/ri_medicaid_postpartum_eligible.py new file mode 100644 index 00000000000..92c3a9e7cb5 --- /dev/null +++ b/policyengine_us/variables/gov/states/ri/eohhs/medicaid/ri_medicaid_postpartum_eligible.py @@ -0,0 +1,33 @@ +from policyengine_us.model_api import * + + +class ri_medicaid_postpartum_eligible(Variable): + value_type = bool + entity = Person + label = "Eligible for Rhode Island postpartum Medicaid continuation" + definition_period = MONTH + defined_for = StateCode.RI + reference = ( + "https://webserver.rilegislature.gov/Statutes/TITLE42/42-12.3/42-12.3-3.htm", + "https://www.law.cornell.edu/uscode/text/42/1396a#e_16", + "https://www.medicaid.gov/medicaid/spa/downloads/RI-22-0024.pdf#page=7", + ) + + def formula(person, period, parameters): + p = parameters(period).gov.states.ri.eohhs.medicaid + months = int(p.postpartum_coverage_months) + coverage = person("ri_pregnancy_coverage", period.this_year) + eligible_during_pregnancy = coverage != coverage.possible_values.NONE + pregnancy_end = person("ri_pregnancy_end_date", period.this_year) + reference_date = np.datetime64(period.start.date) + # 42 U.S.C. 1396a(e)(16) and SPA RI-22-0024 start the 12-month period on + # the last day of pregnancy, so it ends the day before the same date 12 + # months later, in the month of (end date - 1 day) + 12 months. Coverage + # runs through the last day of that month. + day_before_end = pregnancy_end - np.timedelta64(1, "D") + first_uncovered_month = day_before_end.astype("datetime64[M]") + months + 1 + return ( + eligible_during_pregnancy + & (pregnancy_end <= reference_date) + & (reference_date.astype("datetime64[M]") < first_uncovered_month) + ) diff --git a/policyengine_us/variables/gov/states/ri/eohhs/medicaid/ri_medicaid_state_funded_postpartum_eligible.py b/policyengine_us/variables/gov/states/ri/eohhs/medicaid/ri_medicaid_state_funded_postpartum_eligible.py new file mode 100644 index 00000000000..7967e8e9c2a --- /dev/null +++ b/policyengine_us/variables/gov/states/ri/eohhs/medicaid/ri_medicaid_state_funded_postpartum_eligible.py @@ -0,0 +1,63 @@ +from policyengine_us.model_api import * +from policyengine_us.variables.gov.hhs.medicaid.income.medicaid_income_level import ( + medicaid_income_eligible, +) + + +class ri_medicaid_state_funded_postpartum_eligible(Variable): + value_type = bool + entity = Person + label = "Eligible for Rhode Island postpartum Medicaid outside the pregnancy group" + documentation = ( + "Rhode Island's 12-month postpartum continuation for people whose " + "pregnancy was not covered by Medicaid, or who lack Medicaid " + "immigration status. It does not apply while the person takes up " + "Title XXI coverage for a new pregnancy, which requires income within " + "the CHIP limit and no coverage that bars that CHIP route." + ) + definition_period = YEAR + defined_for = StateCode.RI + reference = ( + "https://webserver.rilegislature.gov/Statutes/TITLE42/42-12.3/42-12.3-3.htm", + "https://risos-apa-production-public.s3.amazonaws.com/EOHHS/REG_13314_20250728104245127.pdf#page=5", + "https://www.medicaid.gov/CHIP/Downloads/RI-22-0026.pdf#page=2", + ) + + def formula(person, period, parameters): + continuation = person("ri_medicaid_postpartum_eligible", period.first_month) + coverage = person("ri_pregnancy_coverage", period) + pregnancy_group = (coverage == coverage.possible_values.MEDICAID) & person( + "is_medicaid_immigration_status_eligible", period + ) + state = person.household("state_code", period) + p = parameters(period).gov.hhs.chip + # Standard pregnancy CHIP excludes Rhode Island's third-party list + # (210-RICR-30-00-1 § 1.6(A)(2)(b)). Unborn-child coverage + # (§ 1.6(A)(2)(c)) uses the CHIP no-other-coverage test (42 CFR + # 457.310(b)(2)) without Medicaid enrollment, which is this + # continuation itself. + chip_immigration_eligible = person( + "is_chip_immigration_status_eligible", period + ) + income_limit = where( + chip_immigration_eligible, + p.pregnant.income_limit[state], + p.fcep.income_limit[state], + ) + fcep_coverage_sources = [ + source + for source in p.disqualifying_health_coverage + if source != "medicaid_enrolled" + ] + has_disqualifying_coverage = where( + chip_immigration_eligible, + person("ri_medicaid_has_third_party_coverage", period), + add(person, period, fcep_coverage_sources) > 0, + ) + title_xxi_pregnancy = ( + person("is_pregnant", period) + & medicaid_income_eligible(person, period, parameters, income_limit) + & ~has_disqualifying_coverage + & person("takes_up_chip_if_eligible", period) + ) + return continuation & ~pregnancy_group & ~title_xxi_pregnancy diff --git a/policyengine_us/variables/gov/states/ri/eohhs/medicaid/ri_pregnancy_coverage.py b/policyengine_us/variables/gov/states/ri/eohhs/medicaid/ri_pregnancy_coverage.py new file mode 100644 index 00000000000..8a2883a6640 --- /dev/null +++ b/policyengine_us/variables/gov/states/ri/eohhs/medicaid/ri_pregnancy_coverage.py @@ -0,0 +1,28 @@ +from policyengine_us.model_api import * + + +class RIPregnancyCoverage(Enum): + MEDICAID = "Medicaid" + CHIP = "Separate CHIP" + RITE_START = "RIte Start" + FCEP = "CHIP unborn-child coverage" + NONE = "No established qualifying pregnancy eligibility" + + +class ri_pregnancy_coverage(Variable): + value_type = Enum + possible_values = RIPregnancyCoverage + default_value = RIPregnancyCoverage.NONE + entity = Person + label = "Qualifying Rhode Island coverage during the last completed pregnancy" + documentation = ( + "Eligibility during the last completed pregnancy, including retroactive " + "eligibility. Current income and enrollment cannot establish this " + "history. The input is annual: a value entered only for the year the " + "pregnancy ended gives no continuation in later years." + ) + definition_period = YEAR + reference = ( + "https://webserver.rilegislature.gov/Statutes/TITLE42/42-12.3/42-12.3-3.htm", + "https://www.medicaid.gov/CHIP/Downloads/RI-22-0025.pdf#page=4", + ) diff --git a/policyengine_us/variables/gov/states/ri/eohhs/medicaid/ri_pregnancy_end_date.py b/policyengine_us/variables/gov/states/ri/eohhs/medicaid/ri_pregnancy_end_date.py new file mode 100644 index 00000000000..6c5fee73b9e --- /dev/null +++ b/policyengine_us/variables/gov/states/ri/eohhs/medicaid/ri_pregnancy_end_date.py @@ -0,0 +1,19 @@ +from policyengine_us.model_api import * + + +class ri_pregnancy_end_date(Variable): + value_type = date + entity = Person + label = "End date of the last completed pregnancy for Rhode Island Medicaid" + documentation = ( + "End date of the last completed pregnancy, whether by birth, " + "miscarriage or termination. It describes the same event as " + "count_days_postpartum; if the two disagree, the day-count postpartum " + "route and Rhode Island's calendar continuation are both applied, and " + "either one qualifies. The input is annual: a value entered only for " + "the year the pregnancy ended gives no continuation in later years." + ) + definition_period = YEAR + reference = ( + "https://webserver.rilegislature.gov/Statutes/TITLE42/42-12.3/42-12.3-3.htm" + ) diff --git a/source_conflicts/candidates.yaml b/source_conflicts/candidates.yaml index 51cfa31ec71..7c6690afc9c 100644 --- a/source_conflicts/candidates.yaml +++ b/source_conflicts/candidates.yaml @@ -7155,6 +7155,48 @@ candidates: note: 'PE-US follows the manual: workers_compensation counts, as does disability_benefits, which stands in for TDI and TCI, and the list''s comment records the plan''s unchecked insurance item (income/sources/unearned.yaml, ri_liheap_income.py). Verify whether the unchecked insurance category covers these payments.' +- id: us-ri:medicaid-postpartum-end-month + program: medicaid + years: + from: 2022 + type: calendar + question: For Rhode Island's section 1115 Budget Populations 6a and 6b, when a pregnancy ends on the first day of + a month, does the 12-month postpartum period begin that day and end Medicaid in the 11th following month, or does + coverage run to the end of the 12th following month? + sources: + - kind: statute + citation: 42 U.S.C. 1396a(e)(16), which subparagraph (A) applies to state plans and waivers + url: https://www.law.cornell.edu/uscode/text/42/1396a#e_16 + - kind: plan + citation: Rhode Island Medicaid State Plan Amendment RI-22-0024, section B, page 7 + url: https://www.medicaid.gov/medicaid/spa/downloads/RI-22-0024.pdf#page=7 + - kind: policy + citation: CMS section 1115 amendment approval of the Rhode Island Comprehensive Demonstration (March 21, 2024; 2019 + to 2024), expenditure authorities, Budget Populations 6a and 6b, file page 11 + url: https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/ri-comphnsve-dmnstrtn-aprvl.pdf#page=11 + - kind: policy + citation: CMS section 1115 approval of the Rhode Island Comprehensive Demonstration (November 28, 2025), expenditure + authorities 1(b)-(c), Budget Populations 6a and 6b + url: https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/ri-comp-demo-appvl-11282025.pdf#page=15 + readings: + statute: The 12-month period begins on the last day of pregnancy and coverage runs through the last day of the + month in which that period ends; RI-22-0024 repeats this wording. + other: The 1115 expenditure authorities for Budget Populations 6a and 6b extend coverage to the end of the 12th + month following the end of the pregnancy. + example: For a Budget Population 6b enrollee whose pregnancy ends on January 1, 2023, coverage runs through December + 2023 under the statute and through January 2024 under the 1115 wording; any other end day gives the same last month + under both. + pe_us: + follows: statute + code: + - policyengine_us/variables/gov/states/ri/eohhs/medicaid/ri_medicaid_postpartum_eligible.py + prs: + - https://github.com/PolicyEngine/policyengine-us/pull/10391 + state: unreviewed + note: The conflict is limited to the 1115 Budget Populations 6a and 6b, whose March 2024 and November 2025 approvals + use the same wording. The RI-22-0024 state plan groups, RIte Start and FCEP have no conflicting text, and CHIP + (RI-22-0025 CS27) ends the period "on the last day of the 12th month consistent with paragraphs (5) and (16) of + section 1902(e)". R.I. Gen. Laws 42-12.3-3(g) does not say when the 12-month period begins. - id: us-ri:ssp-category-d-without-federal-ssi program: ssi-state-supplement years: