From bb25901ca3c6bf1daae8652e327f6fa03d92f554 Mon Sep 17 00:00:00 2001 From: Ziming Date: Thu, 22 Oct 2026 17:48:15 -0400 Subject: [PATCH] Fix WV Medicaid spouse standards and ND medically needy coverage --- ...icaid-wv-nd-eligibility-followups.fixed.md | 1 + .../medically_needy/categories/disabled.yaml | 6 +- .../medically_needy/categories/senior.yaml | 6 +- .../medically_needy/limit/income/couple.yaml | 6 + .../limit/income/individual.yaml | 6 + ...al_senior_or_disabled_income_eligible.yaml | 2 + ...ional_senior_or_disabled_income_limit.yaml | 127 +++++++++++++++++- ..._in_medicaid_medically_needy_category.yaml | 38 ++++++ .../is_medically_needy_for_medicaid.yaml | 124 +++++++++++++++++ .../eligibility/is_medicaid_eligible.yaml | 84 ++++++++++++ ...ptional_senior_or_disabled_income_limit.py | 10 ++ ...is_in_medicaid_medically_needy_category.py | 8 +- 12 files changed, 411 insertions(+), 7 deletions(-) create mode 100644 changelog.d/medicaid-wv-nd-eligibility-followups.fixed.md diff --git a/changelog.d/medicaid-wv-nd-eligibility-followups.fixed.md b/changelog.d/medicaid-wv-nd-eligibility-followups.fixed.md new file mode 100644 index 00000000000..beb56573a18 --- /dev/null +++ b/changelog.d/medicaid-wv-nd-eligibility-followups.fixed.md @@ -0,0 +1 @@ +Correct West Virginia's Medicaid income standard for applicants with ineligible spouses, and enable North Dakota's aged, blind, and disabled medically needy coverage with published 2025-2026 income limits. 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..64daadbdd5f 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 @@ -7,6 +7,10 @@ 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: North Dakota Administrative Code 75-02-02.1-05(3)(e) - Medically needy aged, blind, or disabled individuals not receiving SSI + href: https://www.ndlegis.gov/information/acdata/pdf/75-02-02.1.pdf#page=11 + - title: North Dakota Non-ACA Medicaid Policy Manual 510-05-30-05 - Groups Covered Under Medicaid (archived, revised October 1, 2013) + href: https://www.nd.gov/dhs/policymanuals/51005/Archived%20Documents/2014%20-%203406/510_05_30_05%20ML3406.htm AK: 2015-01-01: false @@ -65,7 +69,7 @@ MT: NC: 2015-01-01: true ND: - 2015-01-01: false + 2015-01-01: true NE: 2015-01-01: true NH: 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..b8fc312f809 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 @@ -7,6 +7,10 @@ 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: North Dakota Administrative Code 75-02-02.1-05(3)(e) - Medically needy aged, blind, or disabled individuals not receiving SSI + href: https://www.ndlegis.gov/information/acdata/pdf/75-02-02.1.pdf#page=11 + - title: North Dakota Non-ACA Medicaid Policy Manual 510-05-30-05 - Groups Covered Under Medicaid (archived, revised October 1, 2013) + href: https://www.nd.gov/dhs/policymanuals/51005/Archived%20Documents/2014%20-%203406/510_05_30_05%20ML3406.htm AK: 2015-01-01: false @@ -65,7 +69,7 @@ MT: NC: 2015-01-01: true ND: - 2015-01-01: false + 2015-01-01: true NE: 2015-01-01: true NH: 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..efe2312c09f 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 +8,10 @@ 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: North Dakota Non-ACA Medicaid Policy Manual 510-05-85-40 - Income Levels (archived, effective April 1, 2025) + href: https://www.nd.gov/dhs/policymanuals/51005/Archived%20Documents/2025/3935/510_05_85_40.htm + - title: North Dakota Non-ACA Medicaid Policy Manual 510-05-85-40 - Income Levels + href: https://www.nd.gov/dhs/policymanuals/51005/510_05_85_40.htm AK: 2018-01-01: -.inf @@ -67,6 +71,8 @@ NC: 2018-01-01: 317 ND: 2018-01-01: 1_139 + 2025-04-01: 1_587 + 2026-04-01: 1_623 NE: 2018-01-01: 392 NH: 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..9672adfd77e 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 +8,10 @@ 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: North Dakota Non-ACA Medicaid Policy Manual 510-05-85-40 - Income Levels (archived, effective April 1, 2025) + href: https://www.nd.gov/dhs/policymanuals/51005/Archived%20Documents/2025/3935/510_05_85_40.htm + - title: North Dakota Non-ACA Medicaid Policy Manual 510-05-85-40 - Income Levels + href: https://www.nd.gov/dhs/policymanuals/51005/510_05_85_40.htm AK: 2018-01-01: -.inf @@ -67,6 +71,8 @@ NC: 2018-01-01: 242 ND: 2018-01-01: 840 + 2025-04-01: 1_174 + 2026-04-01: 1_197 NE: 2018-01-01: 392 NH: diff --git a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_income_eligible.yaml b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_income_eligible.yaml index eed9a1321b7..ef931420c05 100644 --- a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_income_eligible.yaml +++ b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/is_optional_senior_or_disabled_income_eligible.yaml @@ -680,8 +680,10 @@ input: people: person1: + age: 70 medicaid_optional_senior_or_disabled_countable_income: 8_946 person2: + age: 68 medicaid_optional_senior_or_disabled_countable_income: 8_946 tax_units: tax_unit: diff --git a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medicaid_optional_senior_or_disabled_income_limit.yaml b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medicaid_optional_senior_or_disabled_income_limit.yaml index 0b6ce7ffb1f..63712e55926 100644 --- a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medicaid_optional_senior_or_disabled_income_limit.yaml +++ b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medicaid_optional_senior_or_disabled_income_limit.yaml @@ -3,9 +3,9 @@ # 85% (DSS Manual ยง 0805.015.45; current dollars in MHABD Appendix J). # Missouri publishes the standards as monthly dollar amounts, rounding # the percentage of the monthly guideline up to the next whole dollar. -# In every state the guideline is the one-person or couple figure (2025: -# $15,650 and $21,150), following the applicant's marital unit rather -# than the tax unit (42 CFR 435.602). +# The guideline is the one-person or couple figure (2025: $15,650 and +# $21,150), following the applicant's marital unit rather than the tax +# unit (42 CFR 435.602). West Virginia's needs-group exceptions are below. - name: Missouri blind single person gets the 100% FPL blind standard period: 2025 input: @@ -409,3 +409,124 @@ output: # 967 x 12 medicaid_optional_senior_or_disabled_income_limit: [11_604] + +# WV IMM 3.17.3.A.2-4: use the individual standard when an ineligible +# spouse has no deemed income, and the couple standard when both spouses +# are eligible or income is deemed. The 2026 SSI standards are $994 and +# $1,491 monthly; the deeming allocation is their $497 difference. +# https://bfa.wv.gov/media/40005/download?inline#page=385 +- name: Case 19, West Virginia uses the individual standard with an ineligible spouse and no deemed income. + period: 2026 + input: + people: + person1: + age: 70 + social_security_retirement: 17_040 + person2: + age: 60 + marital_units: + couple: + members: [person1, person2] + tax_units: + couple: + members: [person1, person2] + tax_unit_is_joint: true + households: + household: + members: [person1, person2] + state_code: WV + output: + # $1,420 monthly retirement income less $20 = $1,400 countable. + # Marriage alone must not give the applicant the $1,491 limit. + is_ssi_spousal_deeming_applies: [false, false] + medicaid_optional_senior_or_disabled_income_limit: [11_928, 11_928] + is_optional_senior_or_disabled_income_eligible: [false, false] + +- name: Case 20, West Virginia keeps the individual standard at the spousal deeming threshold. + period: 2026 + input: + people: + person1: + age: 70 + person2: + age: 62 + social_security_retirement: 5_964 + marital_units: + couple: + members: [person1, person2] + tax_units: + couple: + members: [person1, person2] + tax_unit_is_joint: true + households: + household: + members: [person1, person2] + state_code: WV + output: + # $497 monthly does not exceed the $1,491 - $994 allocation. + is_ssi_spousal_deeming_applies: [false, false] + medicaid_optional_senior_or_disabled_income_limit: [11_928, 11_928] + +- name: Case 21, West Virginia uses the couple standard for the second spouse when deeming applies. + period: 2026 + input: + people: + person1: + age: 62 + social_security_retirement: 7_200 + person2: + age: 70 + social_security_retirement: 10_800 + marital_units: + couple: + members: [person1, person2] + tax_units: + couple: + members: [person1, person2] + tax_unit_is_joint: true + households: + household: + members: [person1, person2] + state_code: WV + output: + # The spouse's $600 monthly exceeds the $497 allocation. Combined + # countable income is $900 + $600 - $20 = $1,480 monthly. + is_ssi_spousal_deeming_applies: [false, true] + medicaid_optional_senior_or_disabled_income_limit: [11_928, 17_892] + is_optional_senior_or_disabled_income_eligible: [false, true] + +- name: Case 22, West Virginia eligible spouses use the couple standard without changing Missouri. + period: 2026 + input: + people: + person1: + age: 70 + person2: + age: 68 + person3: + age: 70 + person4: + age: 60 + marital_units: + wv_couple: + members: [person1, person2] + mo_couple: + members: [person3, person4] + tax_units: + wv_couple: + members: [person1, person2] + tax_unit_is_joint: true + mo_couple: + members: [person3, person4] + tax_unit_is_joint: true + households: + west_virginia: + members: [person1, person2] + state_code: WV + missouri: + members: [person3, person4] + state_code: MO + output: + # WV: $1,491 monthly SSI couple rate. MO: $1,533 monthly, regardless + # of whether the second spouse independently meets the ABD criteria. + medicaid_optional_senior_or_disabled_income_limit: [17_892, 17_892, 18_396, 18_396] 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..d455c2175c4 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 +13,41 @@ state_code: MA output: is_in_medicaid_medically_needy_category: false + +# ND's archived 510-05-30-05 includes non-SSI aged, blind, or disabled +# individuals in its medically needy group on or after January 1, 2014. +- name: Case 3, North Dakota seniors have a medically needy category in 2015. + period: 2015 + input: + age: 70 + state_code: ND + output: + is_in_medicaid_medically_needy_category: true + +- name: Case 4, North Dakota disabled adults have a medically needy category in 2018. + period: 2018 + input: + age: 40 + is_disabled: true + meets_ssi_disability_criteria: true + state_code: ND + output: + is_in_medicaid_medically_needy_category: true + +- name: Case 5, North Dakota childless adults without a disability do not meet an ABD medically needy category. + period: 2026 + input: + age: 40 + state_code: ND + output: + is_in_medicaid_medically_needy_category: false + +- name: Case 6, North Dakota blind adults need not meet the separate SSI disability criteria. + period: 2026 + input: + age: 40 + is_blind: true + meets_ssi_disability_criteria: false + state_code: ND + output: + is_in_medicaid_medically_needy_category: 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 4c889ee6e99..fc8de9c7e6e 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 +50,127 @@ state_code: MA output: is_medically_needy_for_medicaid: false + +# ND 510-05-85-40 publishes $1,174 per month from April 1, 2025, +# and $1,197 from April 1, 2026. Calendar-year calculations read the +# standard at January 1; a rolling year beginning in April reads the update. +- name: Case 3, North Dakota calendar 2026 retains the previous April individual standard. + period: 2026 + input: + age: 70 + state_code: ND + ssi: 0 + receives_ssi: false + is_optional_senior_or_disabled_for_medicaid: false + ssi_countable_income: 14_088 + output: + is_medically_needy_for_medicaid: true + +- name: Case 4, North Dakota calendar 2026 excludes income above the previous April individual standard. + period: 2026 + input: + age: 70 + state_code: ND + ssi: 0 + receives_ssi: false + is_optional_senior_or_disabled_for_medicaid: false + ssi_countable_income: 14_089 + output: + is_medically_needy_for_medicaid: false + +- name: Case 5, North Dakota individual at the April 2026 medically needy standard qualifies. + period: year:2026-04 + input: + age: 70 + state_code: ND + ssi: 0 + receives_ssi: false + is_optional_senior_or_disabled_for_medicaid: false + ssi_countable_income: 14_364 + output: + is_medically_needy_for_medicaid: true + +- name: Case 6, North Dakota individual above the April 2026 medically needy standard does not qualify. + period: year:2026-04 + input: + age: 70 + state_code: ND + ssi: 0 + receives_ssi: false + is_optional_senior_or_disabled_for_medicaid: false + ssi_countable_income: 14_365 + output: + is_medically_needy_for_medicaid: false + +# The April 2026 couple standard is $1,623 per month, or $19,476 annually. +- name: Case 7, North Dakota couple at the April 2026 medically needy standard qualifies. + period: year:2026-04 + input: + people: + person1: + age: 70 + ssi: 0 + receives_ssi: false + is_optional_senior_or_disabled_for_medicaid: false + ssi_countable_income: 9_738 + person2: + age: 68 + ssi: 0 + receives_ssi: false + is_optional_senior_or_disabled_for_medicaid: false + ssi_countable_income: 9_738 + tax_units: + tax_unit: + members: [person1, person2] + tax_unit_is_joint: true + marital_units: + marital_unit: + members: [person1, person2] + households: + household: + members: [person1, person2] + state_code: ND + output: + is_medically_needy_for_medicaid: [true, true] + +- name: Case 8, North Dakota couple above the April 2026 medically needy standard does not qualify. + period: year:2026-04 + input: + people: + person1: + age: 70 + ssi: 0 + receives_ssi: false + is_optional_senior_or_disabled_for_medicaid: false + ssi_countable_income: 9_739 + person2: + age: 68 + ssi: 0 + receives_ssi: false + is_optional_senior_or_disabled_for_medicaid: false + ssi_countable_income: 9_738 + tax_units: + tax_unit: + members: [person1, person2] + tax_unit_is_joint: true + marital_units: + marital_unit: + members: [person1, person2] + households: + household: + members: [person1, person2] + state_code: ND + output: + is_medically_needy_for_medicaid: [false, false] + +- name: Case 9, North Dakota April 2026 income increase is not applied in March. + period: year:2026-03 + input: + age: 70 + state_code: ND + ssi: 0 + receives_ssi: false + is_optional_senior_or_disabled_for_medicaid: false + ssi_countable_income: 14_364 + output: + is_medically_needy_for_medicaid: false 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..6b536ffbe85 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 +314,87 @@ medicaid_category: SECTION_1115_MEC_ADULT is_medicaid_work_requirement_applicable_adult: true is_medicaid_eligible: true + +# ND 510-05-85-40: the January 2026 medically needy standards remain +# $1,174 individual / $1,587 couple from April 2025. These households +# exceed the SSI standards, but qualify without medical spenddown. +- name: Case 17, North Dakota senior above the SSI rate retains medically needy coverage. + period: 2026 + input: + age: 70 + social_security_retirement: 12_180 + state_code: ND + output: + ssi: 0 + ssi_countable_resources: 0 + medicaid_optional_senior_or_disabled_countable_income: 11_940 + medicaid_optional_senior_or_disabled_income_limit: 11_928 + medicaid_medically_needy_medical_expenses: 0 + is_optional_senior_or_disabled_for_medicaid: false + is_medically_needy_for_medicaid: true + medicaid_category: MEDICALLY_NEEDY + is_medicaid_eligible: true + +- name: Case 18, North Dakota aged couple above the SSI couple rate has medically needy coverage. + period: 2026 + input: + people: + person1: + age: 70 + social_security_retirement: 9_600 + person2: + age: 68 + social_security_retirement: 9_360 + marital_units: + marital_unit: + members: [person1, person2] + tax_units: + tax_unit: + members: [person1, person2] + tax_unit_is_joint: true + households: + household: + members: [person1, person2] + state_code: ND + output: + ssi: [0, 0] + ssi_countable_resources: [0, 0] + medicaid_optional_senior_or_disabled_countable_income: [9_360, 9_360] + medicaid_optional_senior_or_disabled_income_limit: [17_892, 17_892] + medicaid_medically_needy_medical_expenses: [0, 0] + is_optional_senior_or_disabled_for_medicaid: [false, false] + is_medically_needy_for_medicaid: [true, true] + medicaid_category: [MEDICALLY_NEEDY, MEDICALLY_NEEDY] + is_medicaid_eligible: [true, true] + +# WV IMM 3.17.3.A.3 uses the individual standard when no income is +# deemed from an ineligible spouse. The younger spouse can qualify +# separately through the adult expansion group. +- name: Case 19, West Virginia senior with an ineligible spouse cannot use the couple standard without deeming. + period: 2026 + input: + people: + person1: + age: 70 + social_security_retirement: 17_040 + person2: + age: 60 + marital_units: + marital_unit: + members: [person1, person2] + tax_units: + tax_unit: + members: [person1, person2] + tax_unit_is_joint: true + households: + household: + members: [person1, person2] + state_code: WV + output: + ssi: [0, 0] + medicaid_optional_senior_or_disabled_countable_income: [16_800, 0] + medicaid_optional_senior_or_disabled_income_limit: [11_928, 11_928] + is_ssi_spousal_deeming_applies: [false, false] + is_optional_senior_or_disabled_for_medicaid: [false, false] + medicaid_category: [NONE, ADULT] + is_medicaid_eligible: [false, true] diff --git a/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/medicaid_optional_senior_or_disabled_income_limit.py b/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/medicaid_optional_senior_or_disabled_income_limit.py index cb5260bda63..c436b313b16 100644 --- a/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/medicaid_optional_senior_or_disabled_income_limit.py +++ b/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/medicaid_optional_senior_or_disabled_income_limit.py @@ -16,6 +16,8 @@ class medicaid_optional_senior_or_disabled_income_limit(Variable): "https://www.ecfr.gov/current/title-42/section-435.210", "https://dssmanuals.mo.gov/mo-healthnet-for-the-aged-blind-and-disabled/0805-000-00/0805-015-00/0805-015-45-income-maximum/", "https://dssmanuals.mo.gov/wp-content/uploads/2022/07/mhabd-appendix-j.pdf#page=1", + # PDF pages 383-385,665 + "https://bfa.wv.gov/media/40005/download?inline#page=383", ) def formula(person, period, parameters): @@ -24,6 +26,14 @@ def formula(person, period, parameters): # couple living together, whatever their filing status. is_couple = person.marital_unit.nb_persons() == 2 state = person.household("state_code_str", period) + # WV IMM 3.17.3.A uses the couple standard only when both spouses + # are eligible or income is deemed from an ineligible spouse. + is_couple = where( + state == "WV", + person("ssi_marital_both_eligible", period) + | person("is_ssi_spousal_deeming_applies", period), + is_couple, + ) p = parameters( period ).gov.hhs.medicaid.eligibility.categories.senior_or_disabled diff --git a/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/medically_needy/is_in_medicaid_medically_needy_category.py b/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/medically_needy/is_in_medicaid_medically_needy_category.py index 7c0ef4771d2..10bd6db46c3 100644 --- a/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/medically_needy/is_in_medicaid_medically_needy_category.py +++ b/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/medically_needy/is_in_medicaid_medically_needy_category.py @@ -7,6 +7,7 @@ class is_in_medicaid_medically_needy_category(Variable): label = "In Medicaid medically needy category" documentation = "Whether this person is in a Medicaid category for which there is a medically needy pathway." definition_period = YEAR + reference = "https://www.ndlegis.gov/information/acdata/pdf/75-02-02.1.pdf#page=11" def formula(person, period, parameters): mn_categories = parameters( @@ -14,11 +15,14 @@ def formula(person, period, parameters): ).gov.hhs.medicaid.eligibility.categories.medically_needy.categories aged_threshold = parameters(period).gov.ssa.ssi.eligibility.aged_threshold is_child = any_(person, period, mn_categories.child.child_categories) - is_disabled = person("is_ssi_disabled", period) + state = person.household("state_code_str", period) + # N.D.A.C. 75-02-02.1-05(3)(e) also covers blind individuals. + is_disabled = person("is_ssi_disabled", period) | ( + (state == "ND") & person("is_blind", period) + ) is_senior = person("age", period) >= aged_threshold is_pregnant = person("is_pregnant_for_medicaid_nfc", period) is_parent = person("is_parent_for_medicaid_nfc", period) - state = person.household("state_code_str", period) mn = mn_categories categories = [ mn.child.child,