Apply immigration tests to Medicare and Medicare Savings Programs

changelog.d/medicare-immigration-test.fixed.md

@@ -0,0 +1 @@
+Apply immigration tests to Medicare (42 U.S.C. 1395o(a)(2), 42 U.S.C. 1395mmm and 8 U.S.C. 1611(b)(3)) and to Medicare Savings Programs (42 U.S.C. 1396b(v), 8 U.S.C. 1611(a) and 1613(a)), so undocumented people no longer get either and, from 2027, only citizens, permanent residents and Cuban and Haitian entrants can get Medicare.

policyengine_us/parameters/gov/hhs/medicare/eligibility/immigration_statuses.yaml

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+description: The United States limits eligibility to these immigration statuses under the Medicare program.
+
+# 42 USC 1395mmm(a) limits Medicare to citizens and nationals, permanent residents,
+# Cuban and Haitian entrants, and Compact of Free Association residents. Nationals
+# and Compact residents have no immigration_status value.
+# 42 USC 1395mmm(b)(1) applies that limit on January 4, 2027 to people already
+# entitled or enrolled on July 4, 2025. A YEAR variable reads parameters at January 1,
+# so the list is dated January 1, 2027; a January 4 date would not apply until 2028.
+# 42 USC 1395mmm(a) bars new entrants from July 4, 2025 at once. No input records
+# enrollment on July 4, 2025, so the model treats everyone as grandfathered through
+# 2026, which overstates eligibility for those new entrants.
+# The earlier list is the lawful presence limit in 8 USC 1611(b)(3), applied backward
+# to the start of Medicare as an approximation.
+values:
+  1966-01-01:
+    - CITIZEN
+    - LEGAL_PERMANENT_RESIDENT
+    - REFUGEE
+    - ASYLEE
+    - DEPORTATION_WITHHELD
+    - CUBAN_HAITIAN_ENTRANT
+    - CONDITIONAL_ENTRANT
+    - PAROLED_ONE_YEAR
+    - DACA
+    - TPS
+
+  2027-01-01:
+    - CITIZEN
+    - LEGAL_PERMANENT_RESIDENT
+    - CUBAN_HAITIAN_ENTRANT
+
+metadata:
+  unit: list
+  period: year
+  label: Medicare eligible immigration statuses
+  reference:
+    - title: 42 U.S. Code § 1395mmm - Limiting Medicare coverage of certain individuals
+      href: https://www.law.cornell.edu/uscode/text/42/1395mmm
+    - title: "Public Law 119-21, section 71201 #page 249-250"
+      href: https://www.govinfo.gov/content/pkg/PLAW-119publ21/pdf/PLAW-119publ21.pdf#page=249
+    - title: 8 U.S. Code § 1611(b)(3)
+      href: https://www.law.cornell.edu/uscode/text/8/1611#b_3

policyengine_us/parameters/gov/hhs/medicare/eligibility/permanent_resident_years.yaml

@@ -0,0 +1,10 @@
+description: The United States requires lawful permanent residents without Part A entitlement to have this many years of continuous residence to enroll in Medicare at the eligibility age.
+metadata:
+  period: year
+  unit: year
+  label: Medicare permanent resident years of continuous residence
+  reference:
+    - title: 42 U.S. Code § 1395o(a)(2)
+      href: https://www.law.cornell.edu/uscode/text/42/1395o#a
+values:
+  1966-01-01: 5

policyengine_us/parameters/gov/hhs/medicare/part_a/premium_free_quarters_threshold.yaml

@@ -6,5 +6,12 @@ metadata:
   reference:
     - title: Medicare.gov - Part A costs
       href: https://www.cms.gov/newsroom/fact-sheets/2026-medicare-parts-b-premiums-deductibles
+    - title: 42 U.S. Code § 426(a) - Entitlement to hospital insurance benefits
+      href: https://www.law.cornell.edu/uscode/text/42/426
+    - title: 42 U.S. Code § 414(a) - Fully insured individual (no more than 40 quarters of coverage required)
+      href: https://www.law.cornell.edu/uscode/text/42/414
+# 40 is the ceiling under 42 USC 414(a), which requires one quarter for each year after
+# 1950 and before the year a person reaches 62, and at least 6, so people reaching 62
+# before 1991 needed fewer. It is applied backward to 1966 as an approximation.
 values:
-  2000-01-01: 40
+  1966-01-01: 40

policyengine_us/tests/policy/baseline/gov/aca/eligibility/is_aca_ptc_eligible.yaml

@@ -495,3 +495,20 @@
     has_qualifying_non_marketplace_health_coverage_at_interview: [true]
     pays_aca_premium: [false]
     is_aca_ptc_eligible: [false]
+
+# 42 U.S.C. 1395o(a)(2): a permanent resident of two years without Part A can't enroll
+# in Medicare at 70, so Medicare doesn't block the credit. The five-year bar in
+# 8 U.S.C. 1613(a) also rules out Medicaid.
+# $30,000 / 2025 individual FPL of $15,650 = 1.91, inside the 1.00 to 4.00 income range.
+- name: Permanent resident barred from Medicare at age 70 qualifies for ACA PTC
+  period: 2026
+  input:
+    age: 70
+    immigration_status: LEGAL_PERMANENT_RESIDENT
+    years_since_us_entry: 2
+    medicare_quarters_of_coverage: 0
+    taxable_private_pension_income: 30_000
+    state_code: TX
+  output:
+    is_medicare_eligible: false
+    is_aca_ptc_eligible: true

policyengine_us/tests/policy/baseline/gov/hhs/medicare/costs/medicare_cost.yaml

@@ -69,3 +69,27 @@
     gross_medicare_part_b_premium: 3_000
   output:
     medicare_cost: 14_751  # $17,751 spending - $3,000 Part B premium
+
+- name: unit test 7 - undocumented person is not enrolled and has no cost
+  period: 2026
+  absolute_error_margin: 0.01
+  input:
+    age: 70
+    immigration_status: UNDOCUMENTED
+    pension_income: 10_000
+    state_code: TX
+  output:
+    medicare_cost: 0
+
+- name: unit test 8 - person with temporary protected status, premium-free Part A
+  period: 2026
+  absolute_error_margin: 0.01
+  input:
+    age: 70
+    immigration_status: TPS
+    medicare_quarters_of_coverage: 40
+    pension_income: 10_000
+    state_code: TX
+  output:
+    # $18,983 spending - $2,434.80 Part B premium ($202.90 * 12) (2026)
+    medicare_cost: 16_548.2

policyengine_us/tests/policy/baseline/gov/hhs/medicare/costs/medicare_enrolled.yaml

@@ -35,3 +35,27 @@
     medicare_enrolled: true
   output:
     medicare_enrolled: true
+
+# 8 U.S.C. 1611(b)(3) limits Medicare benefits to noncitizens lawfully present.
+- name: Undocumented person aged 65 or older is not enrolled.
+  period: 2026
+  input:
+    age: 70
+    immigration_status: UNDOCUMENTED
+    pension_income: 10_000
+    state_code: TX
+  output:
+    medicare_enrolled: false
+
+# Allowed in 2026 because the model treats everyone as grandfathered under
+# 42 U.S.C. 1395mmm(b)(1) through 2026.
+- name: Person with temporary protected status and Part A work history is enrolled.
+  period: 2026
+  input:
+    age: 70
+    immigration_status: TPS
+    medicare_quarters_of_coverage: 40
+    pension_income: 10_000
+    state_code: TX
+  output:
+    medicare_enrolled: true

policyengine_us/tests/policy/baseline/gov/hhs/medicare/eligibility/is_medicare_eligible.yaml

@@ -28,3 +28,165 @@
     months_receiving_social_security_disability: 24
   output:
     is_medicare_eligible: true
+
+# 8 U.S.C. 1611(b)(3) limits Medicare benefits to noncitizens lawfully present.
+- name: is_medicare_eligible unit test 5
+  period: 2026
+  input:
+    age: 70
+    immigration_status: UNDOCUMENTED
+  output:
+    is_medicare_eligible: false
+
+# 42 U.S.C. 1395o(a)(2): a permanent resident of five years may enroll at 65
+# without Part A entitlement, and one of fewer than five years may not.
+- name: is_medicare_eligible unit test 6
+  period: 2026
+  input:
+    age: 70
+    immigration_status: LEGAL_PERMANENT_RESIDENT
+    years_since_us_entry: 5
+    medicare_quarters_of_coverage: 0
+  output:
+    is_medicare_eligible: true
+
+- name: is_medicare_eligible unit test 7
+  period: 2026
+  input:
+    age: 70
+    immigration_status: LEGAL_PERMANENT_RESIDENT
+    years_since_us_entry: 4
+    medicare_quarters_of_coverage: 0
+  output:
+    is_medicare_eligible: false
+
+# 42 U.S.C. 1395o(a)(1): entitlement to Part A opens Part B to anyone with an allowed
+# status, so the five-year rule doesn't apply. A permanent resident stays allowed from
+# 2027 under 42 U.S.C. 1395mmm(a)(2).
+- name: is_medicare_eligible unit test 8
+  period: 2026
+  input:
+    age: 70
+    immigration_status: LEGAL_PERMANENT_RESIDENT
+    years_since_us_entry: 4
+    medicare_quarters_of_coverage: 40
+  output:
+    is_medicare_eligible: true
+
+# Temporary protected status is allowed in 2026 only because the model treats everyone
+# as grandfathered under 42 U.S.C. 1395mmm(b)(1) through 2026. Unit test 14 covers 2027.
+- name: is_medicare_eligible unit test 9
+  period: 2026
+  input:
+    age: 70
+    immigration_status: TPS
+    medicare_quarters_of_coverage: 40
+  output:
+    is_medicare_eligible: true
+
+- name: is_medicare_eligible unit test 10
+  period: 2026
+  input:
+    age: 70
+    immigration_status: TPS
+    medicare_quarters_of_coverage: 39
+  output:
+    is_medicare_eligible: false
+
+# A citizen without enough quarters can still buy Part A and enroll in Part B.
+- name: is_medicare_eligible unit test 11
+  period: 2026
+  input:
+    age: 70
+    medicare_quarters_of_coverage: 0
+  output:
+    is_medicare_eligible: true
+
+# The SSDI route also needs an allowed status. Temporary protected status is allowed in
+# 2026 only because the model treats everyone as grandfathered under 42 U.S.C.
+# 1395mmm(b)(1) through 2026. Unit test 16 covers 2027.
+- name: is_medicare_eligible unit test 12
+  period: 2026
+  input:
+    age: 50
+    immigration_status: TPS
+    social_security_disability: 12_000
+    months_receiving_social_security_disability: 24
+  output:
+    is_medicare_eligible: true
+
+- name: is_medicare_eligible unit test 13
+  period: 2026
+  input:
+    age: 50
+    immigration_status: UNDOCUMENTED
+    social_security_disability: 12_000
+    months_receiving_social_security_disability: 24
+  output:
+    is_medicare_eligible: false
+
+# 42 U.S.C. 1395mmm(a) limits Medicare from 2027 to citizens and nationals, permanent
+# residents, Cuban and Haitian entrants, and Compact of Free Association residents.
+# Part A work history doesn't open Medicare to anyone else.
+- name: is_medicare_eligible unit test 14
+  period: 2027
+  input:
+    age: 70
+    immigration_status: TPS
+    medicare_quarters_of_coverage: 40
+  output:
+    is_medicare_eligible: false
+
+- name: is_medicare_eligible unit test 15
+  period: 2027
+  input:
+    age: 70
+    immigration_status: REFUGEE
+    medicare_quarters_of_coverage: 40
+  output:
+    is_medicare_eligible: false
+
+# 42 U.S.C. 1395mmm(a) applies to the SSDI route as well.
+- name: is_medicare_eligible unit test 16
+  period: 2027
+  input:
+    age: 50
+    immigration_status: TPS
+    social_security_disability: 12_000
+    months_receiving_social_security_disability: 24
+  output:
+    is_medicare_eligible: false
+
+# 42 U.S.C. 1395mmm(a)(3) keeps Cuban and Haitian entrants, and entitlement to Part A
+# opens Part B under 42 U.S.C. 1395o(a)(1).
+- name: is_medicare_eligible unit test 17
+  period: 2027
+  input:
+    age: 70
+    immigration_status: CUBAN_HAITIAN_ENTRANT
+    medicare_quarters_of_coverage: 40
+  output:
+    is_medicare_eligible: true
+
+# 42 U.S.C. 1395o(a)(2): without Part A, only a citizen or a permanent resident of five
+# years may enroll at 65, so an allowed status isn't enough on its own.
+- name: is_medicare_eligible unit test 18
+  period: 2027
+  input:
+    age: 70
+    immigration_status: CUBAN_HAITIAN_ENTRANT
+    medicare_quarters_of_coverage: 0
+  output:
+    is_medicare_eligible: false
+
+# 42 U.S.C. 1395mmm(a)(2) keeps permanent residents, and entitlement to Part A opens
+# Part B under 42 U.S.C. 1395o(a)(1) inside the five years.
+- name: is_medicare_eligible unit test 19
+  period: 2027
+  input:
+    age: 70
+    immigration_status: LEGAL_PERMANENT_RESIDENT
+    years_since_us_entry: 2
+    medicare_quarters_of_coverage: 40
+  output:
+    is_medicare_eligible: true