Add Medicaid LTSS financial eligibility screen (TX, DE, WA)

changelog.d/ltss-financial-eligibility.added.md

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+Add an opt-in Medicaid LTSS financial eligibility screen for Texas, Delaware, and Washington, with source income exclusions, qualified income trust opening-month rules, individual and couple budgeting, initial and continuing spousal resource rules, CMS-indexed home equity limits, and maintenance needs allowances. Derive budgets from each spouse's income, resource inventories, service locations, Delaware elections, Washington institutionalization history, and qualifying impairment-related work expense payment and allocation facts. Keep the screen separate from Medicaid enrollment and benefit calculations.

policyengine_us/parameters/gov/bls/cpi/cpi_u_nsa_september.yaml

@@ -1,6 +1,7 @@
-description: The Bureau of Labor Statistics publishes this September value of the Consumer Price Index for All Urban Consumers, not seasonally adjusted, from which CMS takes the September-to-September percentage change it applies to the Medicaid long-term care home equity limits.
+description: The Bureau of Labor Statistics provides this September value of the not seasonally adjusted Consumer Price Index for All Urban Consumers.
 values:
   # BLS series CUUR0000SA0 (U.S. city average, all items, 1982-84=100).
+  1988-09-01: 119.8
   2018-09-01: 252.439
   2019-09-01: 256.759
   2020-09-01: 260.28
@@ -16,3 +17,5 @@ metadata:
   reference:
     - title: BLS | CPI-U, U.S. city average, all items, not seasonally adjusted (CUUR0000SA0)
       href: https://data.bls.gov/timeseries/CUUR0000SA0
+    - title: BLS | Historical Consumer Price Index for All Urban Consumers, September 2018 release
+      href: https://www.bls.gov/cpi/tables/supplemental-files/historical-cpi-u-201809.pdf#page=2

policyengine_us/parameters/gov/hhs/medicaid/eligibility/long_term_care/financial/de/assistance_unit/same_facility_election_months.yaml

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+description: Delaware sets this minimum number of completed months in the same institutional facility before spouses can elect their assistance unit under the Medicaid long-term services and supports program.
+values:
+  2026-01-01: 6
+
+metadata:
+  unit: month
+  period: year
+  label: Delaware Medicaid LTSS same-facility budget election duration
+  reference:
+    - title: DSSM 20810 - Treatment of Couples, 16 DE Admin Code 20000
+      href: https://regulations.delaware.gov/api/AdminCode/title16/20000/61c317a6-5b56-4745-83ff-60107295dd03#page=67

policyengine_us/parameters/gov/hhs/medicaid/eligibility/long_term_care/financial/de/csra/state_minimum.yaml

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+description: Delaware sets this state spousal share as the minimum community spouse resource allowance under the Medicaid long-term services and supports program.
+values:
+  1993-10-01: 25_000
+
+metadata:
+  unit: currency-USD
+  period: year
+  label: Delaware minimum Medicaid LTSS community spouse resource allowance
+  reference:
+    - title: DSSM 20910.10 - Community Spouse Resource Allowance, 16 DE Admin Code 20000
+      href: https://regulations.delaware.gov/api/AdminCode/title16/20000/61c317a6-5b56-4745-83ff-60107295dd03#page=69
+    - title: DSSM 20950 - Resource Eligibility for Institutionalized Spouse, 16 DE Admin Code 20000
+      href: https://regulations.delaware.gov/api/AdminCode/title16/20000/61c317a6-5b56-4745-83ff-60107295dd03#page=70

policyengine_us/parameters/gov/hhs/medicaid/eligibility/long_term_care/financial/de/special_income_limit/rate.yaml

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+description: Delaware sets the special income limit at this multiple of the Supplemental Security Income federal benefit rate for an individual or couple under the Medicaid long-term services and supports program.
+values:
+  1994-10-01: 2.5
+
+metadata:
+  unit: /1
+  period: year
+  label: Delaware Medicaid LTSS special income limit rate
+  reference:
+    - title: DSSM 20100.2.2 - Individuals Whose Income is 250% of SSI, 16 DE Admin Code 20000
+      href: https://regulations.delaware.gov/api/AdminCode/title16/20000/61c317a6-5b56-4745-83ff-60107295dd03#page=1
+    - title: Delaware DMMA Administrative Notice A-14-2025, 2026 SSI-Related Income Standards and Medicare Premiums
+      href: https://dhss.delaware.gov/wp-content/uploads/sites/11/2026/06/2026-SSI-Related-Income-Standards-and-Medicare-Premiums.pdf#page=1

policyengine_us/parameters/gov/hhs/medicaid/eligibility/long_term_care/financial/federal/csra/maximum.yaml

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+description: The Department of Health and Human Services limits the community spouse resource allowance to this amount under the Medicaid long-term services and supports program.
+values:
+  2026-01-01: 162_660
+
+metadata:
+  unit: currency-USD
+  period: year
+  label: Federal maximum Medicaid LTSS community spouse resource allowance
+  reference:
+    - title: Updated 2026 SSI and Spousal Impoverishment Standards, CMCS Informational Bulletin, April 27, 2026
+      href: https://www.medicaid.gov/sites/default/files/2026-04/cib04272026.pdf#page=2
+    - title: 42 USC 1396r-5(f)(2)(A)(ii)(II) and (g) - Community spouse resource allowance and indexing
+      href: https://www.law.cornell.edu/uscode/text/42/1396r-5#f_2

policyengine_us/parameters/gov/hhs/medicaid/eligibility/long_term_care/financial/federal/csra/maximum_base.yaml

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+description: The Department of Health and Human Services sets this statutory base for the maximum community spouse resource allowance under the Medicaid long-term services and supports program.
+values:
+  1989-01-01: 60_000
+
+metadata:
+  unit: currency-USD
+  period: year
+  label: Federal Medicaid LTSS maximum CSRA statutory base
+  reference:
+    - title: 42 USC 1396r-5(f)(2)(A)(ii)(II) and (g) - Maximum community spouse resource allowance and indexing
+      href: https://www.law.cornell.edu/uscode/text/42/1396r-5#f_2

policyengine_us/parameters/gov/hhs/medicaid/eligibility/long_term_care/financial/federal/csra/minimum.yaml

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+description: The Department of Health and Human Services sets this minimum community spouse resource allowance under the Medicaid long-term services and supports program.
+values:
+  2026-01-01: 32_532
+
+metadata:
+  unit: currency-USD
+  period: year
+  label: Federal minimum Medicaid LTSS community spouse resource allowance
+  reference:
+    - title: Updated 2026 SSI and Spousal Impoverishment Standards, CMCS Informational Bulletin, April 27, 2026
+      href: https://www.medicaid.gov/sites/default/files/2026-04/cib04272026.pdf#page=2
+    - title: 42 USC 1396r-5(f)(2)(A)(i) and (g) - Community spouse resource allowance and indexing
+      href: https://www.law.cornell.edu/uscode/text/42/1396r-5#f_2

policyengine_us/parameters/gov/hhs/medicaid/eligibility/long_term_care/financial/federal/csra/minimum_base.yaml

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+description: The Department of Health and Human Services sets this statutory base for the minimum community spouse resource allowance under the Medicaid long-term services and supports program.
+values:
+  1989-01-01: 12_000
+
+metadata:
+  unit: currency-USD
+  period: year
+  label: Federal Medicaid LTSS minimum CSRA statutory base
+  reference:
+    - title: 42 USC 1396r-5(f)(2)(A)(i) and (g) - Minimum community spouse resource allowance and indexing
+      href: https://www.law.cornell.edu/uscode/text/42/1396r-5#f_2

policyengine_us/parameters/gov/hhs/medicaid/eligibility/long_term_care/financial/federal/csra/snapshot_share.yaml

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+description: The Department of Health and Human Services sets this share of the couple's snapshot resources as the spousal share under the Medicaid long-term services and supports program.
+values:
+  1989-09-30: 0.5
+
+metadata:
+  unit: /1
+  period: year
+  label: Medicaid LTSS community spouse snapshot resource share
+  reference:
+    - title: 42 USC 1396r-5(c)(1)(A)(ii) and (f)(2)(A) - Spousal share
+      href: https://www.law.cornell.edu/uscode/text/42/1396r-5#c_1_A_ii
+    - title: WAC 182-513-1355(3)(b)(i) - Spousal share
+      href: https://app.leg.wa.gov/wac/default.aspx?cite=182-513-1355

policyengine_us/parameters/gov/hhs/medicaid/eligibility/long_term_care/financial/federal/indexing/base_year.yaml

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+description: The Department of Health and Human Services uses this base year for indexing federal spousal impoverishment standards under the Medicaid long-term services and supports program.
+values:
+  1989-01-01: 1988
+
+metadata:
+  unit: year
+  period: year
+  label: Federal Medicaid LTSS spousal impoverishment CPI base year
+  reference:
+    - title: 42 USC 1396r-5(g) - Indexing dollar amounts
+      href: https://www.law.cornell.edu/uscode/text/42/1396r-5#g

policyengine_us/parameters/gov/hhs/medicaid/eligibility/long_term_care/financial/federal/indexing/percentage_rounding_interval.yaml

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+description: The Department of Health and Human Services sets this rounding interval in percentage points for cumulative CPI increases under the Medicaid long-term services and supports program.
+values:
+  1989-01-01: 0.1
+
+metadata:
+  unit: /1
+  period: year
+  label: Federal Medicaid LTSS cumulative CPI percentage rounding interval
+  reference:
+    - title: Updated 2026 SSI and Spousal Impoverishment Standards, CMCS Informational Bulletin, April 27, 2026
+      href: https://www.medicaid.gov/sites/default/files/2026-04/cib04272026.pdf#page=2

policyengine_us/parameters/gov/hhs/medicaid/eligibility/long_term_care/financial/federal/indexing/reference_month.yaml

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+description: The Department of Health and Human Services uses this month for indexing federal spousal impoverishment standards under the Medicaid long-term services and supports program.
+values:
+  1989-01-01: 9
+
+metadata:
+  unit: month
+  period: year
+  label: Federal Medicaid LTSS spousal impoverishment CPI reference month
+  reference:
+    - title: 42 USC 1396r-5(g) - Indexing dollar amounts
+      href: https://www.law.cornell.edu/uscode/text/42/1396r-5#g

policyengine_us/parameters/gov/hhs/medicaid/eligibility/long_term_care/financial/federal/irwe/allocation_months.yaml

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+description: The Social Security Administration sets this number of consecutive months for allocating a nonrecurring impairment-related work expense under the Medicaid long-term services and supports program.
+values:
+  1980-12-01: 12
+
+metadata:
+  unit: month
+  period: year
+  label: Medicaid LTSS impairment-related work expense allocation duration
+  reference:
+    - title: 20 CFR 416.976(e)(2) - Nonrecurring expenses
+      href: https://www.ssa.gov/OP_Home/cfr20/416/416-0976.htm

policyengine_us/parameters/gov/hhs/medicaid/eligibility/long_term_care/financial/federal/mmmna/maximum.yaml

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+description: The Department of Health and Human Services limits the community spouse monthly maintenance needs allowance to this amount under the Medicaid long-term services and supports program.
+values:
+  2026-01-01: 4_066.5
+
+metadata:
+  unit: currency-USD
+  period: month
+  label: Federal maximum Medicaid LTSS monthly maintenance needs allowance
+  reference:
+    - title: Updated 2026 SSI and Spousal Impoverishment Standards, CMCS Informational Bulletin, April 27, 2026
+      href: https://www.medicaid.gov/sites/default/files/2026-04/cib04272026.pdf#page=2
+    - title: 42 USC 1396r-5(d)(3)(C) and (g) - Cap on minimum monthly maintenance needs allowance and indexing
+      href: https://www.law.cornell.edu/uscode/text/42/1396r-5#d_3

policyengine_us/parameters/gov/hhs/medicaid/eligibility/long_term_care/financial/federal/mmmna/maximum_base.yaml

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+description: The Department of Health and Human Services sets this statutory base for the maximum monthly maintenance needs allowance under the Medicaid long-term services and supports program.
+values:
+  1989-01-01: 1_500
+
+metadata:
+  unit: currency-USD
+  period: month
+  label: Federal Medicaid LTSS maximum MMMNA statutory base
+  reference:
+    - title: 42 USC 1396r-5(d)(3)(C) and (g) - Maximum monthly maintenance needs allowance and indexing
+      href: https://www.law.cornell.edu/uscode/text/42/1396r-5#d_3

policyengine_us/parameters/gov/hhs/medicaid/eligibility/long_term_care/financial/federal/mmmna/minimum.yaml

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+description: The Department of Health and Human Services sets this minimum monthly maintenance needs allowance for a community spouse in the contiguous states and the District of Columbia under the Medicaid long-term services and supports program.
+values:
+  2025-07-01: 2_643.75
+  2026-07-01: 2_705
+
+metadata:
+  unit: currency-USD
+  period: month
+  label: Federal minimum Medicaid LTSS monthly maintenance needs allowance
+  reference:
+    - title: Updated 2025 SSI and Spousal Impoverishment Standards, CMCS Informational Bulletin, May 28, 2025
+      href: https://www.medicaid.gov/federal-policy-guidance/downloads/cib05282025.pdf#page=2
+    - title: Updated 2026 SSI and Spousal Impoverishment Standards, CMCS Informational Bulletin, April 27, 2026
+      href: https://www.medicaid.gov/sites/default/files/2026-04/cib04272026.pdf#page=2
+    - title: 42 USC 1396r-5(d)(3)(A)(i) - Minimum monthly maintenance needs allowance
+      href: https://www.law.cornell.edu/uscode/text/42/1396r-5#d_3

policyengine_us/parameters/gov/hhs/medicaid/eligibility/long_term_care/financial/federal/mmmna/shelter_threshold_rate.yaml

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+description: The Department of Health and Human Services uses this share of the minimum monthly maintenance needs allowance as the community spouse excess shelter threshold under the Medicaid long-term services and supports program.
+values:
+  1989-10-01: 0.3
+
+metadata:
+  unit: /1
+  period: year
+  label: Medicaid LTSS community spouse excess shelter threshold rate
+  reference:
+    - title: 42 USC 1396r-5(d)(4) - Excess shelter allowance
+      href: https://www.law.cornell.edu/uscode/text/42/1396r-5#d_4
+    - title: Updated 2026 SSI and Spousal Impoverishment Standards, CMCS Informational Bulletin, April 27, 2026
+      href: https://www.medicaid.gov/sites/default/files/2026-04/cib04272026.pdf#page=2

policyengine_us/parameters/gov/hhs/medicaid/eligibility/long_term_care/financial/tx/special_income_limit/couple_multiplier.yaml

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+description: Texas sets the couple special income limit at this multiple of the individual special income limit under the Medicaid long-term services and supports program.
+values:
+  2009-09-01: 2
+
+metadata:
+  unit: /1
+  period: year
+  label: Texas Medicaid LTSS couple special income limit multiplier
+  reference:
+    - title: 1 TAC 358.433 - Special income limit
+      href: https://www.law.cornell.edu/regulations/texas/1-Tex-Admin-Code-SS-358-433
+    - title: Texas Medicaid for the Elderly and People with Disabilities Handbook, G-6200 - Special Income Limit Eligibility Budget
+      href: https://fhb.hhs.texas.gov/handbooks/medicaid-elderly-people-disabilities-handbook/g-6200-special-income-limit-eligibility-budget
+    - title: Texas Medicaid for the Elderly and People with Disabilities Handbook, Appendix XXXI - Budget Reference Chart, Revision 26-2
+      href: https://fhb.hhs.texas.gov/sites/default/files/documents/mepd-26-2.pdf#page=465

policyengine_us/parameters/gov/hhs/medicaid/eligibility/long_term_care/financial/tx/special_income_limit/rate.yaml

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+description: Texas sets the individual special income limit at this multiple of the individual Supplemental Security Income federal benefit rate under the Medicaid long-term services and supports program.
+values:
+  2009-09-01: 3
+
+metadata:
+  unit: /1
+  period: year
+  label: Texas Medicaid LTSS special income limit rate
+  reference:
+    - title: 1 TAC 358.433 - Special income limit
+      href: https://www.law.cornell.edu/regulations/texas/1-Tex-Admin-Code-SS-358-433
+    - title: Texas Medicaid for the Elderly and People with Disabilities Handbook, G-6200 - Special Income Limit Eligibility Budget
+      href: https://fhb.hhs.texas.gov/handbooks/medicaid-elderly-people-disabilities-handbook/g-6200-special-income-limit-eligibility-budget
+    - title: Texas Medicaid for the Elderly and People with Disabilities Handbook, Appendix XXXI - Budget Reference Chart, Revision 26-2
+      href: https://fhb.hhs.texas.gov/sites/default/files/documents/mepd-26-2.pdf#page=465

policyengine_us/parameters/gov/hhs/medicaid/eligibility/long_term_care/financial/wa/csra/maximum_regime_start.yaml

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+description: Washington sets this onset month, encoded as YYYYMM, as the start of the federal maximum community spouse resource allowance regime under the Medicaid long-term services and supports program.
+values:
+  1989-10-01: 198910
+
+metadata:
+  unit: /1
+  period: year
+  label: Washington Medicaid LTSS federal maximum CSRA regime start month
+  reference:
+    - title: WAC 182-513-1355(2)(b) and (3)(a) - Periods beginning on or after October 1, 1989
+      href: https://app.leg.wa.gov/wac/default.aspx?cite=182-513-1355

policyengine_us/parameters/gov/hhs/medicaid/eligibility/long_term_care/financial/wa/csra/pre_1989_resource_share.yaml

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+description: Washington includes this share of applicant-sole and jointly owned resources for institutionalization periods beginning before the federal maximum allowance regime under the Medicaid long-term services and supports program.
+values:
+  1989-10-01: 0.5
+
+metadata:
+  unit: /1
+  period: year
+  label: Washington Medicaid LTSS pre-1989 countable resource share
+  reference:
+    - title: WAC 182-513-1355(2)(a) - Periods beginning before October 1, 1989
+      href: https://app.leg.wa.gov/wac/default.aspx?cite=182-513-1355

policyengine_us/parameters/gov/hhs/medicaid/eligibility/long_term_care/financial/wa/csra/snapshot_regime_start.yaml

@@ -0,0 +1,11 @@
+description: Washington sets this onset month, encoded as YYYYMM, as the start of the snapshot-based community spouse resource allowance regime under the Medicaid long-term services and supports program.
+values:
+  2003-08-01: 200308
+
+metadata:
+  unit: /1
+  period: year
+  label: Washington Medicaid LTSS snapshot CSRA regime start month
+  reference:
+    - title: WAC 182-513-1355(3)(b) - Periods beginning on or after August 1, 2003
+      href: https://app.leg.wa.gov/wac/default.aspx?cite=182-513-1355

policyengine_us/parameters/gov/hhs/medicaid/eligibility/long_term_care/financial/wa/csra/state_minimum.yaml

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+description: Washington sets this state spousal resource standard as the minimum community spouse resource allowance under the Medicaid long-term services and supports program.
+values:
+  2025-07-01: 72_529
+
+metadata:
+  unit: currency-USD
+  period: year
+  label: Washington minimum Medicaid LTSS community spouse resource allowance
+  reference:
+    - title: WAC 182-513-1100 - Definitions, state spousal resource standard
+      href: https://app.leg.wa.gov/wac/default.aspx?cite=182-513-1100
+    - title: Washington Apple Health Income and Resource Standards, January 1, 2026
+      href: https://www.hca.wa.gov/assets/free-or-low-cost/income-standards-20260101.pdf#page=3

policyengine_us/parameters/gov/hhs/medicaid/eligibility/long_term_care/financial/wa/medically_needy/income_level.yaml

@@ -0,0 +1,16 @@
+description: Washington uses this monthly medically needy income level for a single person under the Medicaid long-term services and supports program.
+values:
+  2026-01-01: 994
+
+metadata:
+  uprating: gov.ssa.ssi.amount.individual
+  unit: currency-USD
+  period: month
+  label: Washington Medicaid LTSS medically needy income level for a single person
+  reference:
+    - title: WAC 182-519-0050(1) and (5) - Annual COLA and the effective one-person medically needy income level
+      href: https://app.leg.wa.gov/wac/default.aspx?cite=182-519-0050
+    - title: Washington Apple Health Income and Resource Standards, January 1, 2026
+      href: https://www.hca.wa.gov/assets/free-or-low-cost/income-standards-20260101.pdf#page=3
+    - title: WAC 182-515-1508 - HCS waiver financial eligibility using institutional rules
+      href: https://app.leg.wa.gov/wac/default.aspx?cite=182-515-1508

policyengine_us/parameters/gov/hhs/medicaid/eligibility/long_term_care/financial/wa/mmmna/minimum.yaml

@@ -0,0 +1,16 @@
+description: Washington sets this minimum monthly maintenance needs allowance for a community spouse under the Medicaid long-term services and supports program.
+values:
+  2025-07-01: 2_644
+  2026-07-01: 2_705
+
+metadata:
+  unit: currency-USD
+  period: month
+  label: Washington Medicaid LTSS minimum monthly maintenance needs allowance
+  reference:
+    - title: WAC 182-513-1385(2) and (4)(a) - Published community spouse standards and minimum allowance
+      href: https://app.leg.wa.gov/wac/default.aspx?cite=182-513-1385
+    - title: Washington Apple Health Income and Resource Standards, January 1, 2026
+      href: https://www.hca.wa.gov/assets/free-or-low-cost/income-standards-20260101.pdf#page=3
+    - title: Washington Apple Health Income and Resource Standards, July 1, 2026
+      href: https://www.hca.wa.gov/assets/free-or-low-cost/income-standards-20260701.pdf#page=3

policyengine_us/parameters/gov/hhs/medicaid/eligibility/long_term_care/financial/wa/mmmna/shelter_threshold.yaml

@@ -0,0 +1,16 @@
+description: Washington sets this monthly community spouse shelter threshold under the Medicaid long-term services and supports program.
+values:
+  2025-07-01: 794
+  2026-07-01: 812
+
+metadata:
+  unit: currency-USD
+  period: month
+  label: Washington Medicaid LTSS community spouse shelter threshold
+  reference:
+    - title: WAC 182-513-1385(2) and (4)(b) - Published community spouse standards and excess shelter expenses
+      href: https://app.leg.wa.gov/wac/default.aspx?cite=182-513-1385
+    - title: Washington Apple Health Income and Resource Standards, January 1, 2026
+      href: https://www.hca.wa.gov/assets/free-or-low-cost/income-standards-20260101.pdf#page=3
+    - title: Washington Apple Health Income and Resource Standards, July 1, 2026
+      href: https://www.hca.wa.gov/assets/free-or-low-cost/income-standards-20260701.pdf#page=3

policyengine_us/parameters/gov/hhs/medicaid/eligibility/long_term_care/financial/wa/resources/individual.yaml

@@ -0,0 +1,15 @@
+description: Washington limits countable resources to this amount for a single person or an institutionalized spouse under the Medicaid long-term services and supports program.
+values:
+  2026-01-01: 2_000
+
+metadata:
+  unit: currency-USD
+  period: year
+  label: Washington Medicaid LTSS resource limit for an individual
+  reference:
+    - title: WAC 182-513-1350(2)(a) - Resource standard for long-term services and supports
+      href: https://app.leg.wa.gov/wac/default.aspx?cite=182-513-1350
+    - title: WAC 182-513-1395(3)(a) - Institutional SSI-related medically needy resource eligibility
+      href: https://app.leg.wa.gov/wac/default.aspx?cite=182-513-1395
+    - title: Washington Apple Health Income and Resource Standards, January 1, 2026
+      href: https://www.hca.wa.gov/assets/free-or-low-cost/income-standards-20260101.pdf#page=3