From 5e3b942411679b3ebafd6fc2819097d60f78f232 Mon Sep 17 00:00:00 2001 From: mikewolfd Date: Wed, 16 Sep 2026 20:40:26 -0400 Subject: [PATCH] NJ Health Plan Savings: cite the 2026 documents for the 2026 claim MIME-Version: 1.0 Content-Type: text/plain; charset=UTF-8 Content-Transfer-Encoding: 8bit The schedule ($20/$40/$50/$100/$50 across 138–600% FPL) is unchanged; what changes is what carries it into plan year 2026. The parameters rested on the Treasury OTA addendum (a November 2021 pass-through calculation) and the DOBI FY2025-2026 budget response, whose 600% statement was conditional — "If the enhanced APTC are extended by the federal government in 2026, the Department intends to continue providing NJ Health Plan Savings subsidies up to 600% FPL" — and whose "$212.2M flat" is a superseded projection. The FY2026-2027 budget response (p.4) states the outcome: "While the enhanced APTCs were not extended by the federal government in 2026, the Department continued providing NJ Health Plan Savings subsidies up to 600% FPL", with PY2025 actual spending of $224.9M, PY2026 estimated at $238.1M, FY2027 projected at $200.0M and the fund's FY2027 closing balance at $0.0M. Its PY2025 cohort averages ($16 under 200% FPL, $43 at 200–250%, $91 and $96 at 250–400%, $40 at 400%+) all sit at or under the schedule, as a premium-capped flat amount must. The Department's 2026-08-18 letter to the Assembly Budget Committee (p.5) fixes the vintage: "For plan year 2026 (using 2025 FPL levels) ... 600 percent of FPL is $192,900" for four. The addendum's bullets are on PDF page 9 (printed page 8); the variables' `#page=8` anchor landed one page short. No New Jersey document for plan year 2026 restates the five amounts — Get Covered NJ's page sends the reader to its calculator — and the comments now say so rather than imply a confirmation that does not exist. 64 pass. Co-Authored-By: Claude Opus 5 (1M context) Claude-Session: https://claude.ai/code/session_01Q7xBzQqLTkE1HJLYJbG5S3 --- .../nj-njhps-py2026-citations.fixed.md | 1 + .../gov/states/nj/dobi/njhps/fpl_limit.yaml | 14 ++++++++- .../gov/states/nj/dobi/njhps/in_effect.yaml | 11 +++++-- .../gov/states/nj/dobi/njhps/pmpm.yaml | 30 ++++++++++++------- .../gov/states/nj/dobi/njhps/nj_njhps.py | 7 ++++- .../states/nj/dobi/njhps/nj_njhps_eligible.py | 7 ++++- .../nj/dobi/njhps/nj_njhps_member_eligible.py | 7 ++++- 7 files changed, 60 insertions(+), 17 deletions(-) create mode 100644 changelog.d/nj-njhps-py2026-citations.fixed.md diff --git a/changelog.d/nj-njhps-py2026-citations.fixed.md b/changelog.d/nj-njhps-py2026-citations.fixed.md new file mode 100644 index 00000000000..76a9b73bc38 --- /dev/null +++ b/changelog.d/nj-njhps-py2026-citations.fixed.md @@ -0,0 +1 @@ +NJ Health Plan Savings: cite the DOBI FY2026-2027 budget response for the program's continuation to 600% FPL in plan year 2026 after the enhanced federal credits lapsed, and the Department's 2026-08-18 letter for the 2025 poverty-guideline vintage; correct the Treasury addendum page anchor. diff --git a/policyengine_us/parameters/gov/states/nj/dobi/njhps/fpl_limit.yaml b/policyengine_us/parameters/gov/states/nj/dobi/njhps/fpl_limit.yaml index 42dd256598c..774f131e493 100644 --- a/policyengine_us/parameters/gov/states/nj/dobi/njhps/fpl_limit.yaml +++ b/policyengine_us/parameters/gov/states/nj/dobi/njhps/fpl_limit.yaml @@ -3,7 +3,15 @@ values: # NJHPS extends premium assistance up to 600% FPL, applied as a "<=" comparison. # The dollar ceilings ($93,900 individual / $192,900 family of four in 2026) # auto-derive from the federal poverty line and are not hard-coded. The DOBI - # FY2026 budget confirms the program continues "up to 600% FPL" for PY2026. + # FY2025-2026 budget response said the Department "intends to continue" + # NJHPS to 600% FPL if the enhanced federal credits were extended; they were + # not, and the FY2026-2027 response (p.4) states the outcome: "While the + # enhanced APTCs were not extended by the federal government in 2026, the + # Department continued providing NJ Health Plan Savings subsidies up to 600% + # FPL." The 2026-08-18 letter to the Assembly Budget Committee (p.5) fixes the + # poverty-guideline vintage: "For plan year 2026 (using 2025 FPL levels), for + # a family of four, the 400 percent of FPL is $128,600, and 600 percent of + # FPL is $192,900". 2026-01-01: 6 metadata: @@ -15,5 +23,9 @@ metadata: href: https://www.cms.gov/files/document/1332-ota-methodology-addendum-nj-pass-through.pdf#page=12 - title: NJ DOBI FY2025-2026 Budget Discussion Points href: https://pub.njleg.state.nj.us/publications/budget/governors-budget/2026/dobi_response_2026.pdf#page=6 + - title: NJ DOBI FY2026-2027 Budget Discussion Points, p.4 ("continued providing NJ Health Plan Savings subsidies up to 600% FPL" in 2026) + href: https://pub.njleg.state.nj.us/publications/budget/governors-budget/2027/dobi_response_2027.pdf#page=4 + - title: NJ DOBI follow-up response to the Assembly Budget Committee, 2026-08-18, p.5 (plan year 2026 uses the 2025 poverty guidelines; 600% FPL is $192,900 for four) + href: https://pub.njleg.state.nj.us/publications/budget/governors-budget/2027/dobi_follow_up_response_abu.pdf#page=5 - title: Get Covered NJ - New Jersey Health Plan Savings href: https://www.nj.gov/getcoverednj/financialhelp/premiums/ diff --git a/policyengine_us/parameters/gov/states/nj/dobi/njhps/in_effect.yaml b/policyengine_us/parameters/gov/states/nj/dobi/njhps/in_effect.yaml index 8232af9c62f..16c1223fd94 100644 --- a/policyengine_us/parameters/gov/states/nj/dobi/njhps/in_effect.yaml +++ b/policyengine_us/parameters/gov/states/nj/dobi/njhps/in_effect.yaml @@ -9,9 +9,12 @@ values: # false before 2026-01-01. The pre-2026 enhanced schedule is left unmodeled and # carried as a backdating backlog item. # No end date: the program is permanent law, so PY2027+ carries the PY2026 design - # forward as a current-law assumption. The DOBI FY2026 budget confirms NJHPS - # continues "up to 600% FPL" with expenditures projected to remain flat at - # $212.2M in FY2026. + # forward as a current-law assumption. The DOBI FY2026-2027 budget response + # (p.4) confirms NJHPS "continued ... up to 600% FPL" in 2026, puts PY2026 + # spending at an estimated $238.1M (against $224.9M actual for PY2025), and + # projects $200.0M for FY2027 with the Health Insurance Affordability Fund's + # FY2027 closing balance at $0.0M — the 2027 allocation "has not [been] + # determined". Re-verify the schedule and the ceiling for PY2027. 0000-01-01: false 2026-01-01: true @@ -24,5 +27,7 @@ metadata: href: https://pub.njleg.gov/bills/2020/AL20/61_.HTM - title: NJ DOBI FY2025-2026 Budget Discussion Points href: https://pub.njleg.state.nj.us/publications/budget/governors-budget/2026/dobi_response_2026.pdf#page=8 + - title: NJ DOBI FY2026-2027 Budget Discussion Points, p.4 (2026 outcome, PY2025 actual and PY2026 estimated NJHPS spending, FY2027 projection) + href: https://pub.njleg.state.nj.us/publications/budget/governors-budget/2027/dobi_response_2027.pdf#page=4 - title: Get Covered NJ - New Jersey Health Plan Savings href: https://www.nj.gov/getcoverednj/financialhelp/premiums/ diff --git a/policyengine_us/parameters/gov/states/nj/dobi/njhps/pmpm.yaml b/policyengine_us/parameters/gov/states/nj/dobi/njhps/pmpm.yaml index b8a97a386f6..8182fb184d3 100644 --- a/policyengine_us/parameters/gov/states/nj/dobi/njhps/pmpm.yaml +++ b/policyengine_us/parameters/gov/states/nj/dobi/njhps/pmpm.yaml @@ -8,8 +8,10 @@ metadata: reference: - title: Treasury Office of Tax Analysis Section 1332 methodology addendum, Table 2 (Enhanced subsidy schedule) href: https://www.cms.gov/files/document/1332-ota-methodology-addendum-nj-pass-through.pdf#page=12 - - title: NJ DOBI FY2025-2026 Budget Discussion Points + - title: NJ DOBI FY2025-2026 Budget Discussion Points, p.8 ("lowest ... $20 and the maximum is $100") href: https://pub.njleg.state.nj.us/publications/budget/governors-budget/2026/dobi_response_2026.pdf#page=8 + - title: NJ DOBI FY2026-2027 Budget Discussion Points, p.4 (schedule continued to 600% FPL in 2026; PY2025 cohort averages by FPL band) + href: https://pub.njleg.state.nj.us/publications/budget/governors-budget/2027/dobi_response_2027.pdf#page=4 - title: P.L. 2020 c.61 href: https://pub.njleg.gov/bills/2020/AL20/61_.HTM - title: Get Covered NJ - New Jersey Health Plan Savings @@ -20,19 +22,27 @@ brackets: # CORROBORATION CHAIN: the exact per-member-per-month (PMPM) values below are # the ENHANCED schedule (post-ARP, effective mid-2021) from the U.S. Treasury # Office of Tax Analysis Section 1332 methodology addendum (Nov 2021). These - # values appear both as body-text bullets on file p.8 and, more cleanly, in the - # side-by-side Table 2 ("Enhanced" column) on file p.12 (the href points at - # Table 2). The enhanced schedule states: + # values appear both as body-text bullets on printed page 8 (PDF page 9) and, + # more cleanly, in the side-by-side Table 2 ("Enhanced" column) on PDF page 12 + # (the href points at Table 2). The enhanced schedule states: # "From 138% through 150% of FPL: $20 PMPM"; "From 150% through 200%: $40 PMPM"; # "From 200% through 250%: $50 PMPM"; "From 250% through 400%: $100 PMPM"; # "From 400% through 600%: $50 PMPM". This is NOT the superseded INITIAL schedule # (Feb 2021: $20/$30/$40/$95, covering only 138-400% FPL) printed in Table 1 on - # file p.5, which the model deliberately does not use. The DOBI FY2025-2026 - # Budget Discussion Points confirm the enhanced schedule remains unchanged/flat - # for PY2026 (NJHPS expenditures "projected to remain flat at $212.2" million in - # FY2026, continuing "up to 600% FPL"). Neither source alone both states the - # values and confirms PY2026 currency, so both are carried. The Get Covered NJ - # URL is a secondary (anchorless) corroborating reference, not a value source. + # file p.5, which the model deliberately does not use. No New Jersey document + # for plan year 2026 restates the five amounts (Get Covered NJ's page sends the + # reader to its calculator), so PY2026 currency rests on the DOBI budget + # responses: FY2025-2026, p.8 — "The lowest amount an eligible individual can + # receive per month in New Jersey Health Plan Savings is $20 and the maximum is + # $100", and "$100 per person per month – which can mean a $400 a month for a + # family of four at 300% FPL"; FY2026-2027, p.4 — the Department "continued + # providing NJ Health Plan Savings subsidies up to 600% FPL" after the enhanced + # federal credits lapsed, with PY2025 cohort averages ($16 under 200% FPL, $43 + # at 200-250%, $91 and $96 at 250-400%, $40 at 400%+) all at or under the + # schedule, as a premium-capped flat amount must be. Neither source alone both + # states the values and confirms PY2026 currency, so all are carried. The Get + # Covered NJ URL is a secondary (anchorless) corroborating reference, not a + # value source. # Bands are lower-exclusive / upper-inclusive, so thresholds use the "x.0001" # convention to match the published "from X% through Y%" banding. The 138% floor # is enforced by the eligibility gate; this base band gives $0 below 138% FPL so diff --git a/policyengine_us/variables/gov/states/nj/dobi/njhps/nj_njhps.py b/policyengine_us/variables/gov/states/nj/dobi/njhps/nj_njhps.py index 09adfb9943c..37e95145cdf 100644 --- a/policyengine_us/variables/gov/states/nj/dobi/njhps/nj_njhps.py +++ b/policyengine_us/variables/gov/states/nj/dobi/njhps/nj_njhps.py @@ -9,8 +9,13 @@ class nj_njhps(Variable): definition_period = YEAR defined_for = "nj_njhps_eligible" reference = ( - "https://www.cms.gov/files/document/1332-ota-methodology-addendum-nj-pass-through.pdf#page=8", + # Treasury OTA 1332 addendum (Nov 2021): the enhanced schedule's + # bullets on PDF page 9 (printed page 8), Table 2 on page 12. + "https://www.cms.gov/files/document/1332-ota-methodology-addendum-nj-pass-through.pdf#page=9", "https://pub.njleg.gov/bills/2020/AL20/61_.HTM", + # DOBI FY2026-2027 budget response, p.4: NJHPS continued to 600% FPL + # in 2026 after the enhanced federal credits lapsed. + "https://pub.njleg.state.nj.us/publications/budget/governors-budget/2027/dobi_response_2027.pdf#page=4", ) documentation = ( "New Jersey Health Plan Savings, the state premium subsidy " diff --git a/policyengine_us/variables/gov/states/nj/dobi/njhps/nj_njhps_eligible.py b/policyengine_us/variables/gov/states/nj/dobi/njhps/nj_njhps_eligible.py index 558647c50a9..036842f80d7 100644 --- a/policyengine_us/variables/gov/states/nj/dobi/njhps/nj_njhps_eligible.py +++ b/policyengine_us/variables/gov/states/nj/dobi/njhps/nj_njhps_eligible.py @@ -8,8 +8,13 @@ class nj_njhps_eligible(Variable): definition_period = YEAR defined_for = StateCode.NJ reference = ( - "https://www.cms.gov/files/document/1332-ota-methodology-addendum-nj-pass-through.pdf#page=8", + # Treasury OTA 1332 addendum (Nov 2021): the enhanced schedule's + # bullets on PDF page 9 (printed page 8), Table 2 on page 12. + "https://www.cms.gov/files/document/1332-ota-methodology-addendum-nj-pass-through.pdf#page=9", "https://pub.njleg.gov/bills/2020/AL20/61_.HTM", + # DOBI FY2026-2027 budget response, p.4: NJHPS continued to 600% FPL + # in 2026 after the enhanced federal credits lapsed. + "https://pub.njleg.state.nj.us/publications/budget/governors-budget/2027/dobi_response_2027.pdf#page=4", ) documentation = ( "A tax unit is eligible for New Jersey Health Plan Savings when the " diff --git a/policyengine_us/variables/gov/states/nj/dobi/njhps/nj_njhps_member_eligible.py b/policyengine_us/variables/gov/states/nj/dobi/njhps/nj_njhps_member_eligible.py index 254b59b405a..3aabe3c14ef 100644 --- a/policyengine_us/variables/gov/states/nj/dobi/njhps/nj_njhps_member_eligible.py +++ b/policyengine_us/variables/gov/states/nj/dobi/njhps/nj_njhps_member_eligible.py @@ -8,8 +8,13 @@ class nj_njhps_member_eligible(Variable): definition_period = YEAR defined_for = StateCode.NJ reference = ( - "https://www.cms.gov/files/document/1332-ota-methodology-addendum-nj-pass-through.pdf#page=8", + # Treasury OTA 1332 addendum (Nov 2021): the enhanced schedule's + # bullets on PDF page 9 (printed page 8), Table 2 on page 12. + "https://www.cms.gov/files/document/1332-ota-methodology-addendum-nj-pass-through.pdf#page=9", "https://pub.njleg.gov/bills/2020/AL20/61_.HTM", + # DOBI FY2026-2027 budget response, p.4: NJHPS continued to 600% FPL + # in 2026 after the enhanced federal credits lapsed. + "https://pub.njleg.state.nj.us/publications/budget/governors-budget/2027/dobi_response_2027.pdf#page=4", ) documentation = ( "A person is a New Jersey Health Plan Savings enrollee when they pay an "