Correct CHIP and Medicaid pregnancy income limits and effective dates

changelog.d/fix-chip-pregnant-income-limit-dates.fixed.md

@@ -0,0 +1 @@
+Correct CHIP pregnancy income limit dates and values from state plan amendments: Kentucky starts July 1, 2022 at 218% FPL, West Virginia CHIP starts July 1, 2019, Colorado, New Jersey and Rhode Island include the 5 percentage point disregard throughout, Colorado's from-conception-to-end-of-pregnancy option starts January 1, 2025, and West Virginia's 190% Medicaid pregnancy limit starts July 1, 2019.

policyengine_us/parameters/gov/hhs/chip/fcep/income_limit.yaml

@@ -1,17 +1,31 @@
-description: State governments limit Children's Health Insurance Program from-conception-to-end-of-pregnancy eligibility to these incomes, as a share of the federal poverty line. A value of -inf indicates the state has not adopted the from-conception-to-end-of-pregnancy option.
+description: State governments limit Children's Health Insurance Program from-conception-to-end-of-pregnancy eligibility to these incomes, as a share of the federal poverty line, including the five percentage point income disregard of 42 CFR 435.603(d)(4). A value of -inf indicates the state has not adopted the from-conception-to-end-of-pregnancy option.
 metadata:
   unit: /1
   period: year
   label: CHIP FCEP pregnant income limit
   breakdown:
   - state_code
   reference:
+    # KFF's January 2026 table adds the disregard only at each state's highest
+    # pregnancy level, so lower levels omit it (for example, West Virginia
+    # Medicaid 185% and Colorado CHIP 260%). 42 CFR 435.603(d)(4) applies the
+    # disregard in each Title.
     - title: Medicaid and CHIP Income Eligibility Limits for Pregnant Women as a Percent of the Federal Poverty Level | KFF State Health Facts
       href: https://www.kff.org/affordable-care-act/state-indicator/medicaid-and-chip-income-eligibility-limits-for-pregnant-women-as-a-percent-of-the-federal-poverty-level/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D
     - title: Medicaid, Children's Health Insurance Program, & Basic Health Program Eligibility Levels | CMS
       href: https://www.medicaid.gov/medicaid/national-medicaid-chip-program-information/medicaid-childrens-health-insurance-program-basic-health-program-eligibility-levels
     - title: MACStats Medicaid and CHIP Data Book, Exhibit 35 | MACPAC
       href: https://www.macpac.gov/publication/medicaid-and-chip-income-eligibility-levels-as-a-percentage-of-the-federal-poverty-level-for-children-and-pregnant-women-by-state/
+    - title: 42 CFR 435.603(d)(4), five percentage point MAGI income disregard
+      href: https://www.law.cornell.edu/cfr/text/42/435.603#d_4
+    - title: 42 CFR 457.315(a), MAGI financial methodologies apply to CHIP
+      href: https://www.law.cornell.edu/cfr/text/42/457.315#a
+    - title: Colorado CHIP State Plan Amendment CO-24-0041, state plan amendment history (Amendment 40)
+      href: https://www.medicaid.gov/CHIP/Downloads/CO-24-0041.pdf#page=3
+    - title: "Colorado CHIP State Plan Amendment CO-25-0044, companion letter and section 3.1.1.1 #page 3,6"
+      href: https://www.medicaid.gov/CHIP/Downloads/CO-25-0044.pdf#page=3
+    - title: Colorado CHIP State Plan Amendment CO-26-0047, superseding pages table (CO-24-0040-0002 CS9, Coverage From Conception to Birth, effective January 1, 2025)
+      href: https://www.medicaid.gov/CHIP/Downloads/CO-26-0047.pdf#page=5
 AK:
   2018-01-01: -.inf
   2019-01-01: -.inf
@@ -53,14 +67,17 @@ CA:
   2023-01-01: 3.22
   2024-01-01: 3.22
 CO:
+  # FCEP authority is CO-24-0040-0002 (CS9), effective January 1, 2025, with no
+  # end date. The December 31, 2026 sunset in the CO-25-0044 approval covers only
+  # the section 5121 pre-release services.
   2018-01-01: -.inf
   2019-01-01: -.inf
   2020-01-01: -.inf
   2021-01-01: -.inf
   2022-01-01: -.inf
   2023-01-01: -.inf
-  2023-10-30: 2.65
-  2024-01-01: 2.65
+  2024-01-01: -.inf
+  2025-01-01: 2.65
 CT:
   2018-01-01: -.inf
   2019-01-01: -.inf

policyengine_us/parameters/gov/hhs/chip/pregnant/income_limit.yaml

@@ -1,16 +1,52 @@
-description: State governments limit standard Children's Health Insurance Program pregnancy eligibility to these incomes, as a share of the federal poverty line. A value of -inf indicates the state does not operate a standard separate CHIP program for pregnant people; these states cover pregnancy through Medicaid or through the from-conception-to-end-of-pregnancy option, reflected in the Medicaid pregnant and CHIP FCEP income limit parameters.
+description: State governments limit standard Children's Health Insurance Program pregnancy eligibility to these incomes, as a share of the federal poverty line, including the five percentage point income disregard of 42 CFR 435.603(d)(4). A value of -inf indicates the state does not operate a standard separate CHIP program for pregnant people; these states cover pregnancy through Medicaid or through the from-conception-to-end-of-pregnancy option, reflected in the Medicaid pregnant and CHIP FCEP income limit parameters.
 metadata:
   unit: /1
   label: CHIP pregnant income limit
   breakdown:
   - state_code
   reference:
+    # KFF's January 2026 table adds the disregard only at each state's highest
+    # pregnancy level, so lower levels omit it (for example, West Virginia
+    # Medicaid 185% and Colorado CHIP 260%). 42 CFR 435.603(d)(4) applies the
+    # disregard in each Title.
     - title: Medicaid and CHIP Income Eligibility Limits for Pregnant Women as a Percent of the Federal Poverty Level | KFF State Health Facts
       href: https://www.kff.org/affordable-care-act/state-indicator/medicaid-and-chip-income-eligibility-limits-for-pregnant-women-as-a-percent-of-the-federal-poverty-level/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D
     - title: Medicaid, Children's Health Insurance Program, & Basic Health Program Eligibility Levels as of December 2023 | CMS
       href: https://www.medicaid.gov/medicaid/national-medicaid-chip-program-information/medicaid-childrens-health-insurance-program-basic-health-program-eligibility-levels
     - title: Medicaid and CHIP Eligibility Levels
       href: https://data.medicaid.gov/dataset/d7e4cccb-1c56-5b5d-acce-5e7744c6d3b4
+    - title: 42 CFR 435.603(d)(4), five percentage point MAGI income disregard
+      href: https://www.law.cornell.edu/cfr/text/42/435.603#d_4
+    - title: 42 CFR 457.315(a), MAGI financial methodologies apply to CHIP
+      href: https://www.law.cornell.edu/cfr/text/42/457.315#a
+    - title: Medicaid and CHIP Eligibility, Enrollment, Renewal, and Cost Sharing Policies as of January 2018 | KFF, Table 4
+      href: https://files.kff.org/attachment/Report-Medicaid-and-CHIP-Eligibility-Enrollment-Renewal-and-Cost-Sharing-Policies-as-of-January-2018#page=33
+    - title: Medicaid and CHIP Eligibility and Enrollment Policies as of January 2022 | KFF, Table 2
+      href: https://files.kff.org/attachment/REPORT-Medicaid-and-CHIP-Eligibility-and-Enrollment-Policies-as-of-January-2022.pdf#page=36
+    - title: Colorado CHIP State Plan Amendment CO-13-0015, CS8 Targeted Low-Income Pregnant Women
+      href: https://www.medicaid.gov/CHIP/Downloads/CO/CO-13-0015-MC1.pdf#page=8
+    - title: "10 CCR 2505-3 § 110.1.F and editor's notes #page 9,37"
+      href: https://www.coloradosos.gov/CCR/GenerateRulePdf.do?ruleVersionId=12687&fileName=10%20CCR%202505-3#page=9
+    - title: 10 CCR 2505-3 § 110.1.F (version effective March 11, 2022, before the June 30, 2022 amendment)
+      href: https://www.coloradosos.gov/CCR/GenerateRulePdf.do?ruleVersionId=10074&fileName=10%20CCR%202505-3#page=5
+    - title: Colorado Medical Services Board Notice of Proposed Rules, CHP 22-01-06-B (May 13, 2022 meeting)
+      href: https://www.coloradosos.gov/CCR/Upload/NoticeOfRulemaking/ProposedRuleAttach2022-00181.pdf
+    - title: "Kentucky CHIP State Plan Amendment KY-21-0001, approval letter and CS8 #page 2,4"
+      href: https://www.medicaid.gov/CHIP/Downloads/KY-21-0001.pdf#page=2
+    - title: "907 KAR 4:030 § 2(1)(e)1 (version effective January 12, 2023) #page 1-3"
+      href: https://apps.legislature.ky.gov/law/kar/downloads/docs/13741/document.engrossed.pdf#page=1
+    - title: New Jersey CHIP State Plan Amendment NJ-13-0018, CS8 Targeted Low-Income Pregnant Women
+      href: https://www.medicaid.gov/CHIP/Downloads/NJ/NJ-13-0018-MC1.pdf#page=8
+    - title: New Jersey DMAHS Section 1115 Comprehensive Demonstration Amendment Request to CMS (February 27, 2020)
+      href: https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/nj-1115-request-pa.pdf#page=1
+    - title: Rhode Island CHIP State Plan Amendment RI-13-023, CS8 Targeted Low-Income Pregnant Women
+      href: https://www.medicaid.gov/CHIP/Downloads/RI/RI-13-023-MC1.pdf#page=8
+    - title: 210-RICR-30-00-1 § 1.5(B) (version effective June 7, 2018 to January 4, 2022)
+      href: https://risos-apa-production-public.s3.amazonaws.com/EOHHS/REG_9690_20180806185730.pdf#page=6
+    - title: 210-RICR-30-00-1 § 1.6(B) (version effective August 17, 2025)
+      href: https://risos-apa-production-public.s3.amazonaws.com/EOHHS/REG_13314_20250728104245127.pdf#page=7
+    - title: "West Virginia CHIP State Plan Amendment WV-19-0006, approval letter and CS8 #page 2,4"
+      href: https://www.medicaid.gov/CHIP/Downloads/WV/WV-19-0006.pdf#page=2
 AK:
   2018-01-01: -.inf
 AL:
@@ -22,8 +58,12 @@ AZ:
 CA:
   2018-01-01: -.inf
 CO:
-  2018-01-01: 2.60
-  2023-10-30: 2.65
+  # 260% FPL (CO-13-0015, effective 2014) plus the 5 percentage point MAGI
+  # disregard. Until the amendment effective June 30, 2022, 10 CCR 2505-3
+  # § 110.1.F printed "greater than 185% but not exceeding 250%"; the amendment
+  # aligned the rule with the existing standard, so 2018 to mid-2022 also uses
+  # 2.65.
+  2018-01-01: 2.65
 CT:
   2018-01-01: -.inf
 DC:
@@ -48,8 +88,9 @@ KS:
   2018-01-01: -.inf
 KY:
   2018-01-01: -.inf
-  2021-01-01: 2.13
-  2021-07-01: 2.18
+  # Effective July 1, 2022 (KY-21-0001). YEAR-defined formulas read January 1,
+  # so this value first applies in 2023.
+  2022-07-01: 2.18
 LA:
   2018-01-01: -.inf
 MA:
@@ -77,8 +118,9 @@ NE:
 NH:
   2018-01-01: -.inf
 NJ:
-  2018-01-01: 2.00
-  2023-12-01: 2.05
+  # NJ-13-0018 has applied since January 1, 2014; 2018-01-01 is this file's
+  # first date.
+  2018-01-01: 2.05
 NM:
   2018-01-01: -.inf
 NV:
@@ -94,8 +136,9 @@ OR:
 PA:
   2018-01-01: -.inf
 RI:
-  2018-01-01: 2.53
-  2023-12-01: 2.58
+  # RI-13-023 has applied since January 1, 2014; 2018-01-01 is this file's
+  # first date.
+  2018-01-01: 2.58
 SC:
   2018-01-01: -.inf
 SD:
@@ -116,6 +159,8 @@ WI:
   2018-01-01: -.inf
 WV:
   2018-01-01: -.inf
-  2021-01-01: 3.05
+  # Effective July 1, 2019 (WV-19-0006). YEAR-defined formulas read January 1,
+  # so this value first applies in 2020.
+  2019-07-01: 3.05
 WY:
   2018-01-01: -.inf

policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/pregnant/income_limit.yaml

@@ -1,4 +1,4 @@
-description: Maximum family income for pregnant people to qualify for Medicaid.
+description: State governments limit Medicaid pregnancy eligibility to these incomes, as a share of the federal poverty line, including the five percentage point income disregard of 42 CFR 435.603(d)(4).
 metadata:
   unit: /1
   label: Medicaid pregnant income limit
@@ -7,6 +7,10 @@ metadata:
   reference:
     - title: Medicaid and CHIP Eligibility and Enrollment Policies as of January 2022 | KFF
       href: https://files.kff.org/attachment/REPORT-Medicaid-and-CHIP-Eligibility-and-Enrollment-Policies-as-of-January-2022.pdf#page=36
+    # KFF's January 2026 table adds the disregard only at each state's highest
+    # pregnancy level, so lower levels omit it (for example, West Virginia
+    # Medicaid 185% and Colorado CHIP 260%). 42 CFR 435.603(d)(4) applies the
+    # disregard in each Title.
     - title: Medicaid and CHIP Income Eligibility Limits for Pregnant Women as a Percent of the Federal Poverty Level | KFF State Health Facts
       href: https://www.kff.org/affordable-care-act/state-indicator/medicaid-and-chip-income-eligibility-limits-for-pregnant-women-as-a-percent-of-the-federal-poverty-level/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D
     - title: Medicaid and CHIP Eligibility, Enrollment, Renewal, and Cost Sharing Policies as of January 2018
@@ -15,10 +19,14 @@ metadata:
       href: https://data.medicaid.gov/dataset/d7e4cccb-1c56-5b5d-acce-5e7744c6d3b4
     - title: Medicaid and CHIP Eligibility Levels | CMS Data.Medicaid.gov CSV download (April 1, 2018)
       href: https://download.medicaid.gov/data/medicaid-and-chip-eligibility-levels.xy8t-auhk.csv
+    - title: 42 CFR 435.603(d)(4), five percentage point MAGI income disregard
+      href: https://www.law.cornell.edu/cfr/text/42/435.603#d_4
     - title: NV-25-0006, Medicaid State Plan Amendment
       href: https://www.medicaid.gov/medicaid-spa/2025-05-07/179381
     - title: Nevada Medicaid Web Announcement 3748 (200% FPL pregnancy standard)
       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
 AK:
   2018-01-01: 2.05
   2024-02-01: 2.30
@@ -129,6 +137,8 @@ WI:
   2018-01-01: 3.06
 WV:
   2018-01-01: 1.63
-  2021-01-01: 1.90
+  # Effective July 1, 2019 (WV-19-0004). YEAR-defined formulas read January 1,
+  # so this value first applies in 2020.
+  2019-07-01: 1.90
 WY:
   2018-01-01: 1.59

policyengine_us/tests/policy/baseline/gov/hhs/chip/is_chip_eligible_fcep.yaml

@@ -514,3 +514,86 @@
     is_chip_eligible_standard_pregnant_person: [false, false, false, false, false]
     is_chip_fcep_eligible_person: [true, true, true, true, true]
     is_chip_eligible_pregnant: [true, true, true, true, true]
+
+# Colorado's FCEP population took effect January 1, 2025, up to 260% FPL
+# (CO-24-0041 and CO-25-0044), plus the 5 percentage point MAGI disregard.
+# The earlier 2023-10-30 date belonged to CO-24-0041 amendment 41, not to FCEP.
+# The applicant is undocumented, so standard pregnancy CHIP does not apply and
+# FCEP, which has no immigration test, is the only CHIP pathway.
+- name: Case 18, Colorado FCEP does not cover an undocumented pregnant applicant in 2024.
+  period: 2024
+  input:
+    people:
+      person1:
+        age: 30
+        is_pregnant: true
+        immigration_status: UNDOCUMENTED
+        is_medicaid_eligible: false
+        medicaid_income_level: 2.3
+    households:
+      household:
+        members: [person1]
+        state_code: CO
+  output:
+    is_chip_fcep_eligible_person: false
+    is_chip_eligible_pregnant: false
+    chip_category: NONE
+    is_chip_eligible: false
+
+- name: Case 19, Colorado FCEP covers an undocumented pregnant applicant in 2025.
+  period: 2025
+  input:
+    people:
+      person1:
+        age: 30
+        is_pregnant: true
+        immigration_status: UNDOCUMENTED
+        is_medicaid_eligible: false
+        medicaid_income_level: 2.3
+    households:
+      household:
+        members: [person1]
+        state_code: CO
+  output:
+    is_chip_fcep_eligible_person: true
+    is_chip_eligible_pregnant: true
+    chip_category: PREGNANT_FCEP
+    is_chip_eligible: true
+
+# Colorado FCEP covers up to and including 260% FPL (CO-25-0044 section
+# 3.1.1.1) plus the 5 percentage point disregard. 2026 household of 2:
+# 21,640 x 2.65 / 12 = 4,778.83 -> $4,779, so 265% qualifies and 266%
+# ($4,796.87) does not.
+- name: Case 20, Colorado FCEP covers an undocumented pregnant applicant at 265% FPL in 2026.
+  period: 2026
+  input:
+    people:
+      person1:
+        age: 30
+        is_pregnant: true
+        immigration_status: UNDOCUMENTED
+        is_medicaid_eligible: false
+        medicaid_income_level: 2.65
+    households:
+      household:
+        members: [person1]
+        state_code: CO
+  output:
+    is_chip_fcep_eligible_person: true
+
+- name: Case 21, Colorado FCEP excludes an undocumented pregnant applicant at 266% FPL in 2026.
+  period: 2026
+  input:
+    people:
+      person1:
+        age: 30
+        is_pregnant: true
+        immigration_status: UNDOCUMENTED
+        is_medicaid_eligible: false
+        medicaid_income_level: 2.66
+    households:
+      household:
+        members: [person1]
+        state_code: CO
+  output:
+    is_chip_fcep_eligible_person: false