Count blind people and use the individual or couple in the Medicaid medically needy test

changelog.d/medicaid-medically-needy-blind-unit.fixed.md

@@ -0,0 +1 @@
+Count blind people in the Medicaid medically needy disabled group, and test medically needy income and resources over the individual or married couple instead of the tax unit, counting a parent's excess resources and medical expenses for a child.

policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/is_in_medicaid_medically_needy_category.yaml

@@ -13,3 +13,21 @@
     state_code: MA
   output:
     is_in_medicaid_medically_needy_category: false
+
+- name: Case 1, blind adult under 65 who is not SSI-disabled is in the medically needy disabled group.
+  period: 2026
+  input:
+    age: 40
+    is_blind: true
+    state_code: MA
+  output:
+    is_in_medicaid_medically_needy_category: true
+
+- name: Case 2, blind adult is not in a medically needy category in a state without the disabled group.
+  period: 2026
+  input:
+    age: 40
+    is_blind: true
+    state_code: TX
+  output:
+    is_in_medicaid_medically_needy_category: false

policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/is_medically_needy_for_medicaid.yaml

@@ -50,3 +50,285 @@
     state_code: MA
   output:
     is_medically_needy_for_medicaid: false
+
+- name: Case 3, aged parent claimed as a tax dependent does not add income or resources to the filer's test.
+  period: 2026
+  input:
+    people:
+      person1:
+        age: 70
+        # $18,000 Social Security - $240 general exclusion.
+        ssi_countable_income: 17_760
+        medicaid_medically_needy_medical_expenses: 13_000
+        ssi_countable_resources: 500
+        is_optional_senior_or_disabled_for_medicaid: false
+      person2:
+        age: 92
+        is_tax_unit_dependent: true
+        # $4,000 pension - $240 general exclusion.
+        ssi_countable_income: 3_760
+        ssi_countable_resources: 1_800
+    tax_units:
+      tax_unit:
+        members: [person1, person2]
+    marital_units:
+      marital_unit1:
+        members: [person1]
+      marital_unit2:
+        members: [person2]
+    households:
+      household:
+        members: [person1, person2]
+        state_code: MA
+  output:
+    # person1: 17,760 - 13,000 = 4,760 <= 522 x 12 = 6,264; resources 500 <= 2,000.
+    # Summing over the tax unit would give 8,520 and 2,300, both over the limits.
+    # person2 receives SSI (3,760 < 994 x 12), so is covered through SSI instead.
+    is_medically_needy_for_medicaid: [true, false]
+
+- name: Case 4, married couple filing separately is tested on combined income against the couple limit.
+  period: 2026
+  input:
+    people:
+      person1:
+        age: 68
+        # Couple's $26,400 Social Security - $240 general exclusion, split
+        # equally between the two aged spouses.
+        ssi_countable_income: 13_080
+        medicaid_medically_needy_medical_expenses: 8_000
+        ssi_countable_resources: 1_000
+        is_optional_senior_or_disabled_for_medicaid: false
+      person2:
+        age: 66
+        ssi_countable_income: 13_080
+        medicaid_medically_needy_medical_expenses: 8_000
+        ssi_countable_resources: 1_000
+        is_optional_senior_or_disabled_for_medicaid: false
+    tax_units:
+      tax_unit1:
+        members: [person1]
+      tax_unit2:
+        members: [person2]
+    marital_units:
+      marital_unit:
+        members: [person1, person2]
+    households:
+      household:
+        members: [person1, person2]
+        state_code: MA
+  output:
+    # 2 x (13,080 - 8,000) = 10,160 > 650 x 12 = 7,800.
+    # Each spouse alone would pass the individual limit: 5,080 <= 6,264.
+    is_medically_needy_for_medicaid: [false, false]
+
+- name: Case 5, disabled child's resource test counts the parents' savings above the SSI couple allowance.
+  period: 2026
+  input:
+    people:
+      person1:
+        age: 40
+        is_tax_unit_head: true
+        is_parent: true
+        employment_income_before_lsr: 40_000
+        ssi_countable_resources: 10_000
+      person2:
+        age: 38
+        is_tax_unit_spouse: true
+        is_parent: true
+        employment_income_before_lsr: 40_000
+        ssi_countable_resources: 10_000
+      person3:
+        age: 10
+        is_tax_unit_dependent: true
+        is_ssi_disabled: true
+        # Parents' $6,666.67 monthly wages deemed to the child (20 CFR 416.1165):
+        # (6,666.67 - 20 - 65) / 2 - 1,491 couple allowance = 1,799.83, less
+        # the child's $20 general exclusion = 1,779.83 a month.
+        ssi_countable_income: 21_358
+        medicaid_medically_needy_medical_expenses: 16_000
+        is_optional_senior_or_disabled_for_medicaid: false
+    tax_units:
+      tax_unit:
+        members: [person1, person2, person3]
+    marital_units:
+      marital_unit1:
+        members: [person1, person2]
+      marital_unit2:
+        members: [person3]
+    households:
+      household:
+        members: [person1, person2, person3]
+        state_code: MA
+  output:
+    # person3: income 21,358 - 16,000 = 5,358 <= 522 x 12 = 6,264, but resources
+    # 0 + (20,000 - 3,000 two-parent allowance) = 17,000 > 2,000 (20 CFR 416.1202(b)).
+    is_medically_needy_for_medicaid: [false, false, false]
+
+- name: Case 6, disabled child qualifies when the parents' savings are within the SSI couple allowance.
+  period: 2026
+  input:
+    people:
+      person1:
+        age: 40
+        is_tax_unit_head: true
+        is_parent: true
+        employment_income_before_lsr: 40_000
+        ssi_countable_resources: 1_200
+      person2:
+        age: 38
+        is_tax_unit_spouse: true
+        is_parent: true
+        employment_income_before_lsr: 40_000
+        ssi_countable_resources: 1_200
+      person3:
+        age: 10
+        is_tax_unit_dependent: true
+        is_ssi_disabled: true
+        # Deemed parental income as in Case 5.
+        ssi_countable_income: 21_358
+        medicaid_medically_needy_medical_expenses: 16_000
+        is_optional_senior_or_disabled_for_medicaid: false
+    tax_units:
+      tax_unit:
+        members: [person1, person2, person3]
+    marital_units:
+      marital_unit1:
+        members: [person1, person2]
+      marital_unit2:
+        members: [person3]
+    households:
+      household:
+        members: [person1, person2, person3]
+        state_code: MA
+  output:
+    # person3: income 5,358 <= 6,264; resources 0 + max(2,400 - 3,000, 0) = 0 <= 2,000.
+    # Counting the parents' full 2,400 would exceed the child's 2,000 limit.
+    is_medically_needy_for_medicaid: [false, false, true]
+
+- name: Case 7, married couple filing separately qualifies on the couple limit when combined net income is between the two limits.
+  period: 2026
+  input:
+    people:
+      person1:
+        age: 68
+        ssi_countable_income: 10_000
+        medicaid_medically_needy_medical_expenses: 6_500
+        ssi_countable_resources: 1_000
+        is_optional_senior_or_disabled_for_medicaid: false
+      person2:
+        age: 66
+        ssi_countable_income: 10_000
+        medicaid_medically_needy_medical_expenses: 6_500
+        ssi_countable_resources: 1_000
+        is_optional_senior_or_disabled_for_medicaid: false
+    tax_units:
+      tax_unit1:
+        members: [person1]
+      tax_unit2:
+        members: [person2]
+    marital_units:
+      marital_unit:
+        members: [person1, person2]
+    households:
+      household:
+        members: [person1, person2]
+        state_code: MA
+  output:
+    # 2 x (10,000 - 6,500) = 7,000: above 6,264, at or below 7,800.
+    is_medically_needy_for_medicaid: [true, true]
+
+- name: Case 8, disabled child in a joint tax unit is tested against the individual limit.
+  period: 2026
+  input:
+    people:
+      person1:
+        age: 40
+        is_tax_unit_head: true
+        is_parent: true
+        employment_income_before_lsr: 40_000
+        ssi_countable_resources: 1_200
+      person2:
+        age: 38
+        is_tax_unit_spouse: true
+        is_parent: true
+        employment_income_before_lsr: 40_000
+        ssi_countable_resources: 1_200
+      person3:
+        age: 10
+        is_tax_unit_dependent: true
+        is_ssi_disabled: true
+        ssi_countable_income: 21_358
+        medicaid_medically_needy_medical_expenses: 15_000
+        is_optional_senior_or_disabled_for_medicaid: false
+    tax_units:
+      tax_unit:
+        members: [person1, person2, person3]
+    marital_units:
+      marital_unit1:
+        members: [person1, person2]
+      marital_unit2:
+        members: [person3]
+    households:
+      household:
+        members: [person1, person2, person3]
+        state_code: MA
+  output:
+    # 21,358 - 15,000 = 6,358 > 6,264 (the couple limit 7,800 would pass).
+    is_medically_needy_for_medicaid: [false, false, false]
+
+- name: Case 9, a parent's medical expenses reduce a disabled child's countable income.
+  period: 2026
+  input:
+    people:
+      person1:
+        age: 40
+        is_tax_unit_head: true
+        is_parent: true
+        employment_income_before_lsr: 40_000
+        ssi_countable_resources: 1_200
+        medicaid_medically_needy_medical_expenses: 8_000
+      person2:
+        age: 38
+        is_tax_unit_spouse: true
+        is_parent: true
+        employment_income_before_lsr: 40_000
+        ssi_countable_resources: 1_200
+      person3:
+        age: 10
+        is_tax_unit_dependent: true
+        is_ssi_disabled: true
+        ssi_countable_income: 21_358
+        medicaid_medically_needy_medical_expenses: 10_000
+        is_optional_senior_or_disabled_for_medicaid: false
+    tax_units:
+      tax_unit:
+        members: [person1, person2, person3]
+    marital_units:
+      marital_unit1:
+        members: [person1, person2]
+      marital_unit2:
+        members: [person3]
+    households:
+      household:
+        members: [person1, person2, person3]
+        state_code: MA
+  output:
+    # 42 CFR 435.831(d): 21,358 - (10,000 own + 8,000 parent's) = 3,358
+    # <= 522 x 12 = 6,264. Resources: nothing deemed (2,400 < 3,000).
+    is_medically_needy_for_medicaid: [false, false, true]
+
+- name: Case 10, blind adult under 65 who is not SSI-disabled qualifies after spenddown.
+  period: 2026
+  input:
+    age: 40
+    is_blind: true
+    is_adult_for_medicaid: false
+    is_optional_senior_or_disabled_for_medicaid: false
+    ssi_countable_income: 12_000
+    medicaid_medically_needy_medical_expenses: 6_000
+    ssi_countable_resources: 1_000
+    state_code: MA
+  output:
+    # 12,000 - 6,000 = 6,000 <= 6,264; resources 1,000 <= 2,000.
+    is_in_medicaid_medically_needy_category: true
+    is_medically_needy_for_medicaid: true

policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/medically_needy/is_in_medicaid_medically_needy_category.py

@@ -7,14 +7,23 @@ 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.ecfr.gov/current/title-42/section-435.301#p-435.301(b)(2)",
+        "https://www.ecfr.gov/current/title-42/section-435.322",
+        "https://www.ecfr.gov/current/title-42/section-435.324",
+        "https://www.kff.org/report-section/medicaid-financial-eligibility-for-seniors-and-people-with-disabilities-findings-from-a-50-state-survey-appendix-tables/",
+    )
 
     def formula(person, period, parameters):
         mn_categories = parameters(
             period
         ).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)
+        # The disabled flag follows KFF's "people with disabilities", which
+        # includes blind people; federal rules list blind (42 CFR 435.322)
+        # and disabled (42 CFR 435.324) as parallel medically needy groups.
+        is_blind_or_disabled = any_(person, period, ["is_blind", "is_ssi_disabled"])
         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)
@@ -30,7 +39,7 @@ def formula(person, period, parameters):
         category_covered = [parameter[state] > 0 for parameter in categories]
         in_category = [
             is_child,
-            is_disabled,
+            is_blind_or_disabled,
             is_parent,
             is_pregnant,
             is_senior,