Fix WV Medicaid spouse standards and ND medically needy coverage

changelog.d/medicaid-wv-nd-eligibility-followups.fixed.md

@@ -0,0 +1 @@
+Correct West Virginia's Medicaid income standard for applicants with ineligible spouses, and enable North Dakota's aged, blind, and disabled medically needy coverage with published 2025-2026 income limits.

policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/categories/disabled.yaml

@@ -7,6 +7,10 @@ metadata:
   reference:
     - title: "Medicaid Financial Eligibility for Seniors and People with Disabilities: Findings from a 50-State Survey | KFF"
       href: https://www.kff.org/report-section/medicaid-financial-eligibility-for-seniors-and-people-with-disabilities-findings-from-a-50-state-survey-appendix-tables/
+    - title: North Dakota Administrative Code 75-02-02.1-05(3)(e) - Medically needy aged, blind, or disabled individuals not receiving SSI
+      href: https://www.ndlegis.gov/information/acdata/pdf/75-02-02.1.pdf#page=11
+    - title: North Dakota Non-ACA Medicaid Policy Manual 510-05-30-05 - Groups Covered Under Medicaid (archived, revised October 1, 2013)
+      href: https://www.nd.gov/dhs/policymanuals/51005/Archived%20Documents/2014%20-%203406/510_05_30_05%20ML3406.htm
 
 AK:
   2015-01-01: false
@@ -65,7 +69,7 @@ MT:
 NC:
   2015-01-01: true
 ND:
-  2015-01-01: false
+  2015-01-01: true
 NE:
   2015-01-01: true
 NH:

policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/categories/senior.yaml

@@ -7,6 +7,10 @@ metadata:
   reference:
     - title: "Medicaid Financial Eligibility for Seniors and People with Disabilities: Findings from a 50-State Survey | KFF"
       href: https://www.kff.org/report-section/medicaid-financial-eligibility-for-seniors-and-people-with-disabilities-findings-from-a-50-state-survey-appendix-tables/
+    - title: North Dakota Administrative Code 75-02-02.1-05(3)(e) - Medically needy aged, blind, or disabled individuals not receiving SSI
+      href: https://www.ndlegis.gov/information/acdata/pdf/75-02-02.1.pdf#page=11
+    - title: North Dakota Non-ACA Medicaid Policy Manual 510-05-30-05 - Groups Covered Under Medicaid (archived, revised October 1, 2013)
+      href: https://www.nd.gov/dhs/policymanuals/51005/Archived%20Documents/2014%20-%203406/510_05_30_05%20ML3406.htm
 
 AK:
   2015-01-01: false
@@ -65,7 +69,7 @@ MT:
 NC:
   2015-01-01: true
 ND:
-  2015-01-01: false
+  2015-01-01: true
 NE:
   2015-01-01: true
 NH:

policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/couple.yaml

@@ -8,6 +8,10 @@ metadata:
   reference:
     - title: "Medicaid Financial Eligibility for Seniors and People with Disabilities: Findings from a 50-State Survey | KFF"
       href: https://www.kff.org/report-section/medicaid-financial-eligibility-for-seniors-and-people-with-disabilities-findings-from-a-50-state-survey-appendix-tables/
+    - title: North Dakota Non-ACA Medicaid Policy Manual 510-05-85-40 - Income Levels (archived, effective April 1, 2025)
+      href: https://www.nd.gov/dhs/policymanuals/51005/Archived%20Documents/2025/3935/510_05_85_40.htm
+    - title: North Dakota Non-ACA Medicaid Policy Manual 510-05-85-40 - Income Levels
+      href: https://www.nd.gov/dhs/policymanuals/51005/510_05_85_40.htm
 
 AK:
   2018-01-01: -.inf
@@ -67,6 +71,8 @@ NC:
   2018-01-01: 317
 ND:
   2018-01-01: 1_139
+  2025-04-01: 1_587
+  2026-04-01: 1_623
 NE:
   2018-01-01: 392
 NH:

policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/individual.yaml

@@ -8,6 +8,10 @@ metadata:
   reference:
     - title: "Medicaid Financial Eligibility for Seniors and People with Disabilities: Findings from a 50-State Survey | KFF"
       href: https://www.kff.org/report-section/medicaid-financial-eligibility-for-seniors-and-people-with-disabilities-findings-from-a-50-state-survey-appendix-tables/
+    - title: North Dakota Non-ACA Medicaid Policy Manual 510-05-85-40 - Income Levels (archived, effective April 1, 2025)
+      href: https://www.nd.gov/dhs/policymanuals/51005/Archived%20Documents/2025/3935/510_05_85_40.htm
+    - title: North Dakota Non-ACA Medicaid Policy Manual 510-05-85-40 - Income Levels
+      href: https://www.nd.gov/dhs/policymanuals/51005/510_05_85_40.htm
 
 AK:
   2018-01-01: -.inf
@@ -67,6 +71,8 @@ NC:
   2018-01-01: 242
 ND:
   2018-01-01: 840
+  2025-04-01: 1_174
+  2026-04-01: 1_197
 NE:
   2018-01-01: 392
 NH:

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

@@ -680,8 +680,10 @@
   input:
     people:
       person1:
+        age: 70
         medicaid_optional_senior_or_disabled_countable_income: 8_946
       person2:
+        age: 68
         medicaid_optional_senior_or_disabled_countable_income: 8_946
     tax_units:
       tax_unit:

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

@@ -3,9 +3,9 @@
 # 85% (DSS Manual § 0805.015.45; current dollars in MHABD Appendix J).
 # Missouri publishes the standards as monthly dollar amounts, rounding
 # the percentage of the monthly guideline up to the next whole dollar.
-# In every state the guideline is the one-person or couple figure (2025:
-# $15,650 and $21,150), following the applicant's marital unit rather
-# than the tax unit (42 CFR 435.602).
+# The guideline is the one-person or couple figure (2025: $15,650 and
+# $21,150), following the applicant's marital unit rather than the tax
+# unit (42 CFR 435.602). West Virginia's needs-group exceptions are below.
 - name: Missouri blind single person gets the 100% FPL blind standard
   period: 2025
   input:
@@ -409,3 +409,124 @@
   output:
     # 967 x 12
     medicaid_optional_senior_or_disabled_income_limit: [11_604]
+
+# WV IMM 3.17.3.A.2-4: use the individual standard when an ineligible
+# spouse has no deemed income, and the couple standard when both spouses
+# are eligible or income is deemed. The 2026 SSI standards are $994 and
+# $1,491 monthly; the deeming allocation is their $497 difference.
+# https://bfa.wv.gov/media/40005/download?inline#page=385
+- name: Case 19, West Virginia uses the individual standard with an ineligible spouse and no deemed income.
+  period: 2026
+  input:
+    people:
+      person1:
+        age: 70
+        social_security_retirement: 17_040
+      person2:
+        age: 60
+    marital_units:
+      couple:
+        members: [person1, person2]
+    tax_units:
+      couple:
+        members: [person1, person2]
+        tax_unit_is_joint: true
+    households:
+      household:
+        members: [person1, person2]
+        state_code: WV
+  output:
+    # $1,420 monthly retirement income less $20 = $1,400 countable.
+    # Marriage alone must not give the applicant the $1,491 limit.
+    is_ssi_spousal_deeming_applies: [false, false]
+    medicaid_optional_senior_or_disabled_income_limit: [11_928, 11_928]
+    is_optional_senior_or_disabled_income_eligible: [false, false]
+
+- name: Case 20, West Virginia keeps the individual standard at the spousal deeming threshold.
+  period: 2026
+  input:
+    people:
+      person1:
+        age: 70
+      person2:
+        age: 62
+        social_security_retirement: 5_964
+    marital_units:
+      couple:
+        members: [person1, person2]
+    tax_units:
+      couple:
+        members: [person1, person2]
+        tax_unit_is_joint: true
+    households:
+      household:
+        members: [person1, person2]
+        state_code: WV
+  output:
+    # $497 monthly does not exceed the $1,491 - $994 allocation.
+    is_ssi_spousal_deeming_applies: [false, false]
+    medicaid_optional_senior_or_disabled_income_limit: [11_928, 11_928]
+
+- name: Case 21, West Virginia uses the couple standard for the second spouse when deeming applies.
+  period: 2026
+  input:
+    people:
+      person1:
+        age: 62
+        social_security_retirement: 7_200
+      person2:
+        age: 70
+        social_security_retirement: 10_800
+    marital_units:
+      couple:
+        members: [person1, person2]
+    tax_units:
+      couple:
+        members: [person1, person2]
+        tax_unit_is_joint: true
+    households:
+      household:
+        members: [person1, person2]
+        state_code: WV
+  output:
+    # The spouse's $600 monthly exceeds the $497 allocation. Combined
+    # countable income is $900 + $600 - $20 = $1,480 monthly.
+    is_ssi_spousal_deeming_applies: [false, true]
+    medicaid_optional_senior_or_disabled_income_limit: [11_928, 17_892]
+    is_optional_senior_or_disabled_income_eligible: [false, true]
+
+- name: Case 22, West Virginia eligible spouses use the couple standard without changing Missouri.
+  period: 2026
+  input:
+    people:
+      person1:
+        age: 70
+      person2:
+        age: 68
+      person3:
+        age: 70
+      person4:
+        age: 60
+    marital_units:
+      wv_couple:
+        members: [person1, person2]
+      mo_couple:
+        members: [person3, person4]
+    tax_units:
+      wv_couple:
+        members: [person1, person2]
+        tax_unit_is_joint: true
+      mo_couple:
+        members: [person3, person4]
+        tax_unit_is_joint: true
+    households:
+      west_virginia:
+        members: [person1, person2]
+        state_code: WV
+      missouri:
+        members: [person3, person4]
+        state_code: MO
+  output:
+    # WV: $1,491 monthly SSI couple rate. MO: $1,533 monthly, regardless
+    # of whether the second spouse independently meets the ABD criteria.
+    medicaid_optional_senior_or_disabled_income_limit: [17_892, 17_892, 18_396, 18_396]

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

@@ -13,3 +13,41 @@
     state_code: MA
   output:
     is_in_medicaid_medically_needy_category: false
+
+# ND's archived 510-05-30-05 includes non-SSI aged, blind, or disabled
+# individuals in its medically needy group on or after January 1, 2014.
+- name: Case 3, North Dakota seniors have a medically needy category in 2015.
+  period: 2015
+  input:
+    age: 70
+    state_code: ND
+  output:
+    is_in_medicaid_medically_needy_category: true
+
+- name: Case 4, North Dakota disabled adults have a medically needy category in 2018.
+  period: 2018
+  input:
+    age: 40
+    is_disabled: true
+    meets_ssi_disability_criteria: true
+    state_code: ND
+  output:
+    is_in_medicaid_medically_needy_category: true
+
+- name: Case 5, North Dakota childless adults without a disability do not meet an ABD medically needy category.
+  period: 2026
+  input:
+    age: 40
+    state_code: ND
+  output:
+    is_in_medicaid_medically_needy_category: false
+
+- name: Case 6, North Dakota blind adults need not meet the separate SSI disability criteria.
+  period: 2026
+  input:
+    age: 40
+    is_blind: true
+    meets_ssi_disability_criteria: false
+    state_code: ND
+  output:
+    is_in_medicaid_medically_needy_category: true