diff --git a/changelog.d/medicaid-chip-lawfully-residing-option.added.md b/changelog.d/medicaid-chip-lawfully-residing-option.added.md new file mode 100644 index 00000000000..4adefe83b25 --- /dev/null +++ b/changelog.d/medicaid-chip-lawfully-residing-option.added.md @@ -0,0 +1 @@ +Add the CHIPRA section 214 option for lawfully residing children and pregnant individuals to Medicaid and CHIP, and apply the five-year bar, qualified-alien limit and H.R.1 section 71109 status limits to CHIP. diff --git a/policyengine_us/parameters/gov/hhs/chip/lawfully_residing/child.yaml b/policyengine_us/parameters/gov/hhs/chip/lawfully_residing/child.yaml new file mode 100644 index 00000000000..e793706a799 --- /dev/null +++ b/policyengine_us/parameters/gov/hhs/chip/lawfully_residing/child.yaml @@ -0,0 +1,162 @@ +description: States provide the lawfully residing children option under the Children's Health Insurance Program if this is true. +# The option reaches separate CHIP only where the state also elected it in Medicaid +# for the same group (42 U.S.C. 1397gg(e)(1)(Q)). States that cover their option +# population through Medicaid-expansion CHIP are false, because this model treats +# that coverage as Medicaid. +# Values before 2022 extrapolate from the January 1, 2022 KFF and Georgetown CCF +# 50-state survey, the earliest state-level source. Later changes come from state +# plan amendments, bulletins and testimony, and current values match the CMS list +# updated April 2, 2026. +AK: + 2022-01-01: false +AL: + 2022-01-01: false +AR: + 2022-01-01: true +AZ: + 2022-01-01: false +CA: + 2022-01-01: true +CO: + 2022-01-01: true +CT: + 2022-01-01: true +DC: + 2022-01-01: false +DE: + 2022-01-01: true +FL: + 2022-01-01: true +# SPA GA-23-0002 covers lawfully residing children in Medicaid and CHIP from +# January 1, 2024. +GA: + 2022-01-01: false + 2024-01-01: true +HI: + 2022-01-01: false +IA: + 2022-01-01: true +ID: + 2022-01-01: false +# Illinois elected the option in its separate CHIP until that program +# ended for children (gov.hhs.chip.child.income_limit); CMS now lists its +# option children under Medicaid-expansion CHIP, which this model treats +# as Medicaid. +IL: + 2022-01-01: true + 2022-07-01: false +IN: + 2022-01-01: false +KS: + 2022-01-01: false +# Kentucky elected the option in its separate CHIP. The July 1, 2022 end date +# comes only from the end of its separate CHIP for children in +# gov.hhs.chip.child.income_limit; KFF's January 2023 Table 3 still marks +# Kentucky's CHIP children as covered. CMS now lists its option children under +# Medicaid-expansion CHIP, which this model treats as Medicaid. +KY: + 2022-01-01: true + 2022-07-01: false +LA: + 2022-01-01: true +MA: + 2022-01-01: true +MD: + 2022-01-01: false +# Maine elected the option in its separate CHIP until that program +# ended for children (gov.hhs.chip.child.income_limit); CMS now lists its +# option children under Medicaid-expansion CHIP, which this model treats +# as Medicaid. +ME: + 2022-01-01: true + 2023-03-28: false +MI: + 2022-01-01: false +MN: + 2022-01-01: false +MO: + 2022-01-01: false +MS: + 2022-01-01: false +MT: + 2022-01-01: true +# North Carolina elected the option in its separate CHIP until that program +# ended for children (gov.hhs.chip.child.income_limit); CMS now lists its +# option children under Medicaid-expansion CHIP, which this model treats +# as Medicaid. +NC: + 2022-01-01: true + 2023-04-01: false +ND: + 2022-01-01: false +NE: + 2022-01-01: false +NH: + 2022-01-01: false +NJ: + 2022-01-01: true +NM: + 2022-01-01: false +NV: + 2022-01-01: true +NY: + 2022-01-01: true +OH: + 2022-01-01: false +OK: + 2022-01-01: false +# CMS lists Oregon's option children under Medicaid-expansion CHIP, and KFF reports +# that Oregon moved its separate CHIP to Medicaid-expansion CHIP on January 1, 2024. +# This model still covers Oregon children from 138% to 305% of the poverty line +# through separate CHIP (gov.hhs.chip.child.income_limit), so the election stays +# true to keep the option's reach until those income limits reflect the move. +OR: + 2022-01-01: true +PA: + 2022-01-01: true +RI: + 2022-01-01: false +SC: + 2022-01-01: false +SD: + 2022-01-01: false +TN: + 2022-01-01: false +TX: + 2022-01-01: true +UT: + 2022-01-01: true +VA: + 2022-01-01: true +VT: + 2022-01-01: false +WA: + 2022-01-01: true +WI: + 2022-01-01: true +WV: + 2022-01-01: true +WY: + 2022-01-01: false + +metadata: + unit: bool + period: year + label: CHIP lawfully residing children option election + breakdown: + - state_code + reference: + - title: 42 U.S.C. 1397gg(e)(1)(Q) + href: https://www.law.cornell.edu/uscode/text/42/1397gg#e_1_Q + - title: "CMS SHO #10-006, Medicaid and CHIP Coverage of Lawfully Residing Children and Pregnant Women" + href: https://downloads.cms.gov/cmsgov/archived-downloads/smdl/downloads/sho10006.pdf#page=2 + - title: CMS, Medicaid and CHIP Coverage of Lawfully Residing Children and Pregnant Individuals (updated April 2, 2026) + href: https://www.medicaid.gov/medicaid/enrollment-strategies/medicaid-and-chip-coverage-lawfully-residing-children-pregnant-individuals + - title: CMS, Georgia State Plan Amendment GA-23-0002 + href: https://www.medicaid.gov/medicaid-spa/2023-11-22/156086 + - title: KFF and Georgetown CCF, Medicaid and CHIP Eligibility and Enrollment Policies as of January 2022, Table 3 + href: https://files.kff.org/attachment/Table-3-Medicaid-and-CHIP-Eligibility-and-Enrollment-Policies-as-of-January-2022.pdf#page=1 + - title: KFF and Georgetown CCF, Medicaid and CHIP Eligibility, Enrollment, and Renewal Policies as of January 2023, Table 3 + href: https://files.kff.org/attachment/Table-3-Medicaid-and-CHIP-Eligibility-Enrollment-and-Renewal-Policies-as-States-Prepare-for-the-Unwinding-of-the-Pandemic-Era-Continuous-Enrollment-Provision.pdf#page=1 + - title: KFF, Medicaid and CHIP Eligibility, Enrollment, and Renewal Policies as States Prepare for Major Medicaid Policy Changes (January 2026) + href: https://www.kff.org/medicaid/medicaid-and-chip-eligibility-enrollment-and-renewal-policies-as-states-prepare-for-major-medicaid-policy-changes/ diff --git a/policyengine_us/parameters/gov/hhs/chip/lawfully_residing/pregnant.yaml b/policyengine_us/parameters/gov/hhs/chip/lawfully_residing/pregnant.yaml new file mode 100644 index 00000000000..0a179f783ae --- /dev/null +++ b/policyengine_us/parameters/gov/hhs/chip/lawfully_residing/pregnant.yaml @@ -0,0 +1,135 @@ +description: States provide the lawfully residing pregnant individuals option under the Children's Health Insurance Program if this is true. +# The option reaches separate CHIP only where the state also elected it in Medicaid +# for the same group (42 U.S.C. 1397gg(e)(1)(Q)). States that cover their option +# population through Medicaid-expansion CHIP are false, because this model treats +# that coverage as Medicaid. +# Values before 2022 extrapolate from the January 1, 2022 KFF and Georgetown CCF +# 50-state survey, the earliest state-level source. Later changes come from state +# plan amendments, bulletins and testimony, and current values match the CMS list +# updated April 2, 2026. +AK: + 2022-01-01: false +AL: + 2022-01-01: false +AR: + 2022-01-01: false +AZ: + 2022-01-01: false +CA: + 2022-01-01: false +CO: + 2022-01-01: true +CT: + 2022-01-01: false +DC: + 2022-01-01: false +DE: + 2022-01-01: false +FL: + 2022-01-01: false +GA: + 2022-01-01: false +HI: + 2022-01-01: false +IA: + 2022-01-01: false +ID: + 2022-01-01: false +IL: + 2022-01-01: false +IN: + 2022-01-01: false +KS: + 2022-01-01: false +# Same date as the Kentucky Medicaid election for pregnant individuals. +KY: + 2022-01-01: false + 2023-01-01: true +LA: + 2022-01-01: false +MA: + 2022-01-01: false +MD: + 2022-01-01: false +ME: + 2022-01-01: false +MI: + 2022-01-01: false +MN: + 2022-01-01: false +MO: + 2022-01-01: false +MS: + 2022-01-01: false +MT: + 2022-01-01: false +NC: + 2022-01-01: false +ND: + 2022-01-01: false +NE: + 2022-01-01: false +NH: + 2022-01-01: false +NJ: + 2022-01-01: true +NM: + 2022-01-01: false +NV: + 2022-01-01: false +NY: + 2022-01-01: false +OH: + 2022-01-01: false +OK: + 2022-01-01: false +OR: + 2022-01-01: false +PA: + 2022-01-01: false +# CHIP SPA RI-22-0025, effective October 1, 2022. +RI: + 2022-01-01: false + 2022-10-01: true +SC: + 2022-01-01: false +SD: + 2022-01-01: false +TN: + 2022-01-01: false +TX: + 2022-01-01: false +UT: + 2022-01-01: false +VA: + 2022-01-01: true +VT: + 2022-01-01: false +WA: + 2022-01-01: false +WI: + 2022-01-01: false +WV: + 2022-01-01: true +WY: + 2022-01-01: false + +metadata: + unit: bool + period: year + label: CHIP lawfully residing pregnant individuals option election + breakdown: + - state_code + reference: + - title: 42 U.S.C. 1397gg(e)(1)(Q) + href: https://www.law.cornell.edu/uscode/text/42/1397gg#e_1_Q + - title: "CMS SHO #10-006, Medicaid and CHIP Coverage of Lawfully Residing Children and Pregnant Women" + href: https://downloads.cms.gov/cmsgov/archived-downloads/smdl/downloads/sho10006.pdf#page=2 + - title: CMS, Medicaid and CHIP Coverage of Lawfully Residing Children and Pregnant Individuals (updated April 2, 2026) + href: https://www.medicaid.gov/medicaid/enrollment-strategies/medicaid-and-chip-coverage-lawfully-residing-children-pregnant-individuals + - title: KFF and Georgetown CCF, Medicaid and CHIP Eligibility and Enrollment Policies as of January 2022, Table 3 + href: https://files.kff.org/attachment/Table-3-Medicaid-and-CHIP-Eligibility-and-Enrollment-Policies-as-of-January-2022.pdf#page=1 + - title: KFF and Georgetown CCF, Medicaid and CHIP Eligibility, Enrollment, and Renewal Policies as of January 2023, Table 3 and footnote 7 + href: https://files.kff.org/attachment/Table-3-Medicaid-and-CHIP-Eligibility-Enrollment-and-Renewal-Policies-as-States-Prepare-for-the-Unwinding-of-the-Pandemic-Era-Continuous-Enrollment-Provision.pdf#page=2 + - title: CMS, Rhode Island CHIP State Plan Amendment RI-22-0025, approval letter + href: https://www.medicaid.gov/sites/default/files/2023-04/RI-22-0025.pdf#page=2 diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/bar_exempt_immigration_statuses.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/bar_exempt_immigration_statuses.yaml index 8fc29656f43..14a5d9e0048 100644 --- a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/bar_exempt_immigration_statuses.yaml +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/bar_exempt_immigration_statuses.yaml @@ -1,4 +1,4 @@ -description: The United States exempts these Medicaid-qualified immigration statuses from the federal five-year bar. +description: The United States excludes these immigration statuses from the five-year bar under the Medicaid program and the Children's Health Insurance Program. # PolicyEngine does not currently distinguish humanitarian parolee subgroups # from the general PAROLED_ONE_YEAR qualified-alien category, so parolees are @@ -14,7 +14,9 @@ values: metadata: unit: list period: year - label: Medicaid five-year bar exempt immigration statuses + label: Medicaid and CHIP five-year bar exempt immigration statuses reference: - title: 8 USC 1613(b)(1) - Exceptions to five-year limited eligibility href: https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title8-section1613&num=0&edition=prelim + - title: "CMS SHO #26-001, Interaction between Section 71109 of the WFTC Legislation and PRWORA" + href: https://www.medicaid.gov/federal-policy-guidance/downloads/sho26001.pdf#page=6 diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/eligible_immigration_statuses.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/eligible_immigration_statuses.yaml index 2dd903e2aca..2ce3185e863 100644 --- a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/eligible_immigration_statuses.yaml +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/eligible_immigration_statuses.yaml @@ -1,4 +1,4 @@ -description: The United States limits Medicaid eligibility to these immigration statuses. +description: The United States limits eligibility to these immigration statuses under the Medicaid program and the Children's Health Insurance Program. values: 2018-01-01: - CITIZEN @@ -17,7 +17,7 @@ values: metadata: - label: Medicaid eligible immigration statuses + label: Medicaid and CHIP eligible immigration statuses period: year unit: list reference: @@ -27,3 +27,7 @@ metadata: href: https://www.law.cornell.edu/uscode/text/8/1641 - title: Health Provisions in the 2025 Federal Budget Reconciliation Bill | KFF href: https://www.kff.org/tracking-the-medicaid-provisions-in-the-2025-budget-bill/ + - title: 42 U.S.C. 1397gg(e)(1)(R) - Application of the Medicaid alien eligibility limit to CHIP + href: https://www.law.cornell.edu/uscode/text/42/1397gg#e_1_R + - title: "CMS SHO #26-001, Background, footnote 3, and Overview of Section 71109 of the WFTC Legislation" + href: https://www.medicaid.gov/federal-policy-guidance/downloads/sho26001.pdf#page=3 diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/five_year_bar_years.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/five_year_bar_years.yaml index 100b9bbcc65..b052c0af59e 100644 --- a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/five_year_bar_years.yaml +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/five_year_bar_years.yaml @@ -1,4 +1,4 @@ -description: The United States bars qualified aliens from federal Medicaid eligibility for this many years after obtaining qualified status, unless an exception applies. +description: The United States sets the qualified alien waiting period to this many years under the Medicaid program and the Children's Health Insurance Program. values: 1996-08-22: 5 @@ -6,7 +6,11 @@ values: metadata: unit: year period: year - label: Medicaid five-year bar duration + label: Medicaid and CHIP five-year bar duration reference: - title: 8 USC 1613(a) - Five-year limited eligibility href: https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title8-section1613&num=0&edition=prelim + - title: "CMS SHO #26-001, Background, footnote 3" + href: https://www.medicaid.gov/federal-policy-guidance/downloads/sho26001.pdf#page=3 + - title: "CMS SHO #26-001, Interaction between Section 71109 of the WFTC Legislation and PRWORA" + href: https://www.medicaid.gov/federal-policy-guidance/downloads/sho26001.pdf#page=6 diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/lawfully_residing/child.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/lawfully_residing/child.yaml new file mode 100644 index 00000000000..d633402aa0b --- /dev/null +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/lawfully_residing/child.yaml @@ -0,0 +1,133 @@ +description: States provide the lawfully residing children option under the Medicaid program if this is true. +# Values before 2022 extrapolate from the January 1, 2022 KFF and Georgetown CCF +# 50-state survey, the earliest state-level source. Later changes come from state +# plan amendments, bulletins and testimony, and current values match the CMS list +# updated April 2, 2026. +AK: + 2022-01-01: false +AL: + 2022-01-01: false +AR: + 2022-01-01: true +AZ: + 2022-01-01: false +CA: + 2022-01-01: true +CO: + 2022-01-01: true +CT: + 2022-01-01: true +DC: + 2022-01-01: true +DE: + 2022-01-01: true +FL: + 2022-01-01: true +# SPA GA-23-0002, effective January 1, 2024. +GA: + 2022-01-01: false + 2024-01-01: true +HI: + 2022-01-01: true +IA: + 2022-01-01: true +ID: + 2022-01-01: false +IL: + 2022-01-01: true +IN: + 2022-01-01: false +KS: + 2022-01-01: false +KY: + 2022-01-01: true +LA: + 2022-01-01: true +MA: + 2022-01-01: true +MD: + 2022-01-01: true +ME: + 2022-01-01: true +# MDHHS Bulletin MMP 24-20, effective August 1, 2024. +MI: + 2022-01-01: false + 2024-08-01: true +MN: + 2022-01-01: true +MO: + 2022-01-01: false +MS: + 2022-01-01: false +MT: + 2022-01-01: true +NC: + 2022-01-01: true +ND: + 2022-01-01: false +NE: + 2022-01-01: true +# SPA NH-24-0003, effective January 1, 2024. +NH: + 2022-01-01: false + 2024-01-01: true +NJ: + 2022-01-01: true +NM: + 2022-01-01: true +NV: + 2022-01-01: true +NY: + 2022-01-01: true +OH: + 2022-01-01: true +OK: + 2022-01-01: false +OR: + 2022-01-01: true +PA: + 2022-01-01: true +RI: + 2022-01-01: true +SC: + 2022-01-01: true +SD: + 2022-01-01: false +TN: + 2022-01-01: false +TX: + 2022-01-01: true +UT: + 2022-01-01: true +VA: + 2022-01-01: true +VT: + 2022-01-01: true +WA: + 2022-01-01: true +WI: + 2022-01-01: true +WV: + 2022-01-01: true +WY: + 2022-01-01: false + +metadata: + unit: bool + period: year + label: Medicaid lawfully residing children option election + breakdown: + - state_code + reference: + - title: 42 U.S.C. 1396b(v)(4)(A) + href: https://www.law.cornell.edu/uscode/text/42/1396b#v_4_A + - title: CMS, Medicaid and CHIP Coverage of Lawfully Residing Children and Pregnant Individuals (updated April 2, 2026) + href: https://www.medicaid.gov/medicaid/enrollment-strategies/medicaid-and-chip-coverage-lawfully-residing-children-pregnant-individuals + - title: CMS, Georgia State Plan Amendment GA-23-0002 + href: https://www.medicaid.gov/medicaid-spa/2023-11-22/156086 + - title: CMS, New Hampshire State Plan Amendment NH-24-0003, approval letter + href: https://www.medicaid.gov/medicaid/spa/downloads/NH-24-0003.pdf#page=2 + - title: Michigan Department of Health and Human Services Bulletin MMP 24-20 + href: https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Assistance-Programs/Medicaid-BPHASA/2023-Bulletins/Final-Bulletin-MMP-24-20-Eligibility.pdf?rev=dbb27d49587c40f6bb87c2669287edf6&hash=8F47918C2161E23831CC56F0BF4A3AD0#page=1 + - title: KFF and Georgetown CCF, Medicaid and CHIP Eligibility and Enrollment Policies as of January 2022, Table 3 + href: https://files.kff.org/attachment/Table-3-Medicaid-and-CHIP-Eligibility-and-Enrollment-Policies-as-of-January-2022.pdf#page=1 diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/lawfully_residing/child_age_limit.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/lawfully_residing/child_age_limit.yaml new file mode 100644 index 00000000000..17d3462f743 --- /dev/null +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/lawfully_residing/child_age_limit.yaml @@ -0,0 +1,125 @@ +description: States limit the lawfully residing children option to individuals younger than this age under the Medicaid program. +# The statute covers individuals under 21, and states may elect a lower age. The +# CMS list marks the states that cover children up to age 19. States that have not +# elected the option carry the statutory 21, which the election parameter keeps +# from applying. No source shows a state changing its age limit. +AK: + 2022-01-01: 21 +AL: + 2022-01-01: 21 +AR: + 2022-01-01: 19 +AZ: + 2022-01-01: 21 +CA: + 2022-01-01: 21 +CO: + 2022-01-01: 19 +CT: + 2022-01-01: 21 +DC: + 2022-01-01: 21 +DE: + 2022-01-01: 21 +FL: + 2022-01-01: 19 +GA: + 2022-01-01: 19 +HI: + 2022-01-01: 19 +IA: + 2022-01-01: 21 +ID: + 2022-01-01: 21 +IL: + 2022-01-01: 19 +IN: + 2022-01-01: 21 +KS: + 2022-01-01: 21 +KY: + 2022-01-01: 19 +LA: + 2022-01-01: 19 +MA: + 2022-01-01: 21 +MD: + 2022-01-01: 21 +ME: + 2022-01-01: 21 +MI: + 2022-01-01: 21 +MN: + 2022-01-01: 21 +MO: + 2022-01-01: 21 +MS: + 2022-01-01: 21 +MT: + 2022-01-01: 19 +NC: + 2022-01-01: 19 +ND: + 2022-01-01: 21 +NE: + 2022-01-01: 19 +NH: + 2022-01-01: 19 +NJ: + 2022-01-01: 21 +NM: + 2022-01-01: 21 +NV: + 2022-01-01: 19 +NY: + 2022-01-01: 21 +OH: + 2022-01-01: 21 +OK: + 2022-01-01: 21 +OR: + 2022-01-01: 19 +PA: + 2022-01-01: 21 +RI: + 2022-01-01: 19 +SC: + 2022-01-01: 21 +SD: + 2022-01-01: 21 +TN: + 2022-01-01: 21 +TX: + 2022-01-01: 19 +UT: + 2022-01-01: 19 +VA: + 2022-01-01: 19 +VT: + 2022-01-01: 21 +WA: + 2022-01-01: 21 +WI: + 2022-01-01: 19 +WV: + 2022-01-01: 19 +WY: + 2022-01-01: 21 + +metadata: + unit: year + period: year + label: Medicaid lawfully residing children option age limit + breakdown: + - state_code + reference: + - title: 42 U.S.C. 1396b(v)(4)(A) + href: https://www.law.cornell.edu/uscode/text/42/1396b#v_4_A + - title: CMS, Medicaid and CHIP Coverage of Lawfully Residing Children and Pregnant Individuals (updated April 2, 2026) + href: https://www.medicaid.gov/medicaid/enrollment-strategies/medicaid-and-chip-coverage-lawfully-residing-children-pregnant-individuals + - title: CMS, New Hampshire State Plan Amendment NH-24-0003, Citizenship and Non-Citizen Eligibility, section C.1 + href: https://www.medicaid.gov/medicaid/spa/downloads/NH-24-0003.pdf#page=9 + - title: CMS, Georgia State Plan Amendment GA-23-0002 + href: https://www.medicaid.gov/medicaid-spa/2023-11-22/156086 + - title: Michigan Department of Health and Human Services Bulletin MMP 24-20 + href: https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Assistance-Programs/Medicaid-BPHASA/2023-Bulletins/Final-Bulletin-MMP-24-20-Eligibility.pdf?rev=dbb27d49587c40f6bb87c2669287edf6&hash=8F47918C2161E23831CC56F0BF4A3AD0#page=1 diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/lawfully_residing/immigration_statuses.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/lawfully_residing/immigration_statuses.yaml new file mode 100644 index 00000000000..74a4dd58b50 --- /dev/null +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/lawfully_residing/immigration_statuses.yaml @@ -0,0 +1,33 @@ +description: The United States limits the lawfully residing children and pregnant individuals option to these immigration statuses under the Medicaid program and the Children's Health Insurance Program. +# CMS treats qualified aliens and other lawfully present noncitizens, including +# Temporary Protected Status holders, as lawfully residing, and excludes Deferred +# Action for Childhood Arrivals recipients. Section 71109 of Public Law 119-21 +# leaves this option unchanged. +values: + 2009-04-01: + - LEGAL_PERMANENT_RESIDENT + - REFUGEE + - ASYLEE + - DEPORTATION_WITHHELD + - CUBAN_HAITIAN_ENTRANT + - CONDITIONAL_ENTRANT + - PAROLED_ONE_YEAR + - TPS + +metadata: + unit: list + period: year + label: Medicaid and CHIP lawfully residing option immigration statuses + reference: + - title: 42 U.S.C. 1396b(v)(4)(A) + href: https://www.law.cornell.edu/uscode/text/42/1396b#v_4_A + - title: Public Law 111-3, section 3(a) + href: https://www.govinfo.gov/content/pkg/PLAW-111publ3/pdf/PLAW-111publ3.pdf#page=4 + - title: Public Law 111-3, section 214(a) + href: https://www.govinfo.gov/content/pkg/PLAW-111publ3/pdf/PLAW-111publ3.pdf#page=50 + - title: "CMS SHO #10-006, definition of lawfully present" + href: https://downloads.cms.gov/cmsgov/archived-downloads/smdl/downloads/sho10006.pdf#page=3 + - title: "CMS SHO #12-002, Individuals with Deferred Action for Childhood Arrivals" + href: https://www.medicaid.gov/federal-policy-guidance/downloads/SHO-12-002.pdf#page=1 + - title: "CMS SHO #26-001, Considerations for Applicants and Current Beneficiaries who are Not FFP-Eligible Noncitizens, footnote 44" + href: https://www.medicaid.gov/federal-policy-guidance/downloads/sho26001.pdf#page=10 diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/lawfully_residing/pregnant.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/lawfully_residing/pregnant.yaml new file mode 100644 index 00000000000..5934987b286 --- /dev/null +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/lawfully_residing/pregnant.yaml @@ -0,0 +1,153 @@ +description: States provide the lawfully residing pregnant individuals option under the Medicaid program if this is true. +# Values before 2022 extrapolate from the January 1, 2022 KFF and Georgetown CCF +# 50-state survey, the earliest state-level source. Later changes come from state +# plan amendments, bulletins and testimony, and current values match the CMS list +# updated April 2, 2026. +AK: + 2022-01-01: false +AL: + 2022-01-01: false +AR: + 2022-01-01: true +AZ: + 2022-01-01: false +CA: + 2022-01-01: true +CO: + 2022-01-01: true +CT: + 2022-01-01: true +DC: + 2022-01-01: true +DE: + 2022-01-01: true +FL: + 2022-01-01: false +# SPA GA-23-0002, effective January 1, 2024. +GA: + 2022-01-01: false + 2024-01-01: true +HI: + 2022-01-01: true +IA: + 2022-01-01: false +ID: + 2022-01-01: false +IL: + 2022-01-01: false +IN: + 2022-01-01: false +KS: + 2022-01-01: false +# Kentucky elected the option for pregnant individuals during 2022 (KFF January +# 2023 survey, footnote 7); the exact date is not published, so the first +# survey date that shows the election, January 1, 2023, is used. +KY: + 2022-01-01: false + 2023-01-01: true +LA: + 2022-01-01: false +MA: + 2022-01-01: true +MD: + 2022-01-01: true +ME: + 2022-01-01: true +# MDHHS Bulletin MMP 24-20, effective August 1, 2024. +MI: + 2022-01-01: false + 2024-08-01: true +MN: + 2022-01-01: true +MO: + 2022-01-01: false +MS: + 2022-01-01: false +MT: + 2022-01-01: false +NC: + 2022-01-01: true +# North Dakota implemented 2023 Senate Bill 2181 on October 1, 2023. +ND: + 2022-01-01: false + 2023-10-01: true +NE: + 2022-01-01: true +# SPA NH-24-0003, effective January 1, 2024. +NH: + 2022-01-01: false + 2024-01-01: true +NJ: + 2022-01-01: true +NM: + 2022-01-01: true +# SPA NV-22-0026, effective January 1, 2023. +NV: + 2022-01-01: false + 2023-01-01: true +NY: + 2022-01-01: true +OH: + 2022-01-01: true +OK: + 2022-01-01: false +OR: + 2022-01-01: false +PA: + 2022-01-01: true +# SPA RI-22-0024, effective October 1, 2022. +RI: + 2022-01-01: false + 2022-10-01: true +SC: + 2022-01-01: true +SD: + 2022-01-01: false +TN: + 2022-01-01: false +TX: + 2022-01-01: false +UT: + 2022-01-01: false +VA: + 2022-01-01: true +VT: + 2022-01-01: true +WA: + 2022-01-01: true +WI: + 2022-01-01: true +WV: + 2022-01-01: true +WY: + 2022-01-01: true + +metadata: + unit: bool + period: year + label: Medicaid lawfully residing pregnant individuals option election + breakdown: + - state_code + reference: + - title: 42 U.S.C. 1396b(v)(4)(A) + href: https://www.law.cornell.edu/uscode/text/42/1396b#v_4_A + - title: CMS, Medicaid and CHIP Coverage of Lawfully Residing Children and Pregnant Individuals (updated April 2, 2026) + href: https://www.medicaid.gov/medicaid/enrollment-strategies/medicaid-and-chip-coverage-lawfully-residing-children-pregnant-individuals + - title: CMS, Rhode Island State Plan Amendment RI-22-0024, Submission Summary, SPA ID and Effective Date + href: https://www.medicaid.gov/medicaid/spa/downloads/RI-22-0024.pdf#page=4 + - title: CMS, Rhode Island State Plan Amendment RI-22-0024, Citizenship and Non-Citizen Eligibility, section C + href: https://www.medicaid.gov/medicaid/spa/downloads/RI-22-0024.pdf#page=11 + - title: CMS, Nevada State Plan Amendment NV-22-0026, approval letter + href: https://www.medicaid.gov/sites/default/files/2023-03/NV-22-0026.pdf#page=2 + - title: North Dakota Department of Health and Human Services, testimony on House Bill 1067 (2025) + href: https://ndlegis.gov/assembly/69-2025/testimony/HHUMSER-1067-20250114-28935-F-FREMMING_KRISTA.pdf#page=2 + - title: CMS, Georgia State Plan Amendment GA-23-0002 + href: https://www.medicaid.gov/medicaid-spa/2023-11-22/156086 + - title: CMS, New Hampshire State Plan Amendment NH-24-0003, approval letter + href: https://www.medicaid.gov/medicaid/spa/downloads/NH-24-0003.pdf#page=2 + - title: Michigan Department of Health and Human Services Bulletin MMP 24-20 + href: https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Assistance-Programs/Medicaid-BPHASA/2023-Bulletins/Final-Bulletin-MMP-24-20-Eligibility.pdf?rev=dbb27d49587c40f6bb87c2669287edf6&hash=8F47918C2161E23831CC56F0BF4A3AD0#page=1 + - title: KFF and Georgetown CCF, Medicaid and CHIP Eligibility and Enrollment Policies as of January 2022, Table 3 + href: https://files.kff.org/attachment/Table-3-Medicaid-and-CHIP-Eligibility-and-Enrollment-Policies-as-of-January-2022.pdf#page=1 + - title: KFF and Georgetown CCF, Medicaid and CHIP Eligibility, Enrollment, and Renewal Policies as of January 2023, Table 3 and footnote 7 + href: https://files.kff.org/attachment/Table-3-Medicaid-and-CHIP-Eligibility-Enrollment-and-Renewal-Policies-as-States-Prepare-for-the-Unwinding-of-the-Pandemic-Era-Continuous-Enrollment-Provision.pdf#page=2 diff --git a/policyengine_us/tests/policy/baseline/gov/hhs/chip/is_chip_eligible_child.yaml b/policyengine_us/tests/policy/baseline/gov/hhs/chip/is_chip_eligible_child.yaml index a0bb2b1ba7d..3ba25f46563 100644 --- a/policyengine_us/tests/policy/baseline/gov/hhs/chip/is_chip_eligible_child.yaml +++ b/policyengine_us/tests/policy/baseline/gov/hhs/chip/is_chip_eligible_child.yaml @@ -309,3 +309,109 @@ chip_enrolled: false per_capita_chip: 0 chip: 0 + +# Separate CHIP applies the five-year bar and the qualified-alien limit (8 USC +# 1611(a) and 1613) unless the state elected the lawfully residing option in both +# CHIP and Medicaid (42 USC 1397gg(e)(1)(Q)). Arizona did not elect it; Texas did. +- name: Case 17, recent permanent resident child in Arizona fails CHIP inside the five-year bar and qualifies after it. + period: 2025 + input: + people: + person1: + age: 10 + immigration_status: LEGAL_PERMANENT_RESIDENT + years_since_us_entry: 2 + medicaid_income_level: 2.0 + person2: + age: 10 + immigration_status: LEGAL_PERMANENT_RESIDENT + years_since_us_entry: 5 + medicaid_income_level: 2.0 + households: + household1: + members: [person1] + state_code: AZ + household2: + members: [person2] + state_code: AZ + output: + is_medicaid_eligible: [false, false] + is_chip_eligible_child: [false, true] + +- name: Case 18, temporary protected status child qualifies for CHIP in Texas but not in Arizona. + period: 2025 + input: + people: + person1: + age: 10 + immigration_status: TPS + medicaid_income_level: 2.0 + person2: + age: 10 + immigration_status: TPS + medicaid_income_level: 2.0 + households: + household1: + members: [person1] + state_code: AZ + household2: + members: [person2] + state_code: TX + output: + is_medicaid_eligible: [false, false] + is_chip_eligible_child: [false, true] + +- name: Case 19, refugee child in Arizona qualifies for CHIP before section 71109 applies. + period: 2025 + input: + age: 10 + immigration_status: REFUGEE + medicaid_income_level: 2.0 + state_code: AZ + output: + is_chip_eligible_child: true + +# H.R.1 section 71109 applies the October 1, 2026 status limits to CHIP +# (42 USC 1397gg(e)(1)(R)), read from 2027 in annual simulations. +- name: Case 20, after section 71109 a refugee child keeps CHIP only in a state that elected the option. + period: 2027 + input: + people: + person1: + age: 10 + immigration_status: REFUGEE + medicaid_income_level: 2.0 + person2: + age: 10 + immigration_status: REFUGEE + medicaid_income_level: 2.0 + households: + household1: + members: [person1] + state_code: AZ + household2: + members: [person2] + state_code: TX + output: + is_medicaid_eligible: [false, false] + is_chip_eligible_child: [false, true] + +- name: Case 21, Georgia CHIP election for lawfully residing children applies from 2024. + period: 2024 + input: + age: 10 + immigration_status: TPS + medicaid_income_level: 2.0 + state_code: GA + output: + is_chip_eligible_child: true + +- name: Case 22, Georgia CHIP election for lawfully residing children does not apply in 2023. + period: 2023 + input: + age: 10 + immigration_status: TPS + medicaid_income_level: 2.0 + state_code: GA + output: + is_chip_eligible_child: false diff --git a/policyengine_us/tests/policy/baseline/gov/hhs/chip/is_chip_eligible_standard_pregnant_person.yaml b/policyengine_us/tests/policy/baseline/gov/hhs/chip/is_chip_eligible_standard_pregnant_person.yaml index d699e45a3a0..2dbfb5117dc 100644 --- a/policyengine_us/tests/policy/baseline/gov/hhs/chip/is_chip_eligible_standard_pregnant_person.yaml +++ b/policyengine_us/tests/policy/baseline/gov/hhs/chip/is_chip_eligible_standard_pregnant_person.yaml @@ -154,3 +154,37 @@ state_code: CO output: is_chip_eligible_standard_pregnant_person: [false, false, true, true, true] + +# Colorado elected the lawfully residing option for pregnant individuals in both +# Medicaid and CHIP; Missouri did not. Income of 230% FPL is above both states' +# Medicaid pregnancy limits (200% and 201%) and below their CHIP limits. +- name: Case 8, recent permanent resident pregnant applicant qualifies for standard CHIP in Colorado but not Missouri, where FCEP still applies. + period: 2025 + input: + people: + person1: + age: 30 + is_pregnant: true + immigration_status: LEGAL_PERMANENT_RESIDENT + years_since_us_entry: 2 + medicaid_income_level: 2.3 + person2: + age: 30 + is_pregnant: true + immigration_status: LEGAL_PERMANENT_RESIDENT + years_since_us_entry: 2 + medicaid_income_level: 2.3 + households: + household1: + members: [person1] + state_code: CO + household2: + members: [person2] + state_code: MO + output: + is_medicaid_eligible: [false, false] + is_chip_eligible_standard_pregnant_person: [true, false] + # FCEP covers the unborn child, so it has no immigration test; both states + # offer it (Colorado since October 30, 2023). + is_chip_fcep_eligible_person: [true, true] + is_chip_eligible_pregnant: [true, true] diff --git a/policyengine_us/tests/policy/baseline/gov/hhs/chip/is_chip_immigration_status_eligible.yaml b/policyengine_us/tests/policy/baseline/gov/hhs/chip/is_chip_immigration_status_eligible.yaml new file mode 100644 index 00000000000..6e40e7c0515 --- /dev/null +++ b/policyengine_us/tests/policy/baseline/gov/hhs/chip/is_chip_immigration_status_eligible.yaml @@ -0,0 +1,301 @@ +# Separate CHIP covers citizens and qualified aliens who are exempt from or past +# the five-year bar (8 USC 1611(a) and 1613). The lawfully residing option +# reaches CHIP only where the state elected it in both CHIP and Medicaid +# (42 USC 1397gg(e)(1)(Q)). Arizona elected neither; Texas elected it for +# children; Colorado elected it for children and pregnant individuals. +- name: Case 1, citizen is eligible in a state without the option. + period: 2025 + input: + state_code: AZ + immigration_status: CITIZEN + age: 10 + output: + is_chip_immigration_status_eligible: true + +- name: Case 2, Arizona permanent resident child becomes eligible when the five-year bar ends. + period: 2025 + input: + people: + person1: + age: 10 + immigration_status: LEGAL_PERMANENT_RESIDENT + years_since_us_entry: 4 + person2: + age: 10 + immigration_status: LEGAL_PERMANENT_RESIDENT + years_since_us_entry: 5 + households: + household1: + members: [person1] + state_code: AZ + household2: + members: [person2] + state_code: AZ + output: + is_chip_immigration_status_eligible: [false, true] + +- name: Case 3, Texas option covers recent permanent resident children under 19 only. + period: 2025 + input: + people: + person1: + age: 18 + immigration_status: LEGAL_PERMANENT_RESIDENT + years_since_us_entry: 2 + person2: + age: 19 + immigration_status: LEGAL_PERMANENT_RESIDENT + years_since_us_entry: 2 + households: + household1: + members: [person1] + state_code: TX + household2: + members: [person2] + state_code: TX + output: + is_chip_immigration_status_eligible: [true, false] + +- name: Case 4, pregnancy option applies in Colorado but not Texas. + period: 2025 + input: + people: + person1: + age: 30 + is_pregnant: true + immigration_status: LEGAL_PERMANENT_RESIDENT + years_since_us_entry: 2 + person2: + age: 30 + is_pregnant: true + immigration_status: LEGAL_PERMANENT_RESIDENT + years_since_us_entry: 2 + households: + household1: + members: [person1] + state_code: CO + household2: + members: [person2] + state_code: TX + output: + is_chip_immigration_status_eligible: [true, false] + +- name: Case 5, DACA and undocumented children are excluded even where the state elected the option. + period: 2025 + input: + people: + person1: + age: 10 + immigration_status: DACA + person2: + age: 10 + immigration_status: UNDOCUMENTED + person3: + age: 10 + immigration_status: TPS + households: + household1: + members: [person1] + state_code: TX + household2: + members: [person2] + state_code: TX + household3: + members: [person3] + state_code: TX + output: + is_chip_immigration_status_eligible: [false, false, true] + +- name: Case 6, refugee child in Arizona remains bar-exempt in 2026 annual simulations. + period: 2026 + input: + state_code: AZ + immigration_status: REFUGEE + age: 10 + output: + is_chip_immigration_status_eligible: true + +# Section 71109 limits federal CHIP funding to citizens, permanent residents and +# Cuban and Haitian entrants from October 1, 2026, except under the option. +- name: Case 7, after section 71109 only permanent residents, Cuban and Haitian entrants and option groups remain eligible. + period: 2027 + input: + people: + person1: + age: 10 + immigration_status: REFUGEE + person2: + age: 10 + immigration_status: REFUGEE + person3: + age: 10 + immigration_status: CUBAN_HAITIAN_ENTRANT + person4: + age: 10 + immigration_status: LEGAL_PERMANENT_RESIDENT + households: + household1: + members: [person1] + state_code: AZ + household2: + members: [person2] + state_code: TX + household3: + members: [person3] + state_code: AZ + household4: + members: [person4] + state_code: AZ + output: + is_chip_immigration_status_eligible: [false, true, true, true] + +- name: Case 8, CHIP elections before they apply in Georgia, Kentucky and Rhode Island. + period: 2022 + input: + people: + person1: + age: 10 + is_pregnant: false + immigration_status: TPS + person2: + age: 30 + is_pregnant: true + immigration_status: TPS + person3: + age: 30 + is_pregnant: true + immigration_status: TPS + households: + household1: + members: [person1] + state_code: GA + household2: + members: [person2] + state_code: KY + household3: + members: [person3] + state_code: RI + output: + is_chip_immigration_status_eligible: [false, false, false] + +# Rhode Island's Medicaid and CHIP pregnancy elections took effect on October 1, +# 2022 (SPAs RI-22-0024 and RI-22-0025), so they first apply in 2023. +- name: Case 9, Kentucky and Rhode Island CHIP pregnancy elections apply in 2023. + period: 2023 + input: + people: + person1: + age: 30 + is_pregnant: true + immigration_status: TPS + person2: + age: 30 + is_pregnant: true + immigration_status: TPS + person3: + age: 30 + is_pregnant: true + immigration_status: LEGAL_PERMANENT_RESIDENT + years_since_us_entry: 2 + households: + household1: + members: [person1] + state_code: KY + household2: + members: [person2] + state_code: RI + household3: + members: [person3] + state_code: RI + output: + is_chip_immigration_status_eligible: [true, true, true] + +- name: Case 10, Georgia children and Rhode Island pregnancy CHIP elections apply in 2024. + period: 2024 + input: + people: + person1: + age: 10 + is_pregnant: false + immigration_status: TPS + person2: + age: 30 + is_pregnant: true + immigration_status: TPS + households: + household1: + members: [person1] + state_code: GA + household2: + members: [person2] + state_code: RI + output: + is_chip_immigration_status_eligible: [true, true] + +# Illinois covered lawfully residing children in its separate CHIP until that +# program ended for children on July 1, 2022; CMS now lists them under +# Medicaid-expansion CHIP. +- name: Case 11, Illinois separate CHIP election applies in 2022 annual simulations. + period: 2022 + input: + state_code: IL + immigration_status: TPS + age: 10 + output: + is_chip_immigration_status_eligible: true + +- name: Case 12, Illinois separate CHIP election no longer applies in 2023. + period: 2023 + input: + state_code: IL + immigration_status: TPS + age: 10 + output: + is_chip_immigration_status_eligible: false + +- name: Case 13, CHIP option requires the matching Medicaid election. + period: 2025 + input: + gov.hhs.medicaid.eligibility.lawfully_residing.child.TX: false + state_code: TX + immigration_status: TPS + age: 10 + output: + is_chip_immigration_status_eligible: false + +# From October 1, 2026, 42 USC 1397gg(e)(1)(R) applies the 1396b(v)(5) limit to +# CHIP, which ends federal CHIP funding for asylees, people granted withholding +# of deportation, parolees and conditional entrants outside the option (SHO +# #26-001 Appendix A). Arizona elected neither option, and the default five years +# since entry clears the bar, so only the status limit applies. +- name: Case 14, after section 71109 asylees, withheld deportations, parolees and conditional entrants lose CHIP in Arizona. + period: 2027 + input: + people: + person1: + age: 10 + immigration_status: ASYLEE + person2: + age: 10 + immigration_status: DEPORTATION_WITHHELD + person3: + age: 10 + immigration_status: PAROLED_ONE_YEAR + person4: + age: 10 + immigration_status: CONDITIONAL_ENTRANT + households: + household1: + members: [person1] + state_code: AZ + household2: + members: [person2] + state_code: AZ + household3: + members: [person3] + state_code: AZ + household4: + members: [person4] + state_code: AZ + output: + is_chip_immigration_status_eligible: [false, false, false, false] diff --git a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/is_medicaid_immigration_status_eligible.yaml b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/is_medicaid_immigration_status_eligible.yaml index a29c8c2aa0f..f1e11a9f544 100644 --- a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/is_medicaid_immigration_status_eligible.yaml +++ b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/is_medicaid_immigration_status_eligible.yaml @@ -107,3 +107,43 @@ is_ca_medicaid_immigration_status_eligible: false output: is_medicaid_immigration_status_eligible: false + +# 42 USC 1396b(v)(4): states that elected the lawfully residing option cover +# children and pregnant individuals inside the five-year bar. +- name: Case 15, recent permanent resident child in California is eligible through the lawfully residing option. + period: 2025 + input: + immigration_status: LEGAL_PERMANENT_RESIDENT + years_since_us_entry: 2 + age: 10 + state_code: CA + output: + is_medicaid_immigration_status_eligible: true + +- name: Case 16, recent permanent resident child in Alabama stays barred because Alabama did not elect the option. + period: 2025 + input: + immigration_status: LEGAL_PERMANENT_RESIDENT + years_since_us_entry: 2 + age: 10 + state_code: AL + output: + is_medicaid_immigration_status_eligible: false + +- name: Case 17, temporary protected status child in Texas is eligible through the lawfully residing option. + period: 2025 + input: + immigration_status: TPS + age: 10 + state_code: TX + output: + is_medicaid_immigration_status_eligible: true + +- name: Case 18, temporary protected status adult in Texas is not eligible. + period: 2025 + input: + immigration_status: TPS + age: 30 + state_code: TX + output: + is_medicaid_immigration_status_eligible: false diff --git a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/is_medicaid_lawfully_residing_option_eligible.yaml b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/is_medicaid_lawfully_residing_option_eligible.yaml new file mode 100644 index 00000000000..e3d822f3895 --- /dev/null +++ b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/is_medicaid_lawfully_residing_option_eligible.yaml @@ -0,0 +1,497 @@ +# 42 USC 1396b(v)(4)(A): states may cover lawfully residing children (California +# under 21, Texas under 19) and pregnant individuals without the five-year bar. +# State elections follow the CMS list updated April 2, 2026. +- name: Case 1, recent permanent resident child in California qualifies through the option. + period: 2025 + input: + state_code: CA + immigration_status: LEGAL_PERMANENT_RESIDENT + age: 10 + years_since_us_entry: 2 + output: + is_medicaid_lawfully_residing_option_eligible: true + +- name: Case 2, child age limits are 21 in California and 19 in Texas. + period: 2025 + input: + people: + person1: + age: 20 + immigration_status: LEGAL_PERMANENT_RESIDENT + years_since_us_entry: 2 + person2: + age: 20 + immigration_status: LEGAL_PERMANENT_RESIDENT + years_since_us_entry: 2 + person3: + age: 18 + immigration_status: LEGAL_PERMANENT_RESIDENT + years_since_us_entry: 2 + households: + household1: + members: [person1] + state_code: CA + household2: + members: [person2] + state_code: TX + household3: + members: [person3] + state_code: TX + output: + is_medicaid_lawfully_residing_option_eligible: [true, false, true] + +- name: Case 3, Wyoming elected the option only for pregnant individuals and Texas only for children. + period: 2025 + input: + people: + person1: + age: 30 + is_pregnant: true + immigration_status: LEGAL_PERMANENT_RESIDENT + years_since_us_entry: 2 + person2: + age: 30 + is_pregnant: true + immigration_status: LEGAL_PERMANENT_RESIDENT + years_since_us_entry: 2 + person3: + age: 10 + is_pregnant: false + immigration_status: LEGAL_PERMANENT_RESIDENT + years_since_us_entry: 2 + households: + household1: + members: [person1] + state_code: TX + household2: + members: [person2] + state_code: WY + household3: + members: [person3] + state_code: WY + output: + is_medicaid_lawfully_residing_option_eligible: [false, true, false] + +- name: Case 4, Alabama has not elected the option. + period: 2025 + input: + state_code: AL + immigration_status: LEGAL_PERMANENT_RESIDENT + age: 10 + years_since_us_entry: 2 + output: + is_medicaid_lawfully_residing_option_eligible: false + +- name: Case 5, option covers temporary protected status but not DACA recipients or undocumented immigrants. + period: 2025 + input: + people: + person1: + age: 10 + immigration_status: TPS + person2: + age: 10 + immigration_status: DACA + person3: + age: 10 + immigration_status: UNDOCUMENTED + households: + household1: + members: [person1] + state_code: NY + household2: + members: [person2] + state_code: NY + household3: + members: [person3] + state_code: FL + output: + is_medicaid_lawfully_residing_option_eligible: [true, false, false] + +- name: Case 6, adult who is not pregnant is outside the option, and past-bar children qualify either way. + period: 2025 + input: + people: + person1: + age: 40 + is_pregnant: false + immigration_status: LEGAL_PERMANENT_RESIDENT + years_since_us_entry: 2 + person2: + age: 10 + is_pregnant: false + immigration_status: LEGAL_PERMANENT_RESIDENT + years_since_us_entry: 5 + households: + household1: + members: [person1] + state_code: CA + household2: + members: [person2] + state_code: CA + output: + is_medicaid_lawfully_residing_option_eligible: [false, true] + is_medicaid_immigration_status_eligible: [false, true] + +# The pregnancy category runs through the state's Medicaid postpartum period. +# New Jersey and Illinois both extend it to 365 days (12 months). +- name: Case 7, postpartum coverage at 90 days follows New Jersey's 12-month extension. + period: 2025 + input: + state_code: NJ + immigration_status: LEGAL_PERMANENT_RESIDENT + age: 30 + years_since_us_entry: 2 + is_pregnant: false + count_days_postpartum: 90 + output: + is_medicaid_lawfully_residing_option_eligible: true + +- name: Case 8, postpartum coverage at 90 days needs the pregnancy election, which Illinois has not made. + period: 2025 + input: + state_code: IL + immigration_status: LEGAL_PERMANENT_RESIDENT + age: 30 + years_since_us_entry: 2 + is_pregnant: false + count_days_postpartum: 90 + output: + is_medicaid_lawfully_residing_option_eligible: false + +# This pins the model's postpartum day limit (count_days_postpartum < +# postpartum_coverage). 42 USC 1396a(e)(16)(A) runs coverage through the last +# day of the month in which the 12-month period ends, so day 365 is usually +# still covered in law. +- name: Case 9, New Jersey postpartum coverage holds at 364 days and stops at the model's 365-day postpartum limit. + period: 2025 + input: + people: + person1: + age: 30 + is_pregnant: false + count_days_postpartum: 364 + immigration_status: LEGAL_PERMANENT_RESIDENT + years_since_us_entry: 2 + person2: + age: 30 + is_pregnant: false + count_days_postpartum: 365 + immigration_status: LEGAL_PERMANENT_RESIDENT + years_since_us_entry: 2 + households: + household1: + members: [person1] + state_code: NJ + household2: + members: [person2] + state_code: NJ + output: + is_medicaid_lawfully_residing_option_eligible: [true, false] + +# MDHHS Bulletin MMP 24-20 starts Michigan's election on August 1, 2024, so +# annual 2024 values still read the pre-election rule. +- name: Case 10, Michigan child election applies from 2025 in annual simulations. + period: 2024 + input: + state_code: MI + immigration_status: LEGAL_PERMANENT_RESIDENT + age: 10 + years_since_us_entry: 2 + output: + is_medicaid_lawfully_residing_option_eligible: false + +- name: Case 11, Michigan child election applies in 2025. + period: 2025 + input: + state_code: MI + immigration_status: LEGAL_PERMANENT_RESIDENT + age: 10 + years_since_us_entry: 2 + output: + is_medicaid_lawfully_residing_option_eligible: true + +- name: Case 12, Georgia and New Hampshire elections do not apply in 2023. + period: 2023 + input: + people: + person1: + age: 10 + is_pregnant: false + immigration_status: LEGAL_PERMANENT_RESIDENT + years_since_us_entry: 2 + person2: + age: 30 + is_pregnant: true + immigration_status: LEGAL_PERMANENT_RESIDENT + years_since_us_entry: 2 + person3: + age: 10 + is_pregnant: false + immigration_status: LEGAL_PERMANENT_RESIDENT + years_since_us_entry: 2 + households: + household1: + members: [person1] + state_code: GA + household2: + members: [person2] + state_code: GA + household3: + members: [person3] + state_code: NH + output: + is_medicaid_lawfully_residing_option_eligible: [false, false, false] + +- name: Case 13, Georgia and New Hampshire elections apply from January 1, 2024. + period: 2024 + input: + people: + person1: + age: 10 + is_pregnant: false + immigration_status: LEGAL_PERMANENT_RESIDENT + years_since_us_entry: 2 + person2: + age: 30 + is_pregnant: true + immigration_status: LEGAL_PERMANENT_RESIDENT + years_since_us_entry: 2 + person3: + age: 10 + is_pregnant: false + immigration_status: LEGAL_PERMANENT_RESIDENT + years_since_us_entry: 2 + households: + household1: + members: [person1] + state_code: GA + household2: + members: [person2] + state_code: GA + household3: + members: [person3] + state_code: NH + output: + is_medicaid_lawfully_residing_option_eligible: [true, true, true] + +# North Dakota began covering lawfully residing pregnant individuals on +# October 1, 2023; Nevada and Kentucky did so from January 1, 2023. +- name: Case 14, pregnancy elections in North Dakota, Nevada and Kentucky before they apply. + period: 2022 + input: + people: + person1: + age: 30 + is_pregnant: true + immigration_status: LEGAL_PERMANENT_RESIDENT + years_since_us_entry: 2 + person2: + age: 30 + is_pregnant: true + immigration_status: LEGAL_PERMANENT_RESIDENT + years_since_us_entry: 2 + person3: + age: 30 + is_pregnant: true + immigration_status: LEGAL_PERMANENT_RESIDENT + years_since_us_entry: 2 + households: + household1: + members: [person1] + state_code: ND + household2: + members: [person2] + state_code: NV + household3: + members: [person3] + state_code: KY + output: + is_medicaid_lawfully_residing_option_eligible: [false, false, false] + +- name: Case 15, North Dakota pregnancy election still off in 2023 while Nevada and Kentucky apply. + period: 2023 + input: + people: + person1: + age: 30 + is_pregnant: true + immigration_status: LEGAL_PERMANENT_RESIDENT + years_since_us_entry: 2 + person2: + age: 30 + is_pregnant: true + immigration_status: LEGAL_PERMANENT_RESIDENT + years_since_us_entry: 2 + person3: + age: 30 + is_pregnant: true + immigration_status: LEGAL_PERMANENT_RESIDENT + years_since_us_entry: 2 + households: + household1: + members: [person1] + state_code: ND + household2: + members: [person2] + state_code: NV + household3: + members: [person3] + state_code: KY + output: + is_medicaid_lawfully_residing_option_eligible: [false, true, true] + +- name: Case 16, North Dakota pregnancy election applies in 2024 but not to children. + period: 2024 + input: + people: + person1: + age: 30 + is_pregnant: true + immigration_status: LEGAL_PERMANENT_RESIDENT + years_since_us_entry: 2 + person2: + age: 10 + is_pregnant: false + immigration_status: LEGAL_PERMANENT_RESIDENT + years_since_us_entry: 2 + households: + household1: + members: [person1] + state_code: ND + household2: + members: [person2] + state_code: ND + output: + is_medicaid_lawfully_residing_option_eligible: [true, false] + +# H.R.1 section 71109 drops refugees from federal Medicaid funding from +# October 1, 2026 (read from 2027 in annual simulations) but leaves the option. +- name: Case 17, after section 71109 refugee children keep Medicaid only in electing states. + period: 2027 + input: + people: + person1: + age: 10 + is_pregnant: false + immigration_status: REFUGEE + person2: + age: 40 + is_pregnant: false + immigration_status: REFUGEE + person3: + age: 10 + is_pregnant: false + immigration_status: REFUGEE + person4: + age: 30 + is_pregnant: true + immigration_status: REFUGEE + households: + household1: + members: [person1] + state_code: NY + household2: + members: [person2] + state_code: NY + household3: + members: [person3] + state_code: AL + household4: + members: [person4] + state_code: FL + output: + is_medicaid_lawfully_residing_option_eligible: [true, false, false, false] + is_medicaid_immigration_status_eligible: [true, false, false, false] + +- name: Case 18, refugees are bar-exempt qualified aliens before section 71109 applies. + period: 2026 + input: + people: + person1: + age: 40 + immigration_status: REFUGEE + person2: + age: 10 + immigration_status: REFUGEE + households: + household1: + members: [person1] + state_code: NY + household2: + members: [person2] + state_code: AL + output: + is_medicaid_lawfully_residing_option_eligible: [false, false] + is_medicaid_immigration_status_eligible: [true, true] + +- name: Case 19, child election stops at the state age limit. + period: 2025 + input: + people: + person1: + age: 21 + immigration_status: LEGAL_PERMANENT_RESIDENT + years_since_us_entry: 2 + person2: + age: 19 + immigration_status: LEGAL_PERMANENT_RESIDENT + years_since_us_entry: 2 + households: + household1: + members: [person1] + state_code: CA + household2: + members: [person2] + state_code: TX + output: + is_medicaid_lawfully_residing_option_eligible: [false, false] + +- name: Case 20, Rhode Island pregnancy election still applies in 2024. + period: 2024 + input: + state_code: RI + immigration_status: TPS + age: 30 + is_pregnant: true + output: + is_medicaid_lawfully_residing_option_eligible: true + +# Rhode Island's pregnancy election took effect on October 1, 2022 (SPA +# RI-22-0024). Income of 150% FPL is below its Medicaid pregnancy limit (195%). +- name: Case 21, Rhode Island pregnancy election covers a TPS holder and a recent permanent resident in 2023. + period: 2023 + input: + people: + person1: + age: 30 + is_pregnant: true + immigration_status: TPS + medicaid_income_level: 1.5 + person2: + age: 30 + is_pregnant: true + immigration_status: LEGAL_PERMANENT_RESIDENT + years_since_us_entry: 2 + medicaid_income_level: 1.5 + households: + household1: + members: [person1] + state_code: RI + household2: + members: [person2] + state_code: RI + output: + is_medicaid_lawfully_residing_option_eligible: [true, true] + is_medicaid_immigration_status_eligible: [true, true] + is_medicaid_eligible: [true, true] + +- name: Case 22, Rhode Island pregnancy election does not apply in 2022 annual simulations. + period: 2022 + input: + state_code: RI + immigration_status: TPS + age: 30 + is_pregnant: true + output: + is_medicaid_lawfully_residing_option_eligible: false diff --git a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/emergency_medicaid/integration.yaml b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/emergency_medicaid/integration.yaml index 8f4c2c5f1bf..ff5b2bcada5 100644 --- a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/emergency_medicaid/integration.yaml +++ b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/emergency_medicaid/integration.yaml @@ -666,3 +666,78 @@ # However, disabled people may qualify under senior_or_disabled category # Need to check if disabled person qualifies for Emergency Medicaid is_emergency_medicaid_eligible: [true] + +# ============================================================ +# LAWFULLY RESIDING CHILDREN OPTION (42 USC 1396b(v)(4)) +# ============================================================ + +- name: Case 21, recent permanent resident child in Texas gets regular Medicaid while the parent gets emergency Medicaid. + period: 2025 + input: + people: + person1: + age: 35 + employment_income: 3_000 + immigration_status: LEGAL_PERMANENT_RESIDENT + years_since_us_entry: 2 + has_emergency_medical_condition: true + person2: + age: 8 + immigration_status: LEGAL_PERMANENT_RESIDENT + years_since_us_entry: 2 + has_emergency_medical_condition: true + tax_units: + tax_unit: + members: [person1, person2] + spm_units: + spm_unit: + members: [person1, person2] + households: + household: + members: [person1, person2] + state_code: TX + output: + # Income of $3,000 is below Texas's 19% FPL parent limit and its 138% FPL + # older-child limit, so both people have a Medicaid category. + medicaid_category: [PARENT, OLDER_CHILD] + # Texas elected the option for children under 19, but not for adults, so + # only the child is immigration-eligible inside the five-year bar. + is_medicaid_lawfully_residing_option_eligible: [false, true] + is_medicaid_immigration_status_eligible: [false, true] + is_medicaid_eligible: [false, true] + # The parent meets every Medicaid rule except immigration status. + is_emergency_medicaid_eligible: [true, false] + +- name: Case 22, recent permanent resident child in Texas gets regular Medicaid while the parent has no Medicaid category. + period: 2025 + input: + people: + person1: + age: 35 + employment_income: 20_000 + immigration_status: LEGAL_PERMANENT_RESIDENT + years_since_us_entry: 2 + has_emergency_medical_condition: true + person2: + age: 8 + immigration_status: LEGAL_PERMANENT_RESIDENT + years_since_us_entry: 2 + has_emergency_medical_condition: true + tax_units: + tax_unit: + members: [person1, person2] + spm_units: + spm_unit: + members: [person1, person2] + households: + household: + members: [person1, person2] + state_code: TX + output: + # Income of $20,000 is above the 19% FPL parent limit, and Texas did not + # expand Medicaid to adults, but it is below the 138% FPL older-child limit. + medicaid_category: [NONE, OLDER_CHILD] + is_medicaid_immigration_status_eligible: [false, true] + is_medicaid_eligible: [false, true] + # Emergency Medicaid needs a Medicaid category, so the parent has none. + is_emergency_medicaid_eligible: [false, false] diff --git a/policyengine_us/tests/policy/baseline/gov/states/ca/dhcs/cchip/ca_cchip_eligible.yaml b/policyengine_us/tests/policy/baseline/gov/states/ca/dhcs/cchip/ca_cchip_eligible.yaml index 320cbc01fbe..d9f4245c57a 100644 --- a/policyengine_us/tests/policy/baseline/gov/states/ca/dhcs/cchip/ca_cchip_eligible.yaml +++ b/policyengine_us/tests/policy/baseline/gov/states/ca/dhcs/cchip/ca_cchip_eligible.yaml @@ -360,3 +360,17 @@ medicaid_income_level: [3, 3, 3] is_medicaid_eligible: [false, false, false] ca_cchip_eligible: [false, false, true] + +- name: Case 20, recent permanent resident child inside the five-year bar is eligible through California's lawfully residing election. + period: 2025 + input: + age: 8 + state_code: CA + county_str: SANTA_CLARA_COUNTY_CA + immigration_status: LEGAL_PERMANENT_RESIDENT + years_since_us_entry: 2 + is_medicaid_eligible: false + medicaid_income_level: 3 + output: + is_chip_immigration_status_eligible: true + ca_cchip_eligible: true diff --git a/policyengine_us/tests/policy/baseline/gov/states/ms/dom/hmw/eligibility/ms_hmw_other_coverage_ineligible.yaml b/policyengine_us/tests/policy/baseline/gov/states/ms/dom/hmw/eligibility/ms_hmw_other_coverage_ineligible.yaml index 2998f6b4241..f0dcdbe7908 100644 --- a/policyengine_us/tests/policy/baseline/gov/states/ms/dom/hmw/eligibility/ms_hmw_other_coverage_ineligible.yaml +++ b/policyengine_us/tests/policy/baseline/gov/states/ms/dom/hmw/eligibility/ms_hmw_other_coverage_ineligible.yaml @@ -59,8 +59,8 @@ # CMS SHO #12-002 excludes DACA from CHIP, so a DACA child is not # potentially CHIP-eligible and passes the other-coverage check. Each case -# also asserts is_chip_eligible_child so the mirrored immigration gate here -# cannot drift from the federal CHIP formula unnoticed. +# also asserts is_chip_eligible_child, because this check shares +# is_chip_immigration_status_eligible with the federal CHIP formula. # https://www.medicaid.gov/federal-policy-guidance/downloads/sho-12-002.pdf - name: Case 4, DACA child otherwise within CHIP limits is not CHIP eligible and passes. period: 2026 @@ -133,3 +133,31 @@ output: is_chip_eligible_child: true ms_hmw_other_coverage_ineligible: false + +# Mississippi made no lawfully residing election, so the five-year bar +# (8 USC 1613) keeps a recent LPR child out of separate CHIP. +- name: Case 7, LPR child two years after entry within CHIP limits is not CHIP eligible and passes. + period: 2026 + input: + state_code: MS + age: 10 + immigration_status: LEGAL_PERMANENT_RESIDENT + years_since_us_entry: 2 + medicaid_income_level: 1 + has_esi: false + is_medicaid_eligible: false + is_ssi_recipient_for_medicaid: false + is_infant_for_medicaid: false + is_young_child_for_medicaid: false + is_older_child_for_medicaid: false + is_pregnant_for_medicaid: false + is_parent_for_medicaid: false + is_young_adult_for_medicaid: false + is_adult_for_medicaid: false + is_optional_senior_or_disabled_for_medicaid: false + is_medically_needy_for_medicaid: false + is_working_disabled_buy_in_for_medicaid: false + output: + is_chip_immigration_status_eligible: false + is_chip_eligible_child: false + ms_hmw_other_coverage_ineligible: true diff --git a/policyengine_us/tests/policy/baseline/gov/states/ms/dom/hmw/integration.yaml b/policyengine_us/tests/policy/baseline/gov/states/ms/dom/hmw/integration.yaml index 936f453f4d9..f7fb8b4e1fc 100644 --- a/policyengine_us/tests/policy/baseline/gov/states/ms/dom/hmw/integration.yaml +++ b/policyengine_us/tests/policy/baseline/gov/states/ms/dom/hmw/integration.yaml @@ -92,3 +92,28 @@ output: ms_hmw_eligible: false ms_hmw_other_coverage_ineligible: false + +# Mississippi made no lawfully residing election under 42 USC 1396b(v)(4) or +# 1397gg(e)(1)(Q), so an LPR child two years after entry is in the five-year +# bar (8 USC 1613) for both Medicaid and separate CHIP. She is not otherwise +# eligible for Medicaid or CHIP, so she meets the HMW category. Her status +# still bars full Medicaid, leaving emergency Medicaid under 42 USC 1396b(v)(2). +- name: Case 8, blind LPR child in the five-year bar fails CHIP and falls to HMW for emergency Medicaid. + period: 2025 + input: + age: 10 + state_code: MS + is_blind: true + immigration_status: LEGAL_PERMANENT_RESIDENT + years_since_us_entry: 2 + social_security_survivors: 17_000 + medicaid_income_level: 1.8 + has_emergency_medical_condition: true + output: + is_chip_immigration_status_eligible: false + is_chip_eligible_child: false + ms_hmw_other_coverage_ineligible: true + ms_hmw_eligible: true + medicaid_category: HEALTHIER_MISSISSIPPI_WAIVER + is_medicaid_eligible: false + is_emergency_medicaid_eligible: true diff --git a/policyengine_us/variables/gov/hhs/chip/is_chip_eligible_child.py b/policyengine_us/variables/gov/hhs/chip/is_chip_eligible_child.py index 3a0da9aa60f..d54926968b9 100644 --- a/policyengine_us/variables/gov/hhs/chip/is_chip_eligible_child.py +++ b/policyengine_us/variables/gov/hhs/chip/is_chip_eligible_child.py @@ -38,10 +38,7 @@ def formula(person, period, parameters): state_has_chip = income_limit > 0 # Check immigration status eligibility - istatus = person("immigration_status", period) - undocumented = istatus == istatus.possible_values.UNDOCUMENTED - daca = istatus == istatus.possible_values.DACA - immigration_eligible = ~(undocumented | daca) + immigration_eligible = person("is_chip_immigration_status_eligible", period) # Check income eligibility # CHIP is for children who make too much for Medicaid but below CHIP limits diff --git a/policyengine_us/variables/gov/hhs/chip/is_chip_eligible_standard_pregnant_person.py b/policyengine_us/variables/gov/hhs/chip/is_chip_eligible_standard_pregnant_person.py index a59e4463c52..35bb1bd16ee 100644 --- a/policyengine_us/variables/gov/hhs/chip/is_chip_eligible_standard_pregnant_person.py +++ b/policyengine_us/variables/gov/hhs/chip/is_chip_eligible_standard_pregnant_person.py @@ -34,10 +34,7 @@ def formula(person, period, parameters): state_has_pregnant_chip = income_limit > 0 # Check immigration status eligibility - istatus = person("immigration_status", period) - undocumented = istatus == istatus.possible_values.UNDOCUMENTED - daca = istatus == istatus.possible_values.DACA - immigration_eligible = ~(undocumented | daca) + immigration_eligible = person("is_chip_immigration_status_eligible", period) # Check income eligibility # CHIP is for pregnant women who make too much for Medicaid but below CHIP limits diff --git a/policyengine_us/variables/gov/hhs/chip/is_chip_immigration_status_eligible.py b/policyengine_us/variables/gov/hhs/chip/is_chip_immigration_status_eligible.py new file mode 100644 index 00000000000..171520c82db --- /dev/null +++ b/policyengine_us/variables/gov/hhs/chip/is_chip_immigration_status_eligible.py @@ -0,0 +1,58 @@ +from policyengine_us.model_api import * + + +class is_chip_immigration_status_eligible(Variable): + value_type = bool + entity = Person + label = "Eligible for CHIP due to immigration status" + definition_period = YEAR + # Separate CHIP covers citizens and qualified aliens who are exempt from or + # past the five-year bar (8 USC 1611(a) and 1613). From October 1, 2026, + # 42 USC 1397gg(e)(1)(R) applies the 1396b(v)(5) status limits to CHIP. + # Under 42 USC 1397gg(e)(1)(Q), states that elected the lawfully residing + # option for a group in both Medicaid and CHIP also cover that group. + reference = ( + "https://www.law.cornell.edu/uscode/text/8/1611#a", + "https://www.law.cornell.edu/uscode/text/8/1613", + "https://www.law.cornell.edu/uscode/text/42/1397gg#e_1_Q", + "https://www.law.cornell.edu/uscode/text/42/1397gg#e_1_R", + "https://downloads.cms.gov/cmsgov/archived-downloads/smdl/downloads/sho10006.pdf#page=2", + "https://www.medicaid.gov/federal-policy-guidance/downloads/SHO-12-002.pdf#page=1", + "https://www.medicaid.gov/federal-policy-guidance/downloads/sho26001.pdf#page=6", + ) + + def formula(person, period, parameters): + p = parameters(period).gov.hhs + medicaid = p.medicaid.eligibility + status = person("immigration_status", period) + status_str = status.decode_to_str() + citizen = status == status.possible_values.CITIZEN + # CHIP shares the Medicaid qualified-alien statuses (narrowed by section + # 71109 from October 2026) and the five-year bar (SHO #26-001). + qualified_status = np.isin(status_str, medicaid.eligible_immigration_statuses) + bar_exempt_status = np.isin( + status_str, medicaid.bar_exempt_immigration_statuses + ) + years_since_entry = person("years_since_us_entry", period) + past_five_year_bar = years_since_entry >= medicaid.five_year_bar_years + federally_eligible_status = citizen | ( + qualified_status & (bar_exempt_status | past_five_year_bar) + ) + # The lawfully residing option reaches CHIP only for a group the state + # elected in both CHIP and Medicaid. + medicaid_option = medicaid.lawfully_residing + chip_option = p.chip.lawfully_residing + lawfully_residing = np.isin(status_str, medicaid_option.immigration_statuses) + state = person.household("state_code_str", period) + age = person("age", period) + child = ( + chip_option.child[state].astype(bool) + & medicaid_option.child[state].astype(bool) + & (age < p.chip.child.max_age) + ) + pregnant = ( + chip_option.pregnant[state].astype(bool) + & medicaid_option.pregnant[state].astype(bool) + & person("is_pregnant", period) + ) + return federally_eligible_status | (lawfully_residing & (child | pregnant)) diff --git a/policyengine_us/variables/gov/hhs/medicaid/eligibility/is_medicaid_immigration_status_eligible.py b/policyengine_us/variables/gov/hhs/medicaid/eligibility/is_medicaid_immigration_status_eligible.py index 29def6328e5..737705a95de 100644 --- a/policyengine_us/variables/gov/hhs/medicaid/eligibility/is_medicaid_immigration_status_eligible.py +++ b/policyengine_us/variables/gov/hhs/medicaid/eligibility/is_medicaid_immigration_status_eligible.py @@ -6,12 +6,13 @@ class is_medicaid_immigration_status_eligible(Variable): entity = Person label = "Person is eligible for Medicaid due to immigration status" definition_period = YEAR - reference = [ + reference = ( "https://www.law.cornell.edu/uscode/text/42/1396b#v", + "https://www.law.cornell.edu/uscode/text/42/1396b#v_4_A", "https://www.law.cornell.edu/uscode/text/8/1641", "https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title8-section1613&num=0&edition=prelim", "https://www.kff.org/racial-equity-and-health-policy/fact-sheet/key-facts-on-health-coverage-of-immigrants/", - ] + ) def formula(person, period, parameters): p = parameters(period).gov.hhs.medicaid.eligibility @@ -30,6 +31,11 @@ def formula(person, period, parameters): federally_eligible_status = citizen | ( eligible_immigration_status & (bar_exempt_status | past_five_year_bar) ) + # 42 USC 1396b(v)(4) lets states cover lawfully residing children and + # pregnant individuals without the qualified-alien limit or five-year bar. + lawfully_residing_option_eligible = person( + "is_medicaid_lawfully_residing_option_eligible", period + ) # Special handling for undocumented immigrants in states that cover them undocumented = ( @@ -45,6 +51,7 @@ def formula(person, period, parameters): return ( federally_eligible_status + | lawfully_residing_option_eligible | undocumented_eligible | ca_eligible_regardless_of_immigration_status ) diff --git a/policyengine_us/variables/gov/hhs/medicaid/eligibility/is_medicaid_lawfully_residing_option_eligible.py b/policyengine_us/variables/gov/hhs/medicaid/eligibility/is_medicaid_lawfully_residing_option_eligible.py new file mode 100644 index 00000000000..0a06faabd39 --- /dev/null +++ b/policyengine_us/variables/gov/hhs/medicaid/eligibility/is_medicaid_lawfully_residing_option_eligible.py @@ -0,0 +1,33 @@ +from policyengine_us.model_api import * + + +class is_medicaid_lawfully_residing_option_eligible(Variable): + value_type = bool + entity = Person + label = "Eligible for Medicaid under the lawfully residing children and pregnant individuals option" + definition_period = YEAR + # 42 USC 1396b(v)(4)(A), added by CHIPRA section 214, lets a state cover + # lawfully residing children and pregnant individuals notwithstanding the + # qualified-alien limit and the five-year bar (8 USC 1611(a) and 1613). + # H.R.1 section 71109 leaves the option unchanged after October 1, 2026. + reference = ( + "https://www.law.cornell.edu/uscode/text/42/1396b#v_4_A", + "https://downloads.cms.gov/cmsgov/archived-downloads/smdl/downloads/sho10006.pdf#page=3", + "https://www.medicaid.gov/federal-policy-guidance/downloads/SHO-12-002.pdf#page=1", + "https://www.medicaid.gov/federal-policy-guidance/downloads/sho21007.pdf#page=17", + "https://www.medicaid.gov/federal-policy-guidance/downloads/sho26001.pdf#page=5", + ) + + def formula(person, period, parameters): + p = parameters(period).gov.hhs.medicaid.eligibility.lawfully_residing + status = person("immigration_status", period).decode_to_str() + lawfully_residing = np.isin(status, p.immigration_statuses) + state = person.household("state_code_str", period) + age = person("age", period) + child = p.child[state].astype(bool) & (age < p.child_age_limit[state]) + # The pregnancy category runs through the state's postpartum period, which + # includes the 12-month extension where the state elected it (SHO #21-007). + pregnant = p.pregnant[state].astype(bool) & person( + "is_pregnant_for_medicaid_nfc", period + ) + return lawfully_residing & (child | pregnant) diff --git a/policyengine_us/variables/gov/states/ca/dhcs/cchip/ca_cchip_eligible.py b/policyengine_us/variables/gov/states/ca/dhcs/cchip/ca_cchip_eligible.py index f92670c8081..2dec11a6665 100644 --- a/policyengine_us/variables/gov/states/ca/dhcs/cchip/ca_cchip_eligible.py +++ b/policyengine_us/variables/gov/states/ca/dhcs/cchip/ca_cchip_eligible.py @@ -33,14 +33,11 @@ def formula(person, period, parameters): # age 19", the federal CHIP definition of a child. age = person("age", period) age_eligible = age < parameters(period).gov.hhs.chip.child.max_age - istatus = person("immigration_status", period) - undocumented = istatus == istatus.possible_values.UNDOCUMENTED - # California elected the CHIPRA section 214 lawfully residing option for - # children (state plan section 4.1-LR). CMS SHO #12-002 excludes DACA - # from that option, and SHO #26-001 leaves the option intact under the - # October 2026 federal funding limits. - daca = istatus == istatus.possible_values.DACA - immigration_eligible = ~(undocumented | daca) + # WIC § 15853(a)(1) applies Title XXI immigration rules. California + # elected the CHIPRA section 214 lawfully residing option for children + # (state plan section 4.1-LR), which CMS SHO #12-002 closes to DACA + # recipients and SHO #26-001 leaves intact after October 2026. + immigration_eligible = person("is_chip_immigration_status_eligible", period) # WIC § 15853(a)(1)(A)-(B): the child must not qualify for the optional # targeted low-income children group or no-cost Medi-Cal. The Medi-Cal # exclusion is a complete floor: WIC § 14007.8 state-funded Medi-Cal diff --git a/policyengine_us/variables/gov/states/ms/dom/hmw/eligibility/ms_hmw_other_coverage_ineligible.py b/policyengine_us/variables/gov/states/ms/dom/hmw/eligibility/ms_hmw_other_coverage_ineligible.py index ae409956078..d3ed11098b5 100644 --- a/policyengine_us/variables/gov/states/ms/dom/hmw/eligibility/ms_hmw_other_coverage_ineligible.py +++ b/policyengine_us/variables/gov/states/ms/dom/hmw/eligibility/ms_hmw_other_coverage_ineligible.py @@ -30,11 +30,8 @@ def formula(person, period, parameters): age = person("age", period) p = parameters(period).gov.hhs.chip.child income_limit = p.income_limit[state_code] - istatus = person("immigration_status", period) - undocumented = istatus == istatus.possible_values.UNDOCUMENTED - daca = istatus == istatus.possible_values.DACA - # Mirror the immigration gate in is_chip_eligible_child. - immigration_eligible = ~(undocumented | daca) + # Share the CHIP immigration test with is_chip_eligible_child. + immigration_eligible = person("is_chip_immigration_status_eligible", period) potentially_chip_child_eligible = ( (age < p.max_age) & (income_limit > 0)