diff --git a/changelog.d/fix-chip-pregnant-income-limit-dates.fixed.md b/changelog.d/fix-chip-pregnant-income-limit-dates.fixed.md new file mode 100644 index 00000000000..894fa4a92db --- /dev/null +++ b/changelog.d/fix-chip-pregnant-income-limit-dates.fixed.md @@ -0,0 +1 @@ +Correct CHIP pregnancy income limit dates and values from state plan amendments: Kentucky starts July 1, 2022 at 218% FPL, West Virginia CHIP starts July 1, 2019, Colorado, New Jersey and Rhode Island include the 5 percentage point disregard throughout, Colorado's from-conception-to-end-of-pregnancy option starts January 1, 2025, and West Virginia's 190% Medicaid pregnancy limit starts July 1, 2019. diff --git a/policyengine_us/parameters/gov/hhs/chip/fcep/income_limit.yaml b/policyengine_us/parameters/gov/hhs/chip/fcep/income_limit.yaml index 8b7a0379c2f..25bdabd38ef 100644 --- a/policyengine_us/parameters/gov/hhs/chip/fcep/income_limit.yaml +++ b/policyengine_us/parameters/gov/hhs/chip/fcep/income_limit.yaml @@ -1,4 +1,4 @@ -description: State governments limit Children's Health Insurance Program from-conception-to-end-of-pregnancy eligibility to these incomes, as a share of the federal poverty line. A value of -inf indicates the state has not adopted the from-conception-to-end-of-pregnancy option. +description: State governments limit Children's Health Insurance Program from-conception-to-end-of-pregnancy eligibility to these incomes, as a share of the federal poverty line, including the five percentage point income disregard of 42 CFR 435.603(d)(4). A value of -inf indicates the state has not adopted the from-conception-to-end-of-pregnancy option. metadata: unit: /1 period: year @@ -6,12 +6,26 @@ metadata: breakdown: - state_code reference: + # KFF's January 2026 table adds the disregard only at each state's highest + # pregnancy level, so lower levels omit it (for example, West Virginia + # Medicaid 185% and Colorado CHIP 260%). 42 CFR 435.603(d)(4) applies the + # disregard in each Title. - title: Medicaid and CHIP Income Eligibility Limits for Pregnant Women as a Percent of the Federal Poverty Level | KFF State Health Facts href: https://www.kff.org/affordable-care-act/state-indicator/medicaid-and-chip-income-eligibility-limits-for-pregnant-women-as-a-percent-of-the-federal-poverty-level/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D - title: Medicaid, Children's Health Insurance Program, & Basic Health Program Eligibility Levels | CMS href: https://www.medicaid.gov/medicaid/national-medicaid-chip-program-information/medicaid-childrens-health-insurance-program-basic-health-program-eligibility-levels - title: MACStats Medicaid and CHIP Data Book, Exhibit 35 | MACPAC href: https://www.macpac.gov/publication/medicaid-and-chip-income-eligibility-levels-as-a-percentage-of-the-federal-poverty-level-for-children-and-pregnant-women-by-state/ + - title: 42 CFR 435.603(d)(4), five percentage point MAGI income disregard + href: https://www.law.cornell.edu/cfr/text/42/435.603#d_4 + - title: 42 CFR 457.315(a), MAGI financial methodologies apply to CHIP + href: https://www.law.cornell.edu/cfr/text/42/457.315#a + - title: Colorado CHIP State Plan Amendment CO-24-0041, state plan amendment history (Amendment 40) + href: https://www.medicaid.gov/CHIP/Downloads/CO-24-0041.pdf#page=3 + - title: "Colorado CHIP State Plan Amendment CO-25-0044, companion letter and section 3.1.1.1 #page 3,6" + href: https://www.medicaid.gov/CHIP/Downloads/CO-25-0044.pdf#page=3 + - title: Colorado CHIP State Plan Amendment CO-26-0047, superseding pages table (CO-24-0040-0002 CS9, Coverage From Conception to Birth, effective January 1, 2025) + href: https://www.medicaid.gov/CHIP/Downloads/CO-26-0047.pdf#page=5 AK: 2018-01-01: -.inf 2019-01-01: -.inf @@ -53,14 +67,17 @@ CA: 2023-01-01: 3.22 2024-01-01: 3.22 CO: + # FCEP authority is CO-24-0040-0002 (CS9), effective January 1, 2025, with no + # end date. The December 31, 2026 sunset in the CO-25-0044 approval covers only + # the section 5121 pre-release services. 2018-01-01: -.inf 2019-01-01: -.inf 2020-01-01: -.inf 2021-01-01: -.inf 2022-01-01: -.inf 2023-01-01: -.inf - 2023-10-30: 2.65 - 2024-01-01: 2.65 + 2024-01-01: -.inf + 2025-01-01: 2.65 CT: 2018-01-01: -.inf 2019-01-01: -.inf diff --git a/policyengine_us/parameters/gov/hhs/chip/pregnant/income_limit.yaml b/policyengine_us/parameters/gov/hhs/chip/pregnant/income_limit.yaml index 453874eb237..5ea4fd1bd86 100644 --- a/policyengine_us/parameters/gov/hhs/chip/pregnant/income_limit.yaml +++ b/policyengine_us/parameters/gov/hhs/chip/pregnant/income_limit.yaml @@ -1,16 +1,52 @@ -description: State governments limit standard Children's Health Insurance Program pregnancy eligibility to these incomes, as a share of the federal poverty line. A value of -inf indicates the state does not operate a standard separate CHIP program for pregnant people; these states cover pregnancy through Medicaid or through the from-conception-to-end-of-pregnancy option, reflected in the Medicaid pregnant and CHIP FCEP income limit parameters. +description: State governments limit standard Children's Health Insurance Program pregnancy eligibility to these incomes, as a share of the federal poverty line, including the five percentage point income disregard of 42 CFR 435.603(d)(4). A value of -inf indicates the state does not operate a standard separate CHIP program for pregnant people; these states cover pregnancy through Medicaid or through the from-conception-to-end-of-pregnancy option, reflected in the Medicaid pregnant and CHIP FCEP income limit parameters. metadata: unit: /1 label: CHIP pregnant income limit breakdown: - state_code reference: + # KFF's January 2026 table adds the disregard only at each state's highest + # pregnancy level, so lower levels omit it (for example, West Virginia + # Medicaid 185% and Colorado CHIP 260%). 42 CFR 435.603(d)(4) applies the + # disregard in each Title. - title: Medicaid and CHIP Income Eligibility Limits for Pregnant Women as a Percent of the Federal Poverty Level | KFF State Health Facts href: https://www.kff.org/affordable-care-act/state-indicator/medicaid-and-chip-income-eligibility-limits-for-pregnant-women-as-a-percent-of-the-federal-poverty-level/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D - title: Medicaid, Children's Health Insurance Program, & Basic Health Program Eligibility Levels as of December 2023 | CMS href: https://www.medicaid.gov/medicaid/national-medicaid-chip-program-information/medicaid-childrens-health-insurance-program-basic-health-program-eligibility-levels - title: Medicaid and CHIP Eligibility Levels href: https://data.medicaid.gov/dataset/d7e4cccb-1c56-5b5d-acce-5e7744c6d3b4 + - title: 42 CFR 435.603(d)(4), five percentage point MAGI income disregard + href: https://www.law.cornell.edu/cfr/text/42/435.603#d_4 + - title: 42 CFR 457.315(a), MAGI financial methodologies apply to CHIP + href: https://www.law.cornell.edu/cfr/text/42/457.315#a + - title: Medicaid and CHIP Eligibility, Enrollment, Renewal, and Cost Sharing Policies as of January 2018 | KFF, Table 4 + href: https://files.kff.org/attachment/Report-Medicaid-and-CHIP-Eligibility-Enrollment-Renewal-and-Cost-Sharing-Policies-as-of-January-2018#page=33 + - title: Medicaid and CHIP Eligibility and Enrollment Policies as of January 2022 | KFF, Table 2 + href: https://files.kff.org/attachment/REPORT-Medicaid-and-CHIP-Eligibility-and-Enrollment-Policies-as-of-January-2022.pdf#page=36 + - title: Colorado CHIP State Plan Amendment CO-13-0015, CS8 Targeted Low-Income Pregnant Women + href: https://www.medicaid.gov/CHIP/Downloads/CO/CO-13-0015-MC1.pdf#page=8 + - title: "10 CCR 2505-3 § 110.1.F and editor's notes #page 9,37" + href: https://www.coloradosos.gov/CCR/GenerateRulePdf.do?ruleVersionId=12687&fileName=10%20CCR%202505-3#page=9 + - title: 10 CCR 2505-3 § 110.1.F (version effective March 11, 2022, before the June 30, 2022 amendment) + href: https://www.coloradosos.gov/CCR/GenerateRulePdf.do?ruleVersionId=10074&fileName=10%20CCR%202505-3#page=5 + - title: Colorado Medical Services Board Notice of Proposed Rules, CHP 22-01-06-B (May 13, 2022 meeting) + href: https://www.coloradosos.gov/CCR/Upload/NoticeOfRulemaking/ProposedRuleAttach2022-00181.pdf + - title: "Kentucky CHIP State Plan Amendment KY-21-0001, approval letter and CS8 #page 2,4" + href: https://www.medicaid.gov/CHIP/Downloads/KY-21-0001.pdf#page=2 + - title: "907 KAR 4:030 § 2(1)(e)1 (version effective January 12, 2023) #page 1-3" + href: https://apps.legislature.ky.gov/law/kar/downloads/docs/13741/document.engrossed.pdf#page=1 + - title: New Jersey CHIP State Plan Amendment NJ-13-0018, CS8 Targeted Low-Income Pregnant Women + href: https://www.medicaid.gov/CHIP/Downloads/NJ/NJ-13-0018-MC1.pdf#page=8 + - title: New Jersey DMAHS Section 1115 Comprehensive Demonstration Amendment Request to CMS (February 27, 2020) + href: https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/nj-1115-request-pa.pdf#page=1 + - title: Rhode Island CHIP State Plan Amendment RI-13-023, CS8 Targeted Low-Income Pregnant Women + href: https://www.medicaid.gov/CHIP/Downloads/RI/RI-13-023-MC1.pdf#page=8 + - title: 210-RICR-30-00-1 § 1.5(B) (version effective June 7, 2018 to January 4, 2022) + href: https://risos-apa-production-public.s3.amazonaws.com/EOHHS/REG_9690_20180806185730.pdf#page=6 + - title: 210-RICR-30-00-1 § 1.6(B) (version effective August 17, 2025) + href: https://risos-apa-production-public.s3.amazonaws.com/EOHHS/REG_13314_20250728104245127.pdf#page=7 + - title: "West Virginia CHIP State Plan Amendment WV-19-0006, approval letter and CS8 #page 2,4" + href: https://www.medicaid.gov/CHIP/Downloads/WV/WV-19-0006.pdf#page=2 AK: 2018-01-01: -.inf AL: @@ -22,8 +58,12 @@ AZ: CA: 2018-01-01: -.inf CO: - 2018-01-01: 2.60 - 2023-10-30: 2.65 + # 260% FPL (CO-13-0015, effective 2014) plus the 5 percentage point MAGI + # disregard. Until the amendment effective June 30, 2022, 10 CCR 2505-3 + # § 110.1.F printed "greater than 185% but not exceeding 250%"; the amendment + # aligned the rule with the existing standard, so 2018 to mid-2022 also uses + # 2.65. + 2018-01-01: 2.65 CT: 2018-01-01: -.inf DC: @@ -48,8 +88,9 @@ KS: 2018-01-01: -.inf KY: 2018-01-01: -.inf - 2021-01-01: 2.13 - 2021-07-01: 2.18 + # Effective July 1, 2022 (KY-21-0001). YEAR-defined formulas read January 1, + # so this value first applies in 2023. + 2022-07-01: 2.18 LA: 2018-01-01: -.inf MA: @@ -77,8 +118,9 @@ NE: NH: 2018-01-01: -.inf NJ: - 2018-01-01: 2.00 - 2023-12-01: 2.05 + # NJ-13-0018 has applied since January 1, 2014; 2018-01-01 is this file's + # first date. + 2018-01-01: 2.05 NM: 2018-01-01: -.inf NV: @@ -94,8 +136,9 @@ OR: PA: 2018-01-01: -.inf RI: - 2018-01-01: 2.53 - 2023-12-01: 2.58 + # RI-13-023 has applied since January 1, 2014; 2018-01-01 is this file's + # first date. + 2018-01-01: 2.58 SC: 2018-01-01: -.inf SD: @@ -116,6 +159,8 @@ WI: 2018-01-01: -.inf WV: 2018-01-01: -.inf - 2021-01-01: 3.05 + # Effective July 1, 2019 (WV-19-0006). YEAR-defined formulas read January 1, + # so this value first applies in 2020. + 2019-07-01: 3.05 WY: 2018-01-01: -.inf diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/pregnant/income_limit.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/pregnant/income_limit.yaml index 9692fa78886..a416c7e4519 100644 --- a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/pregnant/income_limit.yaml +++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/pregnant/income_limit.yaml @@ -1,4 +1,4 @@ -description: Maximum family income for pregnant people to qualify for Medicaid. +description: State governments limit Medicaid pregnancy eligibility to these incomes, as a share of the federal poverty line, including the five percentage point income disregard of 42 CFR 435.603(d)(4). metadata: unit: /1 label: Medicaid pregnant income limit @@ -7,6 +7,10 @@ metadata: reference: - title: Medicaid and CHIP Eligibility and Enrollment Policies as of January 2022 | KFF href: https://files.kff.org/attachment/REPORT-Medicaid-and-CHIP-Eligibility-and-Enrollment-Policies-as-of-January-2022.pdf#page=36 + # KFF's January 2026 table adds the disregard only at each state's highest + # pregnancy level, so lower levels omit it (for example, West Virginia + # Medicaid 185% and Colorado CHIP 260%). 42 CFR 435.603(d)(4) applies the + # disregard in each Title. - title: Medicaid and CHIP Income Eligibility Limits for Pregnant Women as a Percent of the Federal Poverty Level | KFF State Health Facts href: https://www.kff.org/affordable-care-act/state-indicator/medicaid-and-chip-income-eligibility-limits-for-pregnant-women-as-a-percent-of-the-federal-poverty-level/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D - title: Medicaid and CHIP Eligibility, Enrollment, Renewal, and Cost Sharing Policies as of January 2018 @@ -15,10 +19,14 @@ metadata: href: https://data.medicaid.gov/dataset/d7e4cccb-1c56-5b5d-acce-5e7744c6d3b4 - title: Medicaid and CHIP Eligibility Levels | CMS Data.Medicaid.gov CSV download (April 1, 2018) href: https://download.medicaid.gov/data/medicaid-and-chip-eligibility-levels.xy8t-auhk.csv + - title: 42 CFR 435.603(d)(4), five percentage point MAGI income disregard + href: https://www.law.cornell.edu/cfr/text/42/435.603#d_4 - title: NV-25-0006, Medicaid State Plan Amendment href: https://www.medicaid.gov/medicaid-spa/2025-05-07/179381 - title: Nevada Medicaid Web Announcement 3748 (200% FPL pregnancy standard) href: https://medicaid.nv.gov/Downloads/provider/web_announcement_3748_20251020.pdf + - title: "West Virginia Medicaid State Plan Amendment WV-19-0004, approval letter and S14 Pregnant Women #page 3,14" + href: https://www.medicaid.gov/State-resource-center/Medicaid-State-Plan-Amendments/Downloads/WV/WV-19-0004.pdf#page=3 AK: 2018-01-01: 2.05 2024-02-01: 2.30 @@ -129,6 +137,8 @@ WI: 2018-01-01: 3.06 WV: 2018-01-01: 1.63 - 2021-01-01: 1.90 + # Effective July 1, 2019 (WV-19-0004). YEAR-defined formulas read January 1, + # so this value first applies in 2020. + 2019-07-01: 1.90 WY: 2018-01-01: 1.59 diff --git a/policyengine_us/tests/policy/baseline/gov/hhs/chip/is_chip_eligible_fcep.yaml b/policyengine_us/tests/policy/baseline/gov/hhs/chip/is_chip_eligible_fcep.yaml index 3374ad88144..c95fa2025c3 100644 --- a/policyengine_us/tests/policy/baseline/gov/hhs/chip/is_chip_eligible_fcep.yaml +++ b/policyengine_us/tests/policy/baseline/gov/hhs/chip/is_chip_eligible_fcep.yaml @@ -514,3 +514,86 @@ is_chip_eligible_standard_pregnant_person: [false, false, false, false, false] is_chip_fcep_eligible_person: [true, true, true, true, true] is_chip_eligible_pregnant: [true, true, true, true, true] + +# Colorado's FCEP population took effect January 1, 2025, up to 260% FPL +# (CO-24-0041 and CO-25-0044), plus the 5 percentage point MAGI disregard. +# The earlier 2023-10-30 date belonged to CO-24-0041 amendment 41, not to FCEP. +# The applicant is undocumented, so standard pregnancy CHIP does not apply and +# FCEP, which has no immigration test, is the only CHIP pathway. +- name: Case 18, Colorado FCEP does not cover an undocumented pregnant applicant in 2024. + period: 2024 + input: + people: + person1: + age: 30 + is_pregnant: true + immigration_status: UNDOCUMENTED + is_medicaid_eligible: false + medicaid_income_level: 2.3 + households: + household: + members: [person1] + state_code: CO + output: + is_chip_fcep_eligible_person: false + is_chip_eligible_pregnant: false + chip_category: NONE + is_chip_eligible: false + +- name: Case 19, Colorado FCEP covers an undocumented pregnant applicant in 2025. + period: 2025 + input: + people: + person1: + age: 30 + is_pregnant: true + immigration_status: UNDOCUMENTED + is_medicaid_eligible: false + medicaid_income_level: 2.3 + households: + household: + members: [person1] + state_code: CO + output: + is_chip_fcep_eligible_person: true + is_chip_eligible_pregnant: true + chip_category: PREGNANT_FCEP + is_chip_eligible: true + +# Colorado FCEP covers up to and including 260% FPL (CO-25-0044 section +# 3.1.1.1) plus the 5 percentage point disregard. 2026 household of 2: +# 21,640 x 2.65 / 12 = 4,778.83 -> $4,779, so 265% qualifies and 266% +# ($4,796.87) does not. +- name: Case 20, Colorado FCEP covers an undocumented pregnant applicant at 265% FPL in 2026. + period: 2026 + input: + people: + person1: + age: 30 + is_pregnant: true + immigration_status: UNDOCUMENTED + is_medicaid_eligible: false + medicaid_income_level: 2.65 + households: + household: + members: [person1] + state_code: CO + output: + is_chip_fcep_eligible_person: true + +- name: Case 21, Colorado FCEP excludes an undocumented pregnant applicant at 266% FPL in 2026. + period: 2026 + input: + people: + person1: + age: 30 + is_pregnant: true + immigration_status: UNDOCUMENTED + is_medicaid_eligible: false + medicaid_income_level: 2.66 + households: + household: + members: [person1] + state_code: CO + output: + is_chip_fcep_eligible_person: false 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 2dbfb5117dc..6b5851d0d88 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 @@ -185,6 +185,474 @@ 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). + # offer it (Colorado since January 1, 2025). is_chip_fcep_eligible_person: [true, true] is_chip_eligible_pregnant: [true, true] + +# The CHIP state plans have set these pregnancy bands since before 2018: +# Colorado 260% (CO-13-0015), New Jersey 200% (NJ-13-0018) and Rhode Island +# 253% (RI-13-023), each plus the 5 percentage point MAGI disregard. +# Kentucky's 213% band takes effect July 1, 2022 (KY-21-0001), and this +# YEAR-defined variable reads the January value, so Kentucky has no group in +# 2022. +- name: Case 9, pregnancy bands in Colorado, New Jersey and Rhode Island include the disregard, and Kentucky's July 2022 group does not apply in 2022 annual simulations. + period: 2022 + input: + people: + person1: + age: 30 + is_pregnant: true + immigration_status: CITIZEN + is_medicaid_eligible: false + medicaid_income_level: 2.63 + person2: + age: 30 + is_pregnant: true + immigration_status: CITIZEN + is_medicaid_eligible: false + medicaid_income_level: 2.03 + person3: + age: 30 + is_pregnant: true + immigration_status: CITIZEN + is_medicaid_eligible: false + medicaid_income_level: 2.55 + person4: + age: 30 + is_pregnant: true + immigration_status: CITIZEN + is_medicaid_eligible: false + medicaid_income_level: 2.1 + tax_units: + tax_unit1: + members: [person1] + tax_unit2: + members: [person2] + tax_unit3: + members: [person3] + tax_unit4: + members: [person4] + spm_units: + spm_unit1: + members: [person1] + spm_unit2: + members: [person2] + spm_unit3: + members: [person3] + spm_unit4: + members: [person4] + families: + family1: + members: [person1] + family2: + members: [person2] + family3: + members: [person3] + family4: + members: [person4] + marital_units: + marital_unit1: + members: [person1] + marital_unit2: + members: [person2] + marital_unit3: + members: [person3] + marital_unit4: + members: [person4] + households: + household1: + members: [person1] + state_code: CO + household2: + members: [person2] + state_code: NJ + household3: + members: [person3] + state_code: RI + household4: + members: [person4] + state_code: KY + output: + is_chip_eligible_standard_pregnant_person: [true, true, true, false] + +# 907 KAR 4:030 Section 2(1)(e)1 sets 213% plus a five percent cushion (218%). +# The limit is inclusive, so income exactly at 218% FPL qualifies. +- name: Case 10, Kentucky pregnancy group covers income up to and including 218% FPL in 2023. + period: 2023 + input: + people: + person1: + age: 30 + is_pregnant: true + immigration_status: CITIZEN + is_medicaid_eligible: false + medicaid_income_level: 2.1 + person2: + age: 30 + is_pregnant: true + immigration_status: CITIZEN + is_medicaid_eligible: false + medicaid_income_level: 2.25 + person3: + age: 30 + is_pregnant: true + immigration_status: CITIZEN + is_medicaid_eligible: false + medicaid_income_level: 2.18 + tax_units: + tax_unit1: + members: [person1] + tax_unit2: + members: [person2] + tax_unit3: + members: [person3] + spm_units: + spm_unit1: + members: [person1] + spm_unit2: + members: [person2] + spm_unit3: + members: [person3] + families: + family1: + members: [person1] + family2: + members: [person2] + family3: + members: [person3] + marital_units: + marital_unit1: + members: [person1] + marital_unit2: + members: [person2] + marital_unit3: + members: [person3] + households: + household1: + members: [person1] + state_code: KY + household2: + members: [person2] + state_code: KY + household3: + members: [person3] + state_code: KY + output: + is_chip_eligible_standard_pregnant_person: [true, false, true] + +# West Virginia's group starts July 1, 2019, so the 2019 annual value is still +# -inf. Colorado's 265% limit already applied in 2019. +- name: Case 11, West Virginia's July 2019 pregnancy group does not apply in 2019 annual simulations, and Colorado excludes income above 265% FPL. + period: 2019 + input: + people: + person1: + age: 30 + is_pregnant: true + immigration_status: CITIZEN + is_medicaid_eligible: false + medicaid_income_level: 2.5 + person2: + age: 30 + is_pregnant: true + immigration_status: CITIZEN + is_medicaid_eligible: false + medicaid_income_level: 2.66 + tax_units: + tax_unit1: + members: [person1] + tax_unit2: + members: [person2] + spm_units: + spm_unit1: + members: [person1] + spm_unit2: + members: [person2] + families: + family1: + members: [person1] + family2: + members: [person2] + marital_units: + marital_unit1: + members: [person1] + marital_unit2: + members: [person2] + households: + household1: + members: [person1] + state_code: WV + household2: + members: [person2] + state_code: CO + output: + is_chip_eligible_standard_pregnant_person: [false, false] + +# West Virginia's 300% band took effect July 1, 2019 (WV-19-0006), so 2020 is +# the first year the YEAR-defined variable reads it. +- name: Case 12, West Virginia pregnancy group applies in 2020. + period: 2020 + input: + people: + person1: + age: 30 + is_pregnant: true + immigration_status: CITIZEN + is_medicaid_eligible: false + medicaid_income_level: 2.5 + households: + household: + members: [person1] + state_code: WV + output: + is_chip_eligible_standard_pregnant_person: true + +# The limits are inclusive, so income exactly at 265% (Colorado), 205% (New +# Jersey) and 258% (Rhode Island) qualifies. +- name: Case 13, income exactly at the Colorado, New Jersey and Rhode Island pregnancy limits qualifies in 2022. + period: 2022 + input: + people: + person1: + age: 30 + is_pregnant: true + immigration_status: CITIZEN + is_medicaid_eligible: false + medicaid_income_level: 2.65 + person2: + age: 30 + is_pregnant: true + immigration_status: CITIZEN + is_medicaid_eligible: false + medicaid_income_level: 2.05 + person3: + age: 30 + is_pregnant: true + immigration_status: CITIZEN + is_medicaid_eligible: false + medicaid_income_level: 2.58 + tax_units: + tax_unit1: + members: [person1] + tax_unit2: + members: [person2] + tax_unit3: + members: [person3] + spm_units: + spm_unit1: + members: [person1] + spm_unit2: + members: [person2] + spm_unit3: + members: [person3] + families: + family1: + members: [person1] + family2: + members: [person2] + family3: + members: [person3] + marital_units: + marital_unit1: + members: [person1] + marital_unit2: + members: [person2] + marital_unit3: + members: [person3] + households: + household1: + members: [person1] + state_code: CO + household2: + members: [person2] + state_code: NJ + household3: + members: [person3] + state_code: RI + output: + is_chip_eligible_standard_pregnant_person: [true, true, true] + +# West Virginia's band is 300% FPL (WV-19-0006 CS8) plus the 5 percentage point +# disregard. 2026 household of 2 (FPG 21,640): 21,640 x 3.05 / 12 = 5,500.17 +# -> $5,501, so 305% qualifies and 306% ($5,518.20) does not. +- name: Case 14, West Virginia pregnancy group covers income at 305% FPL in 2026. + period: 2026 + input: + people: + person1: + age: 30 + is_pregnant: true + immigration_status: CITIZEN + is_medicaid_eligible: false + medicaid_income_level: 3.05 + households: + household: + members: [person1] + state_code: WV + output: + is_chip_eligible_standard_pregnant_person: true + +- name: Case 15, West Virginia pregnancy group excludes income at 306% FPL in 2026. + period: 2026 + input: + people: + person1: + age: 30 + is_pregnant: true + immigration_status: CITIZEN + is_medicaid_eligible: false + medicaid_income_level: 3.06 + households: + household: + members: [person1] + state_code: WV + output: + is_chip_eligible_standard_pregnant_person: false + +# 2026 household of 2: 21,640 x 2.05 / 12 = 3,696.83 -> $3,697; 2.06 gives +# $3,714.87. +- name: Case 16, New Jersey pregnancy group excludes income at 206% FPL in 2026. + period: 2026 + input: + people: + person1: + age: 30 + is_pregnant: true + immigration_status: CITIZEN + is_medicaid_eligible: false + medicaid_income_level: 2.06 + households: + household: + members: [person1] + state_code: NJ + output: + is_chip_eligible_standard_pregnant_person: false + +# 2026 household of 2: 21,640 x 2.58 / 12 = 4,652.60 -> $4,653; 2.59 gives +# $4,670.63. +- name: Case 17, Rhode Island pregnancy group excludes income at 259% FPL in 2026. + period: 2026 + input: + people: + person1: + age: 30 + is_pregnant: true + immigration_status: CITIZEN + is_medicaid_eligible: false + medicaid_income_level: 2.59 + households: + household: + members: [person1] + state_code: RI + output: + is_chip_eligible_standard_pregnant_person: false + +# 2026 household of 2: 21,640 x 2.18 / 12 = 3,931.27 -> $3,932; 2.19 gives +# $3,949.30. +- name: Case 18, Kentucky pregnancy group excludes income at 219% FPL in 2026. + period: 2026 + input: + people: + person1: + age: 30 + is_pregnant: true + immigration_status: CITIZEN + is_medicaid_eligible: false + medicaid_income_level: 2.19 + households: + household: + members: [person1] + state_code: KY + output: + is_chip_eligible_standard_pregnant_person: false + +# Kentucky's group starts July 1, 2022 (KY-21-0001), so 2021 has no group. +- name: Case 19, Kentucky has no CHIP pregnancy group in 2021. + period: 2021 + input: + people: + person1: + age: 30 + is_pregnant: true + immigration_status: CITIZEN + is_medicaid_eligible: false + medicaid_income_level: 2.1 + households: + household: + members: [person1] + state_code: KY + output: + is_chip_eligible_standard_pregnant_person: false + +# 2019 household of 2: 16,910 x 2.65 / 12 = 3,734.29 -> $3,735, so 265% +# qualifies (the old 2.60 limit gave $3,664). +- name: Case 20, Colorado pregnancy group covers income at 265% FPL in 2019. + period: 2019 + input: + people: + person1: + age: 30 + is_pregnant: true + immigration_status: CITIZEN + is_medicaid_eligible: false + medicaid_income_level: 2.65 + households: + household: + members: [person1] + state_code: CO + output: + is_chip_eligible_standard_pregnant_person: true + +# West Virginia's Medicaid pregnancy limit is 190% FPL (185% plus the 5 +# percentage point disregard), and its separate CHIP pregnancy band runs above +# it to 305%. Both start July 1, 2019, so 2020 is the first annual year. 2020 +# household of 2 (FPG 17,240): 17,240 x 1.90 / 12 = 2,729.67 -> $2,730 a month +# ($32,760 a year). At $2,730 a month the applicant stays in Medicaid; at +# $2,731 a month ($32,772 a year) she moves to standard pregnancy CHIP. +- name: Case 21, West Virginia pregnant applicant at the $2,730 Medicaid ceiling stays in Medicaid in 2020. + period: 2020 + input: + people: + person1: + age: 30 + is_pregnant: true + immigration_status: CITIZEN + employment_income: 32_760 + tax_units: + tax_unit: + members: [person1] + households: + household: + members: [person1] + state_code: WV + output: + medicaid_household_size: 2 + is_pregnant_for_medicaid: true + medicaid_category: PREGNANT + is_medicaid_eligible: true + is_chip_eligible_standard_pregnant_person: false + chip_category: NONE + +- name: Case 22, West Virginia pregnant applicant $1 above the Medicaid ceiling moves to standard pregnancy CHIP in 2020. + period: 2020 + input: + people: + person1: + age: 30 + is_pregnant: true + immigration_status: CITIZEN + employment_income: 32_772 + tax_units: + tax_unit: + members: [person1] + households: + household: + members: [person1] + state_code: WV + output: + medicaid_household_size: 2 + is_pregnant_for_medicaid: false + medicaid_category: NONE + is_medicaid_eligible: false + is_chip_eligible_standard_pregnant_person: true + chip_category: PREGNANT_STANDARD diff --git a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/is_pregnant_for_medicaid.yaml b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/is_pregnant_for_medicaid.yaml index 46e8fac1504..a64736f438e 100644 --- a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/is_pregnant_for_medicaid.yaml +++ b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/is_pregnant_for_medicaid.yaml @@ -569,3 +569,45 @@ output: is_pregnant_for_medicaid_nfc: true is_pregnant_for_medicaid: true + +# SPA WV-19-0004 raised the pregnancy standard to 185% FPL (190% with the +# disregard) effective 2019-07-01; the YEAR-defined variable resolves the +# January value, so the change first applies in 2020. +- name: Pregnancy above the pre-July 2019 FPL limit confers ineligibility in WV + period: 2019 + input: + state_code: WV + is_pregnant: true + medicaid_income_level: 1.8 + output: + is_pregnant_for_medicaid: false + +- name: Pregnancy under the 190% FPL limit (185% plus the disregard) confers eligibility in WV + period: 2020 + input: + state_code: WV + is_pregnant: true + medicaid_income_level: 1.8 + output: + is_pregnant_for_medicaid: true + +# WV-19-0004 S14 sets 185% FPL; with the 5 percentage point disregard the +# limit is 190%. 2026 household of 2: 21,640 x 1.90 / 12 = 3,426.33 -> $3,427. +- name: Pregnancy at the 190% FPL limit confers eligibility in WV + period: 2026 + input: + state_code: WV + is_pregnant: true + medicaid_income_level: 1.9 + output: + is_pregnant_for_medicaid: true + +# 21,640 x 1.91 / 12 = $3,444.37 per month, above the $3,427 ceiling. +- name: Pregnancy one point above the 190% FPL limit confers ineligibility in WV + period: 2026 + input: + state_code: WV + is_pregnant: true + medicaid_income_level: 1.91 + output: + is_pregnant_for_medicaid: false diff --git a/source_conflicts/candidates.yaml b/source_conflicts/candidates.yaml index e06355446bb..68e0c10f8a7 100644 --- a/source_conflicts/candidates.yaml +++ b/source_conflicts/candidates.yaml @@ -2525,6 +2525,46 @@ candidates: state: open note: A source-choice decision was requested; resolve the incorporated restriction and verify applicability beyond 2025. +- id: us-ky:kchip-phase-iii-pregnant-citizens + program: chip + years: + from: 2023 + type: calendar + question: Does KCHIP Phase III cover pregnant citizens at 195-213% FPL, or only pregnant people who are lawfully + present immigrants? + sources: + - kind: regulation + citation: 907 KAR 4:030 Section 2(1), version effective January 12, 2023, file page 1 + url: https://apps.legislature.ky.gov/law/kar/downloads/docs/13741/document.engrossed.pdf#page=1 + - kind: plan + citation: CMS approval letter for Kentucky CHIP State Plan Amendments KY-21-0001 and KY-21-0002, file page 2; CS8, + Eligibility - Targeted Low-Income Pregnant Women, file page 4 + url: https://www.medicaid.gov/CHIP/Downloads/KY-21-0001.pdf#page=2 + readings: + regulation: Eligibility requires all of the listed conditions, including "(b) Is an immigrant who is lawfully + present"; the section gives no route for citizens. + other: The state plan covers "targeted low-income pregnant individuals" in CHIP with income above 195% and up to + 213% FPL and, in addition, elects section 2107(e)(1)(O) to cover otherwise eligible lawfully residing pregnant + individuals. + example: A Kentucky citizen who is pregnant with income at 210% FPL in 2024 is covered under the state plan, which + PE-US follows, but not under the regulation's literal text. + pe_us: + follows: gap-fill + code: + - policyengine_us/parameters/gov/hhs/chip/pregnant/income_limit.yaml + - policyengine_us/variables/gov/hhs/chip/is_chip_eligible_standard_pregnant_person.py + prs: + - https://github.com/PolicyEngine/policyengine-us/pull/10365 + state: ruled + note: 'Ruled on 2026-10-27 for the state plan under agency-breaks-ties + (https://github.com/PolicyEngine/policyengine-us/pull/10365#issuecomment-6445848549); the model needs no change. + KRS 205.6485 has the cabinet set KCHIP eligibility by regulation and says nothing about immigration status. 907 + KAR 4:020 Section 2(1)(b), the children''s rule amended in the same 2022 package, has the same form ("Is a + noncitizen who meets the requirement established in 907 KAR 20:005"), and no one reads it to exclude citizen + children. The impact analysis for this amendment (49 Ky.R. 645-647) describes the group by income only and says + the amendment implements a state plan amendment to KCHIP Phase III that extends coverage to pregnant recipients, + which is KY-21-0001. Since the text does not settle the question, the agency''s reading decides. The register + entry and the code marker follow the merge.' - id: us-ky:ktap-payment-maximum-2025 program: tanf years: