From ab1081282bd8b14c400b237ba5432bfb5dafde46 Mon Sep 17 00:00:00 2001 From: Ziming Date: Wed, 21 Oct 2026 17:10:11 -0400 Subject: [PATCH 1/6] Correct CHIP and Medicaid pregnancy income limit dates from state plan amendments Kentucky's CHIP pregnancy group starts July 1, 2022 at 218% FPL (KY-21-0001, 907 KAR 4:030). West Virginia's CHIP group and 185% Medicaid standard start July 1, 2019 (WV-19-0006, WV-19-0004). Colorado, New Jersey and Rhode Island store the disregard-inclusive CHIP limits from 2018, Colorado's FCEP option starts January 1, 2025, and Rhode Island's Medicaid pregnancy limit stays at 195% FPL. Co-Authored-By: Claude Opus 5.5 --- ...-chip-pregnant-income-limit-dates.fixed.md | 1 + .../gov/hhs/chip/fcep/income_limit.yaml | 8 +- .../gov/hhs/chip/pregnant/income_limit.yaml | 37 +++- .../categories/pregnant/income_limit.yaml | 13 +- .../gov/hhs/chip/is_chip_eligible_fcep.yaml | 36 ++++ ...hip_eligible_standard_pregnant_person.yaml | 194 +++++++++++++++++- .../categories/is_pregnant_for_medicaid.yaml | 21 ++ 7 files changed, 296 insertions(+), 14 deletions(-) create mode 100644 changelog.d/fix-chip-pregnant-income-limit-dates.fixed.md 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..f32a39f4927 --- /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, West Virginia's 190% Medicaid pregnancy limit starts July 1, 2019, and Rhode Island's Medicaid pregnancy limit stays at 195% FPL. 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..8de0e64f304 100644 --- a/policyengine_us/parameters/gov/hhs/chip/fcep/income_limit.yaml +++ b/policyengine_us/parameters/gov/hhs/chip/fcep/income_limit.yaml @@ -12,6 +12,10 @@ metadata: 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: 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, section 3.1.1.1 + href: https://www.medicaid.gov/CHIP/Downloads/CO-25-0044.pdf#page=6 AK: 2018-01-01: -.inf 2019-01-01: -.inf @@ -59,8 +63,8 @@ CO: 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..bee16c55df6 100644 --- a/policyengine_us/parameters/gov/hhs/chip/pregnant/income_limit.yaml +++ b/policyengine_us/parameters/gov/hhs/chip/pregnant/income_limit.yaml @@ -11,6 +11,26 @@ metadata: 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: 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 + href: https://www.coloradosos.gov/CCR/GenerateRulePdf.do?ruleVersionId=12687&fileName=10%20CCR%202505-3#page=9 + - 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 #page 1-2" + 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 FamilyCare Section 1115 Demonstration Amendment Request Public Notice (December 23, 2019) + href: https://www.nj.gov/humanservices/providers/grants/public/publicnoticefiles/Public%20Notice%20Amendment%20Request%20-%20NJ%201115%2012-23-19%20Final.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) (effective June 7, 2018) + href: https://risos-apa-production-public.s3.amazonaws.com/EOHHS/REG_9690_20180806185730.pdf#page=6 + - 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 +42,10 @@ 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% FPL disregard. 10 CCR + # 2505-3 printed 250% until a June 30, 2022 correction that 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 +70,7 @@ KS: 2018-01-01: -.inf KY: 2018-01-01: -.inf - 2021-01-01: 2.13 - 2021-07-01: 2.18 + 2022-07-01: 2.18 LA: 2018-01-01: -.inf MA: @@ -77,8 +98,7 @@ NE: NH: 2018-01-01: -.inf NJ: - 2018-01-01: 2.00 - 2023-12-01: 2.05 + 2018-01-01: 2.05 NM: 2018-01-01: -.inf NV: @@ -94,8 +114,7 @@ OR: PA: 2018-01-01: -.inf RI: - 2018-01-01: 2.53 - 2023-12-01: 2.58 + 2018-01-01: 2.58 SC: 2018-01-01: -.inf SD: @@ -116,6 +135,6 @@ WI: 2018-01-01: -.inf WV: 2018-01-01: -.inf - 2021-01-01: 3.05 + 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..db6951c3be1 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 @@ -19,6 +19,12 @@ metadata: 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: 210-RICR-30-00-1 § 1.6(A)(2) (effective August 17, 2025) + href: https://risos-apa-production-public.s3.amazonaws.com/EOHHS/REG_13314_20250728104245127.pdf#page=5 + - title: "Rhode Island Comprehensive Section 1115 Demonstration approval (November 28, 2025), Budget Population 6b #page 3,15" + href: https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/ri-comp-demo-appvl-11282025.pdf#page=3 + - 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 @@ -105,8 +111,11 @@ OR: PA: 2018-01-01: 2.20 RI: + # 190% FPL plus the 5% FPL disregard; separate CHIP covers 190% to 253%. + # Insured pregnant people at 190% to 253% get Medicaid through the section + # 1115 demonstration (Budget Population 6b). The model has no other-coverage + # split, so they count under standard pregnancy CHIP. 2018-01-01: 1.95 - 2023-01-01: 2.58 SC: 2018-01-01: 1.99 SD: @@ -129,6 +138,6 @@ WI: 2018-01-01: 3.06 WV: 2018-01-01: 1.63 - 2021-01-01: 1.90 + 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..f83e5d06d09 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 +514,39 @@ 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. +- 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 + +- 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 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..6eee4473094 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 +185,198 @@ 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 in 2022, before Kentucky's group starts. + 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 + 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 + 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 pregnancy group does not apply in 2019 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 + 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 + 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] + +# Rhode Island's Medicaid pregnancy limit is 190% FPL (195% with the +# disregard) and its separate CHIP covers income above it up to 253% (258%), +# so a pregnant citizen at 230% FPL is in CHIP, not Medicaid. +- name: Case 14, Rhode Island pregnant citizen above the Medicaid limit qualifies for standard CHIP in 2024. + period: 2024 + input: + people: + person1: + age: 30 + is_pregnant: true + immigration_status: CITIZEN + medicaid_income_level: 2.3 + households: + household: + members: [person1] + state_code: RI + output: + is_pregnant_for_medicaid: false + is_medicaid_eligible: false + is_chip_eligible_standard_pregnant_person: true 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 6f858fba434..fc1c478eb04 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 @@ -135,3 +135,24 @@ output: is_pregnant_for_medicaid_fc: false is_pregnant_for_medicaid: false + +# 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 185% FPL standard confers eligibility in WV + period: 2020 + input: + state_code: WV + is_pregnant: true + medicaid_income_level: 1.8 + output: + is_pregnant_for_medicaid: true From 9264d3d2e45c4dd4492cb9e1587bbaf2ad0f47fb Mon Sep 17 00:00:00 2001 From: Ziming Date: Thu, 22 Oct 2026 16:24:45 -0400 Subject: [PATCH 2/6] Keep Rhode Island pathway changes out of parameter corrections --- ...-chip-pregnant-income-limit-dates.fixed.md | 2 +- .../categories/pregnant/income_limit.yaml | 9 +------- ...hip_eligible_standard_pregnant_person.yaml | 21 ------------------- 3 files changed, 2 insertions(+), 30 deletions(-) diff --git a/changelog.d/fix-chip-pregnant-income-limit-dates.fixed.md b/changelog.d/fix-chip-pregnant-income-limit-dates.fixed.md index f32a39f4927..894fa4a92db 100644 --- a/changelog.d/fix-chip-pregnant-income-limit-dates.fixed.md +++ b/changelog.d/fix-chip-pregnant-income-limit-dates.fixed.md @@ -1 +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, West Virginia's 190% Medicaid pregnancy limit starts July 1, 2019, and Rhode Island's Medicaid pregnancy limit stays at 195% FPL. +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/medicaid/eligibility/categories/pregnant/income_limit.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/pregnant/income_limit.yaml index db6951c3be1..93b18dd5ff5 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 @@ -19,10 +19,6 @@ metadata: 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: 210-RICR-30-00-1 § 1.6(A)(2) (effective August 17, 2025) - href: https://risos-apa-production-public.s3.amazonaws.com/EOHHS/REG_13314_20250728104245127.pdf#page=5 - - title: "Rhode Island Comprehensive Section 1115 Demonstration approval (November 28, 2025), Budget Population 6b #page 3,15" - href: https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/ri-comp-demo-appvl-11282025.pdf#page=3 - 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: @@ -111,11 +107,8 @@ OR: PA: 2018-01-01: 2.20 RI: - # 190% FPL plus the 5% FPL disregard; separate CHIP covers 190% to 253%. - # Insured pregnant people at 190% to 253% get Medicaid through the section - # 1115 demonstration (Budget Population 6b). The model has no other-coverage - # split, so they count under standard pregnancy CHIP. 2018-01-01: 1.95 + 2023-01-01: 2.58 SC: 2018-01-01: 1.99 SD: 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 6eee4473094..5ad2ea4777e 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 @@ -359,24 +359,3 @@ state_code: RI output: is_chip_eligible_standard_pregnant_person: [true, true, true] - -# Rhode Island's Medicaid pregnancy limit is 190% FPL (195% with the -# disregard) and its separate CHIP covers income above it up to 253% (258%), -# so a pregnant citizen at 230% FPL is in CHIP, not Medicaid. -- name: Case 14, Rhode Island pregnant citizen above the Medicaid limit qualifies for standard CHIP in 2024. - period: 2024 - input: - people: - person1: - age: 30 - is_pregnant: true - immigration_status: CITIZEN - medicaid_income_level: 2.3 - households: - household: - members: [person1] - state_code: RI - output: - is_pregnant_for_medicaid: false - is_medicaid_eligible: false - is_chip_eligible_standard_pregnant_person: true From 300d6bf2cb285023880e525f22965987849112cf Mon Sep 17 00:00:00 2001 From: Ziming Date: Fri, 23 Oct 2026 22:24:31 -0400 Subject: [PATCH 3/6] Fix issues from review: boundary tests, New Jersey and Rhode Island sources - Add boundary cases that pin the corrected WV CHIP, WV Medicaid, NJ, RI, KY and Colorado FCEP limits on both sides, plus KY 2021 and CO 2019. - Replace the dead New Jersey notice link with the medicaid.gov 1115 amendment request and add the current Rhode Island rule version. - State the five percentage point disregard (42 CFR 435.603(d)(4)) in the descriptions, cite the older Colorado rule text and CO-26-0047, and explain the January 1 read and the Colorado FCEP end date. - Assert the Colorado FCEP downstream CHIP result, rename three cases, and give each person in Cases 9-11 and 13 their own units. Co-Authored-By: Claude Opus 5.5 --- .../gov/hhs/chip/fcep/income_limit.yaml | 19 +- .../gov/hhs/chip/pregnant/income_limit.yaml | 44 +++- .../categories/pregnant/income_limit.yaml | 10 +- .../gov/hhs/chip/is_chip_eligible_fcep.yaml | 47 ++++ ...hip_eligible_standard_pregnant_person.yaml | 247 +++++++++++++++++- .../categories/is_pregnant_for_medicaid.yaml | 23 +- 6 files changed, 374 insertions(+), 16 deletions(-) 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 8de0e64f304..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 @@ -6,16 +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, section 3.1.1.1 - href: https://www.medicaid.gov/CHIP/Downloads/CO-25-0044.pdf#page=6 + - 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 @@ -57,6 +67,9 @@ 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 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 bee16c55df6..f151f155df4 100644 --- a/policyengine_us/parameters/gov/hhs/chip/pregnant/income_limit.yaml +++ b/policyengine_us/parameters/gov/hhs/chip/pregnant/income_limit.yaml @@ -1,34 +1,50 @@ -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 + - 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 #page 1-2" + - title: "907 KAR 4:030 § 2(1)(e)1 (version effective January 12, 2023) #page 1-2" 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 FamilyCare Section 1115 Demonstration Amendment Request Public Notice (December 23, 2019) - href: https://www.nj.gov/humanservices/providers/grants/public/publicnoticefiles/Public%20Notice%20Amendment%20Request%20-%20NJ%201115%2012-23-19%20Final.pdf#page=1 + - 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) (effective June 7, 2018) + - 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: @@ -42,9 +58,11 @@ AZ: CA: 2018-01-01: -.inf CO: - # 260% FPL (CO-13-0015, effective 2014) plus the 5% FPL disregard. 10 CCR - # 2505-3 printed 250% until a June 30, 2022 correction that aligned the rule - # with the existing standard, so 2018 to mid-2022 also uses 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 @@ -70,6 +88,8 @@ KS: 2018-01-01: -.inf KY: 2018-01-01: -.inf + # 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 @@ -98,6 +118,8 @@ NE: NH: 2018-01-01: -.inf NJ: + # 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 @@ -114,6 +136,8 @@ OR: PA: 2018-01-01: -.inf RI: + # 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 @@ -135,6 +159,8 @@ WI: 2018-01-01: -.inf WV: 2018-01-01: -.inf + # 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 93b18dd5ff5..ee303970a80 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: Maximum family income for pregnant people to qualify for Medicaid, 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 @@ -15,6 +19,8 @@ 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) @@ -131,6 +137,8 @@ WI: 2018-01-01: 3.06 WV: 2018-01-01: 1.63 + # 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 f83e5d06d09..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 @@ -517,6 +517,9 @@ # 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: @@ -533,6 +536,9 @@ 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 @@ -550,3 +556,44 @@ 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 5ad2ea4777e..b1593ae51b2 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 @@ -195,7 +195,7 @@ # 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 in 2022, before Kentucky's group starts. +- 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: @@ -223,6 +223,42 @@ 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] @@ -263,6 +299,34 @@ 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] @@ -278,7 +342,7 @@ # 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 pregnancy group does not apply in 2019 and Colorado excludes income above 265% FPL. +- 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: @@ -294,6 +358,26 @@ 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] @@ -347,6 +431,34 @@ 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] @@ -359,3 +471,134 @@ 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 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 fc1c478eb04..dfad37eaf3d 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 @@ -148,7 +148,7 @@ output: is_pregnant_for_medicaid: false -- name: Pregnancy under the 185% FPL standard confers eligibility in WV +- name: Pregnancy under the 190% FPL limit (185% plus the disregard) confers eligibility in WV period: 2020 input: state_code: WV @@ -156,3 +156,24 @@ 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 From c0d43bcc9284f5b812398c703fc9f851d9d81683 Mon Sep 17 00:00:00 2001 From: Ziming Date: Mon, 26 Oct 2026 16:24:33 -0400 Subject: [PATCH 4/6] Apply approving-review suggestions: West Virginia hand-off pair, description verb, 907 KAR pages Add the West Virginia Medicaid-to-CHIP hand-off pair with computed income (Cases 21-22), give the Medicaid pregnancy limit description a verb, and add file page 3 (the version date) to the 907 KAR 4:030 page list. Co-Authored-By: Claude Opus 5.5 --- .../gov/hhs/chip/pregnant/income_limit.yaml | 2 +- .../categories/pregnant/income_limit.yaml | 2 +- ...hip_eligible_standard_pregnant_person.yaml | 54 +++++++++++++++++++ 3 files changed, 56 insertions(+), 2 deletions(-) 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 f151f155df4..5ea4fd1bd86 100644 --- a/policyengine_us/parameters/gov/hhs/chip/pregnant/income_limit.yaml +++ b/policyengine_us/parameters/gov/hhs/chip/pregnant/income_limit.yaml @@ -33,7 +33,7 @@ metadata: 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 1-2" + - 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 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 ee303970a80..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, as a share of the federal poverty line, including the five percentage point income disregard of 42 CFR 435.603(d)(4). +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 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 b1593ae51b2..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 @@ -602,3 +602,57 @@ 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 From f9cab43f595696bddc6a6ded4f584166da6a0a97 Mon Sep 17 00:00:00 2001 From: Ziming Date: Mon, 26 Oct 2026 20:34:23 -0400 Subject: [PATCH 5/6] Record the KCHIP Phase III pregnancy conflict as a candidate 907 KAR 4:030 Section 2(1)(b) limits KCHIP Phase III to lawfully present immigrants, while the KY-21-0001 state plan covers targeted low-income pregnant individuals at 195-213% FPL. The code follows the state plan; the candidate awaits a project sign-off. Co-Authored-By: Claude Opus 5.5 --- source_conflicts/candidates.yaml | 32 ++++++++++++++++++++++++++++++++ 1 file changed, 32 insertions(+) diff --git a/source_conflicts/candidates.yaml b/source_conflicts/candidates.yaml index ab0faa5b4ec..843e73f54bd 100644 --- a/source_conflicts/candidates.yaml +++ b/source_conflicts/candidates.yaml @@ -2525,6 +2525,38 @@ 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: policy + citation: CMS approval letter for Kentucky CHIP State Plan Amendments KY-21-0001 and KY-21-0002, page 2 + 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 200% FPL in 2024 is covered under the state plan and not + under the regulation. + pe_us: + follows: conflicting-source + 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: unreviewed + note: The code follows the state plan, against the regulation. The statute (KRS 205.6481 and following) was not + checked. A project sign-off on the reading is pending. - id: us-ky:ktap-payment-maximum-2025 program: tanf years: From 2bdcd57d5cc05cc01d1982cd949a196efafcf91e Mon Sep 17 00:00:00 2001 From: Ziming Date: Tue, 27 Oct 2026 14:56:25 -0400 Subject: [PATCH 6/6] Record Pavel's state-plan ruling on the KCHIP Phase III conflict The candidate is now ruled under agency-breaks-ties and follows gap-fill: KRS 205.6485 is silent on immigration status, the children's rule has the same form, and the 2022 impact analysis describes the group by income and implements the state plan amendment. The example moves to 210% FPL, above Kentucky's pregnancy Medicaid limit. Co-Authored-By: Claude Opus 5.5 --- source_conflicts/candidates.yaml | 24 ++++++++++++++++-------- 1 file changed, 16 insertions(+), 8 deletions(-) diff --git a/source_conflicts/candidates.yaml b/source_conflicts/candidates.yaml index 9c562b3dba3..68e0c10f8a7 100644 --- a/source_conflicts/candidates.yaml +++ b/source_conflicts/candidates.yaml @@ -2536,8 +2536,9 @@ candidates: - 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: policy - citation: CMS approval letter for Kentucky CHIP State Plan Amendments KY-21-0001 and KY-21-0002, page 2 + - 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 @@ -2545,18 +2546,25 @@ candidates: 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 200% FPL in 2024 is covered under the state plan and not - under the regulation. + 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: conflicting-source + 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: unreviewed - note: The code follows the state plan, against the regulation. The statute (KRS 205.6481 and following) was not - checked. A project sign-off on the reading is pending. + 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: