Use state dollar standards for the Medicaid aged, blind and disabled income limit in AK, ID, NH, VT and WI

changelog.d/medicaid-abd-state-dollar-standards.fixed.md

@@ -0,0 +1 @@
+Use state dollar standards, not shares of the poverty guideline, as the Medicaid income limit for aged, blind and disabled people who do not receive SSI in Alaska, Idaho, New Hampshire, Vermont and Wisconsin, require income below Idaho's standard, and add Vermont's 2017-2023 AABD independent-living supplement ($52.04 individual, $98.88 couple).

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

@@ -1,4 +1,4 @@
-description: Maximum countable income limit for a couple to qualify for Medicaid under the optional senior or disabled pathway, as percent of Federal Poverty Line. States whose limit is the SSI federal benefit rate are listed in uses_ssi_federal_benefit_rate and omitted here.
+description: Maximum countable income limit for a couple to qualify for Medicaid under the optional senior or disabled pathway, as percent of Federal Poverty Line. States whose limit is the SSI federal benefit rate (uses_ssi_federal_benefit_rate) or a dollar standard of their own (uses_state_standard) in every year are omitted here.
 metadata:
   unit: /1
   label: Medicaid senior or disabled income limit (couple)
@@ -17,9 +17,6 @@ metadata:
     - title: Connecticut CHOICES Benefits Quick Guide (Rev 04.04.2025)
       href: https://portal.ct.gov/ads/-/media/ads-beta/choices/choices-benefits-quick-guide.pdf?rev=3b8c59ca12224218bc4c4438649e7ac7#page=1
 
-AK:
-  2018-01-01: 0.74
-  2021-01-01: 0.83
 AL:
   2018-01-01: 0.75
 AZ:
@@ -45,9 +42,6 @@ GA:
   2018-01-01: 0.75
 HI:
   2018-01-01: 1.00
-ID:
-  2018-01-01: 0.80
-  2021-01-01: 0.78
 IL:
   2018-01-01: 1.00
 IN:
@@ -75,8 +69,6 @@ NE:
   2018-01-01: 1.00
 NV:
   2018-01-01: 0.75
-NH:
-  2018-01-01: 0.75
 NJ:
   2018-01-01: 1.00
 NM:
@@ -103,15 +95,9 @@ TX:
   2018-01-01: 0.75
 UT:
   2018-01-01: 1.00
-VT:
-  2018-01-01: 0.74
-  2021-01-01: 0.80
 VA:
   2018-01-01: 0.80
 WV:
   2018-01-01: 0.75
-WI:
-  2018-01-01: 0.83
-  2021-01-01: 1.00
 WY:
   2018-01-01: 0.75

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

@@ -1,4 +1,4 @@
-description: Maximum countable income limit for an individual to qualify for Medicaid under the optional senior or disabled pathway, as percent of Federal Poverty Line. States whose limit is the SSI federal benefit rate are listed in uses_ssi_federal_benefit_rate and omitted here.
+description: Maximum countable income limit for an individual to qualify for Medicaid under the optional senior or disabled pathway, as percent of Federal Poverty Line. States whose limit is the SSI federal benefit rate (uses_ssi_federal_benefit_rate) or a dollar standard of their own (uses_state_standard) in every year are omitted here.
 metadata:
   unit: /1
   label: Medicaid senior or disabled income limit (individual)
@@ -17,9 +17,6 @@ metadata:
     - title: Connecticut CHOICES Benefits Quick Guide (Rev 04.04.2025)
       href: https://portal.ct.gov/ads/-/media/ads-beta/choices/choices-benefits-quick-guide.pdf?rev=3b8c59ca12224218bc4c4438649e7ac7#page=1
 
-AK:
-  2018-01-01: 0.74
-  2021-01-01: 0.83
 AL:
   2018-01-01: 0.75
 AZ:
@@ -45,9 +42,6 @@ GA:
   2018-01-01: 0.75
 HI:
   2018-01-01: 1.00
-ID:
-  2018-01-01: 0.80
-  2021-01-01: 0.78
 IL:
   2018-01-01: 1.00
 IN:
@@ -75,8 +69,6 @@ NE:
   2018-01-01: 1.00
 NV:
   2018-01-01: 0.75
-NH:
-  2018-01-01: 0.75
 NJ:
   2018-01-01: 1.00
 NM:
@@ -103,15 +95,9 @@ TX:
   2018-01-01: 0.75
 UT:
   2018-01-01: 1.00
-VT:
-  2018-01-01: 0.74
-  2021-01-01: 0.80
 VA:
   2018-01-01: 0.80
 WV:
   2018-01-01: 0.75
-WI:
-  2018-01-01: 0.83
-  2021-01-01: 1.00
 WY:
   2018-01-01: 0.75

policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/income/limit/requires_income_below_limit.yaml

@@ -28,6 +28,8 @@ metadata:
       href: https://secure.ssa.gov/apps10/poms.nsf/lnx/0502005001
     - title: 42 U.S. Code § 1396a(m)(1)(B) - poverty-level aged and disabled group (income that "does not exceed" the state's standard)
       href: https://www.law.cornell.edu/uscode/text/42/1396a#m_1_B
+    - title: IDAPA 16.03.05.500 - Financial Need ("The participant has financial need if their allowances ... are more than their income")
+      href: https://adminrules.idaho.gov/rules/current/16/160305.pdf#page=39
 
 AK:
   2018-01-01: false
@@ -56,7 +58,7 @@ HI:
 IA:
   2018-01-01: false
 ID:
-  2018-01-01: false
+  2018-01-01: true
 IL:
   2018-01-01: false
 IN:

policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/income/limit/state_standard/id/couple.yaml

@@ -0,0 +1,19 @@
+description: Idaho adds this monthly amount to the SSI federal benefit rate for a couple to set its Medicaid income standard for aged, blind, or disabled people who do not receive SSI.
+# Idaho: the AABD basic allowance, equal to the SSI couple rate.
+# NOTE: gov.states.id.dhw.aabd.payment.basic_allowance holds the same
+# allowance for Idaho's AABD cash program, still at the 2000 base amounts
+# without the 501 increases (PolicyEngine/policyengine-us#10462). Once that
+# is fixed, Idaho's Medicaid standard can read from it.
+values:
+  2018-01-01: 0
+metadata:
+  unit: currency-USD
+  period: month
+  label: Idaho Medicaid senior or disabled amount above the SSI couple rate
+  reference:
+    - title: IDAPA 16.03.05.501 - Basic Allowance ($545 single and $768 couple, each raised by the dollar amount of each SSI cost-of-living increase since January 1, 2001)
+      href: https://adminrules.idaho.gov/rules/current/16/160305.pdf#page=39
+    - title: "Idaho Medicaid State Plan TN 18-0002, Supplement 6 to Attachment 2.6-A, Income Limits by Living Situation ($783 single and $1,125 couple from April 1, 2018) #page 5-6"
+      href: https://www.medicaid.gov/State-resource-center/Medicaid-State-Plan-Amendments/Downloads/ID/ID-18-0002.pdf#page=5
+    - title: Idaho Department of Health and Welfare, Medicaid Program Income Limits, AABD Cash and AABD Medicaid (January 2026, $1,047 and $1,511 including the $20 disregard)
+      href: https://healthandwelfare.idaho.gov/medicaid-program-income-limits

policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/income/limit/state_standard/id/individual.yaml

@@ -0,0 +1,19 @@
+description: Idaho adds this monthly amount to the SSI federal benefit rate for an individual to set its Medicaid income standard for aged, blind, or disabled people who do not receive SSI.
+# Idaho: the AABD basic allowance, $33 above the SSI rate.
+# NOTE: gov.states.id.dhw.aabd.payment.basic_allowance holds the same
+# allowance for Idaho's AABD cash program, still at the 2000 base amounts
+# without the 501 increases (PolicyEngine/policyengine-us#10462). Once that
+# is fixed, Idaho's Medicaid standard can read from it.
+values:
+  2018-01-01: 33
+metadata:
+  unit: currency-USD
+  period: month
+  label: Idaho Medicaid senior or disabled amount above the SSI individual rate
+  reference:
+    - title: IDAPA 16.03.05.501 - Basic Allowance ($545 single and $768 couple, each raised by the dollar amount of each SSI cost-of-living increase since January 1, 2001)
+      href: https://adminrules.idaho.gov/rules/current/16/160305.pdf#page=39
+    - title: "Idaho Medicaid State Plan TN 18-0002, Supplement 6 to Attachment 2.6-A, Income Limits by Living Situation ($783 single and $1,125 couple from April 1, 2018) #page 5-6"
+      href: https://www.medicaid.gov/State-resource-center/Medicaid-State-Plan-Amendments/Downloads/ID/ID-18-0002.pdf#page=5
+    - title: Idaho Department of Health and Welfare, Medicaid Program Income Limits, AABD Cash and AABD Medicaid (January 2026, $1,047 and $1,511 including the $20 disregard)
+      href: https://healthandwelfare.idaho.gov/medicaid-program-income-limits

policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/senior_or_disabled/income/limit/uses_state_standard.yaml

@@ -0,0 +1,138 @@
+description: The state tests the Medicaid income of aged, blind, or disabled people who do not receive SSI against a monthly dollar standard of its own, rather than a share of the federal poverty guideline, if this is true.
+metadata:
+  unit: bool
+  period: year
+  label: Medicaid senior or disabled income limit is a state dollar standard
+  breakdown:
+  - state_code
+  reference:
+    - title: 42 CFR 435.210 - Optional eligibility for individuals who meet the income and resource requirements of the cash assistance programs
+      href: https://www.ecfr.gov/current/title-42/section-435.210
+    - title: 7 AAC 100.400(a)(17) - Applies the Adult Public Assistance income eligibility standards of 7 AAC 40.310 to Medicaid for aged and disabled people
+      href: https://www.law.cornell.edu/regulations/alaska/7-AAC-100.400
+    - title: 7 AAC 100.410(c) - Medicaid for an individual eligible for SSI or Adult Public Assistance who chooses not to receive the cash benefit
+      href: https://www.law.cornell.edu/regulations/alaska/7-AAC-100.410
+    - title: Alaska Aged, Disabled and Long Term Care Medicaid Manual 530 C - Use of the Refused Cash Medicaid subtype (from January 2020)
+      href: http://dpaweb.hss.state.ak.us/manuals/adltc/530_ssi_and_apa_related_categories/530_ssi_and_apa_related_categories.htm
+    - title: "IDAPA 16.03.05.301.01 (AABD-Medicaid without applying for SSI), 16.03.05.500 (financial need) and 16.03.05.501 (basic allowance) #page 28,39"
+      href: https://adminrules.idaho.gov/rules/current/16/160305.pdf#page=28
+    - title: "Idaho Medicaid State Plan TN 18-0002, Supplement 6 to Attachment 2.6-A, Income Limits by Living Situation #page 5-6"
+      href: https://www.medicaid.gov/State-resource-center/Medicaid-State-Plan-Amendments/Downloads/ID/ID-18-0002.pdf#page=5
+    - title: N.H. Code Admin. R. He-W 802.04(b)(1) (categorically needy group of 42 CFR 435.210) and He-W 858.03 (adult category standard of need)
+      href: https://gc.nh.gov/rules/state_agencies/he-w800.html
+    - title: "Vermont Health Benefits Eligibility and Enrollment Rules § 8.05(b) - Individual who is SSI-eligible (income \"at or below the SSI/AABD payment level\") #page 10-11"
+      href: https://humanservices.vermont.gov/sites/ahsnew/files/documents/HBEE-Part-2-Eligibility-Standards.pdf#page=10
+    - title: Wis. Admin. Code DHS 103.04(1)(c) - SSI-related categorically needy income standard ("the maximum SSI payment including state supplement")
+      href: https://docs.legis.wisconsin.gov/code/admin_code/dhs/101/103/04/1/c
+    - title: "Wisconsin DHS Operations Memo 20-13, SSI-Related Medicaid Categorically Needy Income Limit Changes (fixed amounts from the August 2020 benefit month) #page 1-2"
+      href: https://www.dhs.wisconsin.gov/dms/memos/ops/dms-ops-2020-13.pdf#page=1
+    - title: Wisconsin Medicaid Eligibility Handbook 39.4.1, Release 18-01 (2018 categorically needy limits, $583.78 and $882.05 plus actual shelter up to $250.00 and $375.00)
+      href: https://www.emhandbooks.wisconsin.gov/meh-ebd/history/18-01/18-01_39.4.htm
+    - title: Wisconsin Medicaid Eligibility Handbook 39.4.1, Release 19-02 (2019 categorically needy limits, $597.78 and $903.38 plus actual shelter up to $257.00 and $385.67; SSI payment level with the supplement $854.78 and $1,289.05)
+      href: https://www.emhandbooks.wisconsin.gov/meh-ebd/history/19-02/19-02_39.4.htm
+
+AK:
+  2018-01-01: true
+AL:
+  2018-01-01: false
+AR:
+  2018-01-01: false
+AZ:
+  2018-01-01: false
+CA:
+  2018-01-01: false
+CO:
+  2018-01-01: false
+CT:
+  2018-01-01: false
+DC:
+  2018-01-01: false
+DE:
+  2018-01-01: false
+FL:
+  2018-01-01: false
+GA:
+  2018-01-01: false
+HI:
+  2018-01-01: false
+IA:
+  2018-01-01: false
+ID:
+  2018-01-01: true
+IL:
+  2018-01-01: false
+IN:
+  2018-01-01: false
+KS:
+  2018-01-01: false
+KY:
+  2018-01-01: false
+LA:
+  2018-01-01: false
+MA:
+  2018-01-01: false
+MD:
+  2018-01-01: false
+ME:
+  2018-01-01: false
+MI:
+  2018-01-01: false
+MN:
+  2018-01-01: false
+MO:
+  2018-01-01: false
+MS:
+  2018-01-01: false
+MT:
+  2018-01-01: false
+NC:
+  2018-01-01: false
+ND:
+  2018-01-01: false
+NE:
+  2018-01-01: false
+NH:
+  2018-01-01: true
+NJ:
+  2018-01-01: false
+NM:
+  2018-01-01: false
+NV:
+  2018-01-01: false
+NY:
+  2018-01-01: false
+OH:
+  2018-01-01: false
+OK:
+  2018-01-01: false
+OR:
+  2018-01-01: false
+PA:
+  2018-01-01: false
+RI:
+  2018-01-01: false
+SC:
+  2018-01-01: false
+SD:
+  2018-01-01: false
+TN:
+  2018-01-01: false
+TX:
+  2018-01-01: false
+UT:
+  2018-01-01: false
+VA:
+  2018-01-01: false
+VT:
+  2018-01-01: true
+WA:
+  2018-01-01: false
+# Until July 2020 Wisconsin's standard was a base amount plus the person's
+# shelter costs up to a cap; the base plus the cap equals the SSI rate plus the
+# state supplement, which the model uses for those years too.
+WI:
+  2018-01-01: true
+WV:
+  2018-01-01: false
+WY:
+  2018-01-01: false

policyengine_us/parameters/gov/states/ak/dpa/ssp/income_eligibility_standard/couple.yaml

@@ -0,0 +1,39 @@
+description: Alaska sets this amount as the income eligibility standard for a couple living independently under the Adult Public Assistance program.
+values:
+  # The 2018 and 2019 amounts are the Adult Public Assistance need standard.
+  # Since January 2020, Medicaid disregards income between the Adult Public
+  # Assistance payment standard and this amount (ADLTC 530 C; AK-26-0001).
+  2018-01-01: 2_063
+  2019-01-01: 2_121
+  2020-01-01: 2_155
+  2021-01-01: 2_183
+  2022-01-01: 2_312
+  2023-01-01: 2_513
+  2024-01-01: 2_593
+  2025-01-01: 2_658
+  2026-01-01: 2_732
+
+metadata:
+  unit: currency-USD
+  period: month
+  label: Alaska APA income eligibility standard (couple)
+  # 7 AAC 40.310(c) raises the standards each January 1 by the Social Security
+  # cost-of-living percentage.
+  uprating:
+    parameter: gov.ssa.uprating
+    rounding:
+      type: nearest
+      interval: 1
+  reference:
+    - title: 7 AAC 40.310(a) and (c) - Income Eligibility Standards ($1,047 for an individual and $1,551 for a couple, raised each January by the Social Security cost-of-living percentage)
+      href: https://www.law.cornell.edu/regulations/alaska/7-AAC-40.310
+    - title: Alaska DPA, Adult Public Assistance Need and Maximum Payment Standards, 2018-2021 (need standards for 2018 and 2019)
+      href: https://web.archive.org/web/20210102211125/http://dpaweb.hss.state.ak.us/POLICY/PDF/APA-Standards.pdf
+    - title: Alaska Aged, Disabled and Long Term Care Medicaid Manual, Addendum 1 - Expanded Refused Cash Income Limits, 2020-2021 (archived January 2, 2021)
+      href: https://web.archive.org/web/20210102215241/http://dpaweb.hss.state.ak.us/manuals/adltc/addenda/addendum_1.htm
+    - title: Alaska Aged, Disabled and Long Term Care Medicaid Manual, Addendum 1 - Expanded Refused Cash Income Limits, 2022-2024 (archived March 9, 2024)
+      href: https://web.archive.org/web/20240309020647/http://dpaweb.hss.state.ak.us/manuals/adltc/addenda/addendum_1.htm
+    - title: Alaska Aged, Disabled and Long Term Care Medicaid Manual, Addendum 1 - Expanded Refused Cash Income Limits, 2024-2026
+      href: http://dpaweb.hss.state.ak.us/manuals/adltc/addenda/addendum_1.htm
+    - title: Alaska Medicaid State Plan Amendment AK-26-0001, income disregard between the Adult Public Assistance standard and $1,845 (individual) or $2,732 (couple), effective January 1, 2026
+      href: https://www.medicaid.gov/medicaid/spa/downloads/AK-26-0001.pdf#page=13

policyengine_us/parameters/gov/states/ak/dpa/ssp/income_eligibility_standard/individual.yaml

@@ -0,0 +1,39 @@
+description: Alaska sets this amount as the income eligibility standard for an individual living independently under the Adult Public Assistance program.
+values:
+  # The 2018 and 2019 amounts are the Adult Public Assistance need standard.
+  # Since January 2020, Medicaid disregards income between the Adult Public
+  # Assistance payment standard and this amount (ADLTC 530 C; AK-26-0001).
+  2018-01-01: 1_393
+  2019-01-01: 1_432
+  2020-01-01: 1_455
+  2021-01-01: 1_474
+  2022-01-01: 1_561
+  2023-01-01: 1_697
+  2024-01-01: 1_751
+  2025-01-01: 1_795
+  2026-01-01: 1_845
+
+metadata:
+  unit: currency-USD
+  period: month
+  label: Alaska APA income eligibility standard (individual)
+  # 7 AAC 40.310(c) raises the standards each January 1 by the Social Security
+  # cost-of-living percentage.
+  uprating:
+    parameter: gov.ssa.uprating
+    rounding:
+      type: nearest
+      interval: 1
+  reference:
+    - title: 7 AAC 40.310(a) and (c) - Income Eligibility Standards ($1,047 for an individual and $1,551 for a couple, raised each January by the Social Security cost-of-living percentage)
+      href: https://www.law.cornell.edu/regulations/alaska/7-AAC-40.310
+    - title: Alaska DPA, Adult Public Assistance Need and Maximum Payment Standards, 2018-2021 (need standards for 2018 and 2019)
+      href: https://web.archive.org/web/20210102211125/http://dpaweb.hss.state.ak.us/POLICY/PDF/APA-Standards.pdf
+    - title: Alaska Aged, Disabled and Long Term Care Medicaid Manual, Addendum 1 - Expanded Refused Cash Income Limits, 2020-2021 (archived January 2, 2021)
+      href: https://web.archive.org/web/20210102215241/http://dpaweb.hss.state.ak.us/manuals/adltc/addenda/addendum_1.htm
+    - title: Alaska Aged, Disabled and Long Term Care Medicaid Manual, Addendum 1 - Expanded Refused Cash Income Limits, 2022-2024 (archived March 9, 2024)
+      href: https://web.archive.org/web/20240309020647/http://dpaweb.hss.state.ak.us/manuals/adltc/addenda/addendum_1.htm
+    - title: Alaska Aged, Disabled and Long Term Care Medicaid Manual, Addendum 1 - Expanded Refused Cash Income Limits, 2024-2026
+      href: http://dpaweb.hss.state.ak.us/manuals/adltc/addenda/addendum_1.htm
+    - title: Alaska Medicaid State Plan Amendment AK-26-0001, income disregard between the Adult Public Assistance standard and $1,845 (individual) or $2,732 (couple), effective January 1, 2026
+      href: https://www.medicaid.gov/medicaid/spa/downloads/AK-26-0001.pdf#page=13

policyengine_us/parameters/gov/states/vt/dcf/aabd/amount/couple.yaml

@@ -9,9 +9,16 @@ metadata:
   reference:
     - title: POMS SI 01415.058 M.2.b, Vermont January 2026 couple payment levels
       href: https://secure.ssa.gov/poms.nsf/lnx/0501415058#m2b
+    - title: Vermont DCF Bulletin 17-26, P-2740A SSI/AABD Payment Maximums (effective January 1, 2017 and 2018)
+      href: https://outside.vermont.gov/dept/DCF/Shared%20Documents/ESD/Rules-Adopted/B17-26.pdf#page=11
+    - title: Vermont DVHA, 2024 Standards Change for Healthcare, SSI/AABD Payment Maximums (effective January 1, 2023 and 2024)
+      href: https://dvha.vermont.gov/sites/dvha/files/documents/2024%20Standards%20Change%20for%20Healthcare%20FINAL%20Corrected%2012.19.pdf#page=7
 
+# The earlier values are recorded for independent living, which the Medicaid
+# aged, blind and disabled standard also uses.
 INDEPENDENT:
-  2026-01-01: 105.8
+  2017-01-01: 98.88
+  2024-01-01: 105.8
 
 HOUSEHOLD_OF_ANOTHER:
   2026-01-01: 51.69