Reworking HR1 Medicaid Rules

policyengine_us/parameters/gov/hhs/medicaid/eligibility/work_requirements/total_veteran_disability_minimum.yaml

@@ -0,0 +1,14 @@
+description: The Department of Health and Human Services exempts Medicaid work requirement for veterans with an overall disability rating of 100
+
+values:
+  2027-01-01: 100
+
+metadata:
+  unit: year
+  label: Veteran Disability Rating Minimum
+  period: year
+  reference:
+    - title: H.R.1 - One Big Beautiful Bill Act
+      href: https://www.congress.gov/bill/119th-congress/house-bill/1/text
+    - title: 38 U.S. Code § 1155 - Authority for schedule for rating disabilities
+      href: https://www.law.cornell.edu/uscode/text/38/1155

policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/medicaid_work_requirement_eligible.yaml

@@ -1,86 +1,86 @@
 - name: Case 1, age 18, work exempted age. 
-  period: 2026
+  period: 2027-03
   input:
     age: 18
   output:
     medicaid_work_requirement_eligible: true
 
 - name: Case 2, age 65, work exempted age. 
-  period: 2026
+  period: 2027-03
   input:
     age: 65
   output:
     medicaid_work_requirement_eligible: true
 
 - name: Case 3, age 19, need working. 
-  period: 2026
+  period: 2027-03
   input:
     age: 19
   output:
     medicaid_work_requirement_eligible: false
 
 - name: Case 4, age 30, working 79 hours per month. 
-  period: 2026
+  period: 2027-03
   input:
     age: 30
-    monthly_hours_worked: 79
+    ce_activity_hours: 79
   output:
     medicaid_work_requirement_eligible: false
 
 - name: Case 5, age 30, working 80 hours per month. 
-  period: 2026
+  period: 2027-03
   input:
     age: 30
-    monthly_hours_worked: 80
+    ce_activity_hours: 80
   output:
     medicaid_work_requirement_eligible: true
 
 - name: Case 6, age 30, is disabled. 
-  period: 2026
+  period: 2027-03
   input:
     age: 19
-    monthly_hours_worked: 5
+    ce_activity_hours: 5
     is_disabled: true
   output:
     medicaid_work_requirement_eligible: true
 
 - name: Case 7, integration. 
-  period: 2026
+  period: 2027-03
   input:
     people:
       person1:
         age: 30
         is_tax_unit_head_or_spouse: true
-        monthly_hours_worked: 80
+        ce_activity_hours: 80
       person2:
         age: 30
         is_tax_unit_head_or_spouse: true
-        monthly_hours_worked: 79
+        ce_activity_hours: 79
   output:
     medicaid_work_requirement_eligible: [true, false]
 
 - name: Case 8, not working, but has child at age 13. 
-  period: 2026
+  period: 2027-03
   input:
     people:
       person1:
         age: 30
         is_tax_unit_head_or_spouse: true
-        monthly_hours_worked: 0
+        ce_activity_hours: 0
       person2:
         age: 13
         is_tax_unit_dependent: true
   output:
     medicaid_work_requirement_eligible: [true, true]
 
 - name: Case 9, not working, has child at age 14, ineligible under Senate Version. 
-  period: 2026
+  period: 2027-03
   input:
     people:
       person1:
         age: 30
         is_tax_unit_head_or_spouse: true
-        monthly_hours_worked: 0
+        ce_activity_hours: 0
       person2:
         age: 14
         is_tax_unit_dependent: true

policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/work_requirements/has_age_exemption.yaml

@@ -0,0 +1,19 @@
+- name: Return false if no conditions set
+  period: 2027-03
+  output:
+    has_age_exemption: false
+
+- name: Return true if less than 19
+  period: 2027-03
+  input:
+    age: 18
+  output:
+    has_age_exemption: true
+
+- name: Return true if greater than or equal to 65
+  period: 2027-03
+  input:
+    age: 65
+  output:
+    has_age_exemption: true
+

policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/work_requirements/has_medicaid_work_requirement_ce.yaml

@@ -0,0 +1,39 @@
+- name: Return false if no conditions set
+  period: 2027-03
+  output:
+    has_medicaid_work_requirement_ce: false
+
+- name: Return true if enrolled at least half-time
+  period: 2027-03
+  input:
+    enrolled_half_time_or_more: true
+  output:
+    has_medicaid_work_requirement_ce: true
+
+- name: Return false if hours are too low
+  period: 2027-03
+  input:
+    ce_activity_hours: 79.5
+  output:
+    has_medicaid_work_requirement_ce: false
+
+- name: Return true if hours >= 80
+  period: 2027-03
+  input:
+    ce_activity_hours: 80
+  output:
+    has_medicaid_work_requirement_ce: true
+
+- name: Return false if income < 580
+  period: 2027-03
+  input:
+    ce_activity_income: 579.50
+  output:
+    has_medicaid_work_requirement_ce: false
+
+- name: Return true if income >= 580
+  period: 2027-03
+  input:
+    ce_activity_income: 580
+  output:
+    has_medicaid_work_requirement_ce: true

policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/work_requirements/has_medicaid_work_requirement_exemption.yaml

@@ -0,0 +1,39 @@
+- name: Return false if no conditions set
+  period: '2027-03'
+  output:
+    has_medicaid_work_requirement_exemption: false
+
+- name: Return true if is_totally_disabled_veteran
+  period: '2027-03'
+  input:
+    is_totally_disabled_veteran: true
+  output:
+    has_medicaid_work_requirement_exemption: true
+
+- name: Return true if is_medically_frail
+  period: '2027-03'
+  input:
+    is_medically_frail: true
+  output:
+    has_medicaid_work_requirement_exemption: true
+
+- name: Return true if is_pregnant
+  period: '2027-03'
+  input:
+    is_pregnant: true
+  output:
+    has_medicaid_work_requirement_exemption: true
+
+- name: Return true if <19 years old
+  period: '2027-03'
+  input:
+    age: 18
+  output:
+    has_medicaid_work_requirement_exemption: true
+
+- name: Return true if 65 or older
+  period: '2027-03'
+  input:
+    age: 65
+  output:
+    has_medicaid_work_requirement_exemption: true

policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/work_requirements/is_medically_frail.yaml

@@ -0,0 +1,52 @@
+- name: Return false if no conditions set
+  period: 2027
+  output:
+    is_medically_frail: false
+
+
+- name: return true if blind
+  period: 2027
+  input:
+    is_blind: true
+  output:
+    is_medically_frail: true
+
+
+- name: return true if has disability as defined by SSI
+  period: 2027
+  input:
+    is_ssi_disabled: true
+  output:
+    is_medically_frail: true
+
+
+- name: return true if has substance_use_disorder
+  period: 2027
+  input:
+    has_substance_use_disorder: true
+  output:
+    is_medically_frail: true
+
+
+- name: return true if has_disabling_mental_disorder
+  period: 2027
+  input:
+    has_disabling_mental_disorder: true
+  output:
+    is_medically_frail: true
+
+
+- name: return true if has_adl_impairment
+  period: 2027
+  input:
+    has_adl_impairment: true
+  output:
+    is_medically_frail: true
+
+
+- name: return true if has_serious_or_complex_medical_condition
+  period: 2027
+  input:
+    has_serious_or_complex_medical_condition: true
+  output:
+    is_medically_frail: true

policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/work_requirements/is_totally_disabled_veteran.yaml

@@ -0,0 +1,26 @@
+- name: Return false if is_veteran is not set
+  period: 2027
+  input:
+    is_veteran: false
+    veteran_disability_rating: 100
+  output:
+    is_totally_disabled_veteran: false
+
+
+- name: Return false if veteran_disability_rating < 100
+  period: 2027
+  input:
+    is_veteran: true
+    veteran_disability_rating: 90
+  output:
+    is_totally_disabled_veteran: false
+
+
+- name: Return true if veteran and veteran_disability_rating >= 100
+  period: 2027
+  input:
+    is_veteran: true
+    veteran_disability_rating: 100 
+  output:
+    is_totally_disabled_veteran: true
+

policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/work_requirements/medicaid_work_income_threshold.yaml

@@ -0,0 +1,4 @@
+- name: should equal the federal minimum wage multiplied by the work hours requirement
+  period: 2027-01
+  output:
+    medicaid_work_income_threshold: 580

policyengine_us/variables/gov/hhs/medicaid/eligibility/has_medicaid_work_requirement_ce.py

@@ -0,0 +1,22 @@
+from policyengine_us.model_api import *
+
+
+class has_medicaid_work_requirement_ce(Variable):
+    value_type = bool
+    entity = Person
+    label = "Has demonstrated Community Engagement (CE) compliance for Medicaid work requirements"
+    definition_period = MONTH
+    reference = "https://www.congress.gov/bill/119th-congress/house-bill/1/text"
+
+    def formula(person, period, parameters) -> bool:
+        enrolled_half_time = person("enrolled_half_time_or_more", period)
+
+        monthly_hours_worked = person("ce_activity_hours", period)
+        hours_threshold = parameters(period).gov.hhs.medicaid.eligibility.work_requirements.monthly_hours_threshold
+        passed_hours: bool = monthly_hours_worked >= hours_threshold
+
+        monthly_income_earned = person("ce_activity_income", period)
+        income_threshold = person("medicaid_work_income_threshold", period)
+        passed_income: bool = monthly_income_earned >= income_threshold
+
+        return enrolled_half_time or passed_hours or passed_income

policyengine_us/variables/gov/hhs/medicaid/eligibility/has_medicaid_work_requirement_exemption.py

@@ -0,0 +1,29 @@
+from policyengine_us.model_api import *
+
+
+class has_medicaid_work_requirement_exemption(Variable):
+    value_type = bool
+    entity = Person
+    label = "Has an exemption for Medicaid work requirements"
+    definition_period = MONTH
+    reference = "https://www.congress.gov/bill/119th-congress/house-bill/1/text"
+
+    def formula(person, period, parameters):
+        has_age_exemption = person("has_age_exemption", period)
+        is_totally_disabled_veteran = person("is_totally_disabled_veteran", period)
+        is_medically_frail = person("is_medically_frail", period)
+        is_pregnant = person("is_pregnant", period)
+        has_young_dependent = person("has_young_dependent", period)
+        is_disabled = person("is_disabled", period)
+        has_disabled_dependent = person("has_disabled_dependent", period)
+
+
+        return (
+            has_age_exemption or
+            is_pregnant or
+            is_totally_disabled_veteran or
+            is_medically_frail or
+            is_disabled or
+            has_disabled_dependent or
+            has_young_dependent
+        )

policyengine_us/variables/gov/hhs/medicaid/eligibility/in_medicaid_expansion.py

@@ -0,0 +1,11 @@
+from policyengine_us.model_api import *
+
+
+class has_work_requirement(Variable):
+    # FIXME Replace with formula based on MAGI and needing financial qualifications
+    value_type = bool
+    entity = Person
+    label = "Required to do the Medicaid work requirement"
+    definition_period = MONTH
+    reference = "https://www.congress.gov/bill/119th-congress/house-bill/1/text"
+    default_value: False