policyengine-us 1.458.0__py3-none-any.whl → 1.471.0__py3-none-any.whl

policyengine_us/tests/policy/baseline/gov/hhs/medicaid/emergency_medicaid/is_emergency_medicaid_eligible.yaml

@@ -0,0 +1,376 @@
+# Unit tests for is_emergency_medicaid_eligible variable
+# Per 42 USC 1396b(v)(2), Emergency Medicaid eligibility requires:
+# 1. Person is NOT eligible for regular Medicaid due to immigration status
+# 2. Person meets other Medicaid eligibility requirements (income, categorical)
+# 3. Person has an emergency medical condition
+#
+# Reference: https://www.law.cornell.edu/uscode/text/42/1396b#v
+
+# ============================================================
+# ELIGIBLE CASES - Undocumented/ineligible immigrants with emergency
+# ============================================================
+
+- name: Case 1, undocumented immigrant with emergency condition and low income.
+  period: 2025
+  input:
+    immigration_status: UNDOCUMENTED
+    has_emergency_medical_condition: true
+    medicaid_category: ADULT
+    is_medicaid_immigration_status_eligible: false
+  output:
+    is_emergency_medicaid_eligible: true
+
+- name: Case 2, DACA recipient with emergency condition.
+  period: 2025
+  input:
+    immigration_status: DACA
+    has_emergency_medical_condition: true
+    medicaid_category: ADULT
+    is_medicaid_immigration_status_eligible: false
+  output:
+    is_emergency_medicaid_eligible: true
+
+- name: Case 3, TPS recipient with emergency condition.
+  period: 2025
+  input:
+    immigration_status: TPS
+    has_emergency_medical_condition: true
+    medicaid_category: ADULT
+    is_medicaid_immigration_status_eligible: false
+  output:
+    is_emergency_medicaid_eligible: true
+
+- name: Case 4, DACA-TPS combined status with emergency condition.
+  period: 2025
+  input:
+    immigration_status: DACA_TPS
+    has_emergency_medical_condition: true
+    medicaid_category: ADULT
+    is_medicaid_immigration_status_eligible: false
+  output:
+    is_emergency_medicaid_eligible: true
+
+# ============================================================
+# ELIGIBLE CASES - All Medicaid Category Types
+# ============================================================
+
+- name: Case 5, undocumented infant with emergency condition.
+  period: 2025
+  input:
+    immigration_status: UNDOCUMENTED
+    has_emergency_medical_condition: true
+    medicaid_category: INFANT
+    is_medicaid_immigration_status_eligible: false
+  output:
+    is_emergency_medicaid_eligible: true
+
+- name: Case 6, undocumented young child with emergency condition.
+  period: 2025
+  input:
+    immigration_status: UNDOCUMENTED
+    has_emergency_medical_condition: true
+    medicaid_category: YOUNG_CHILD
+    is_medicaid_immigration_status_eligible: false
+  output:
+    is_emergency_medicaid_eligible: true
+
+- name: Case 7, undocumented older child with emergency condition.
+  period: 2025
+  input:
+    immigration_status: UNDOCUMENTED
+    has_emergency_medical_condition: true
+    medicaid_category: OLDER_CHILD
+    is_medicaid_immigration_status_eligible: false
+  output:
+    is_emergency_medicaid_eligible: true
+
+- name: Case 8, undocumented young adult with emergency condition.
+  period: 2025
+  input:
+    immigration_status: UNDOCUMENTED
+    has_emergency_medical_condition: true
+    medicaid_category: YOUNG_ADULT
+    is_medicaid_immigration_status_eligible: false
+  output:
+    is_emergency_medicaid_eligible: true
+
+- name: Case 9, undocumented parent with emergency condition.
+  period: 2025
+  input:
+    immigration_status: UNDOCUMENTED
+    has_emergency_medical_condition: true
+    medicaid_category: PARENT
+    is_medicaid_immigration_status_eligible: false
+  output:
+    is_emergency_medicaid_eligible: true
+
+- name: Case 10, undocumented pregnant woman with emergency condition.
+  period: 2025
+  input:
+    immigration_status: UNDOCUMENTED
+    has_emergency_medical_condition: true
+    medicaid_category: PREGNANT
+    is_medicaid_immigration_status_eligible: false
+  output:
+    is_emergency_medicaid_eligible: true
+
+- name: Case 11, undocumented SSI recipient with emergency condition.
+  period: 2025
+  input:
+    immigration_status: UNDOCUMENTED
+    has_emergency_medical_condition: true
+    medicaid_category: SSI_RECIPIENT
+    is_medicaid_immigration_status_eligible: false
+  output:
+    is_emergency_medicaid_eligible: true
+
+- name: Case 12, undocumented senior or disabled with emergency condition.
+  period: 2025
+  input:
+    immigration_status: UNDOCUMENTED
+    has_emergency_medical_condition: true
+    medicaid_category: SENIOR_OR_DISABLED
+    is_medicaid_immigration_status_eligible: false
+  output:
+    is_emergency_medicaid_eligible: true
+
+# ============================================================
+# INELIGIBLE CASES - US citizens and qualified aliens
+# (Should get regular Medicaid, not Emergency Medicaid)
+# ============================================================
+
+- name: Case 13, US citizen should get regular Medicaid not Emergency Medicaid.
+  period: 2025
+  input:
+    immigration_status: CITIZEN
+    has_emergency_medical_condition: true
+    medicaid_category: ADULT
+    is_medicaid_immigration_status_eligible: true
+  output:
+    is_emergency_medicaid_eligible: false
+
+- name: Case 14, legal permanent resident eligible for regular Medicaid.
+  period: 2025
+  input:
+    immigration_status: LEGAL_PERMANENT_RESIDENT
+    has_emergency_medical_condition: true
+    medicaid_category: ADULT
+    is_medicaid_immigration_status_eligible: true
+  output:
+    is_emergency_medicaid_eligible: false
+
+- name: Case 15, refugee should get regular Medicaid not Emergency Medicaid.
+  period: 2025
+  input:
+    immigration_status: REFUGEE
+    has_emergency_medical_condition: true
+    medicaid_category: ADULT
+    is_medicaid_immigration_status_eligible: true
+  output:
+    is_emergency_medicaid_eligible: false
+
+- name: Case 16, asylee should get regular Medicaid not Emergency Medicaid.
+  period: 2025
+  input:
+    immigration_status: ASYLEE
+    has_emergency_medical_condition: true
+    medicaid_category: ADULT
+    is_medicaid_immigration_status_eligible: true
+  output:
+    is_emergency_medicaid_eligible: false
+
+- name: Case 17, deportation withheld status eligible for regular Medicaid.
+  period: 2025
+  input:
+    immigration_status: DEPORTATION_WITHHELD
+    has_emergency_medical_condition: true
+    medicaid_category: ADULT
+    is_medicaid_immigration_status_eligible: true
+  output:
+    is_emergency_medicaid_eligible: false
+
+- name: Case 18, Cuban-Haitian entrant eligible for regular Medicaid.
+  period: 2025
+  input:
+    immigration_status: CUBAN_HAITIAN_ENTRANT
+    has_emergency_medical_condition: true
+    medicaid_category: ADULT
+    is_medicaid_immigration_status_eligible: true
+  output:
+    is_emergency_medicaid_eligible: false
+
+- name: Case 19, conditional entrant eligible for regular Medicaid.
+  period: 2025
+  input:
+    immigration_status: CONDITIONAL_ENTRANT
+    has_emergency_medical_condition: true
+    medicaid_category: ADULT
+    is_medicaid_immigration_status_eligible: true
+  output:
+    is_emergency_medicaid_eligible: false
+
+- name: Case 20, paroled one year eligible for regular Medicaid.
+  period: 2025
+  input:
+    immigration_status: PAROLED_ONE_YEAR
+    has_emergency_medical_condition: true
+    medicaid_category: ADULT
+    is_medicaid_immigration_status_eligible: true
+  output:
+    is_emergency_medicaid_eligible: false
+
+# ============================================================
+# INELIGIBLE CASES - No emergency medical condition
+# ============================================================
+
+- name: Case 21, undocumented immigrant without emergency condition.
+  period: 2025
+  input:
+    immigration_status: UNDOCUMENTED
+    has_emergency_medical_condition: false
+    medicaid_category: ADULT
+    is_medicaid_immigration_status_eligible: false
+  output:
+    is_emergency_medicaid_eligible: false
+
+- name: Case 22, DACA recipient without emergency condition.
+  period: 2025
+  input:
+    immigration_status: DACA
+    has_emergency_medical_condition: false
+    medicaid_category: ADULT
+    is_medicaid_immigration_status_eligible: false
+  output:
+    is_emergency_medicaid_eligible: false
+
+# ============================================================
+# INELIGIBLE CASES - No Medicaid category eligibility
+# ============================================================
+
+- name: Case 23, undocumented immigrant with emergency but no Medicaid category.
+  period: 2025
+  input:
+    immigration_status: UNDOCUMENTED
+    has_emergency_medical_condition: true
+    medicaid_category: NONE
+    is_medicaid_immigration_status_eligible: false
+  output:
+    is_emergency_medicaid_eligible: false
+
+- name: Case 24, DACA recipient with emergency but no Medicaid category.
+  period: 2025
+  input:
+    immigration_status: DACA
+    has_emergency_medical_condition: true
+    medicaid_category: NONE
+    is_medicaid_immigration_status_eligible: false
+  output:
+    is_emergency_medicaid_eligible: false
+
+- name: Case 25, TPS recipient with emergency but no Medicaid category.
+  period: 2025
+  input:
+    immigration_status: TPS
+    has_emergency_medical_condition: true
+    medicaid_category: NONE
+    is_medicaid_immigration_status_eligible: false
+  output:
+    is_emergency_medicaid_eligible: false
+
+# ============================================================
+# EDGE CASES - Program enabled check (pre-1987)
+# ============================================================
+
+- name: Case 26, program not enabled before 1987.
+  period: 1986
+  input:
+    immigration_status: UNDOCUMENTED
+    has_emergency_medical_condition: true
+    medicaid_category: ADULT
+    is_medicaid_immigration_status_eligible: false
+  output:
+    is_emergency_medicaid_eligible: false
+
+- name: Case 27, program enabled starting 1987.
+  period: 1987
+  input:
+    immigration_status: UNDOCUMENTED
+    has_emergency_medical_condition: true
+    medicaid_category: ADULT
+    is_medicaid_immigration_status_eligible: false
+  output:
+    is_emergency_medicaid_eligible: true
+
+# ============================================================
+# EDGE CASES - All conditions must be met
+# ============================================================
+
+- name: Case 28, all conditions false.
+  period: 2025
+  input:
+    immigration_status: CITIZEN
+    has_emergency_medical_condition: false
+    medicaid_category: NONE
+    is_medicaid_immigration_status_eligible: true
+  output:
+    is_emergency_medicaid_eligible: false
+
+- name: Case 29, only emergency condition true.
+  period: 2025
+  input:
+    immigration_status: CITIZEN
+    has_emergency_medical_condition: true
+    medicaid_category: NONE
+    is_medicaid_immigration_status_eligible: true
+  output:
+    is_emergency_medicaid_eligible: false
+
+- name: Case 30, only medicaid category met.
+  period: 2025
+  input:
+    immigration_status: CITIZEN
+    has_emergency_medical_condition: false
+    medicaid_category: ADULT
+    is_medicaid_immigration_status_eligible: true
+  output:
+    is_emergency_medicaid_eligible: false
+
+- name: Case 31, only immigration ineligible.
+  period: 2025
+  input:
+    immigration_status: UNDOCUMENTED
+    has_emergency_medical_condition: false
+    medicaid_category: NONE
+    is_medicaid_immigration_status_eligible: false
+  output:
+    is_emergency_medicaid_eligible: false
+
+- name: Case 32, emergency and immigration ineligible but no category.
+  period: 2025
+  input:
+    immigration_status: UNDOCUMENTED
+    has_emergency_medical_condition: true
+    medicaid_category: NONE
+    is_medicaid_immigration_status_eligible: false
+  output:
+    is_emergency_medicaid_eligible: false
+
+- name: Case 33, category and immigration ineligible but no emergency.
+  period: 2025
+  input:
+    immigration_status: UNDOCUMENTED
+    has_emergency_medical_condition: false
+    medicaid_category: ADULT
+    is_medicaid_immigration_status_eligible: false
+  output:
+    is_emergency_medicaid_eligible: false
+
+- name: Case 34, category and emergency but immigration eligible.
+  period: 2025
+  input:
+    immigration_status: CITIZEN
+    has_emergency_medical_condition: true
+    medicaid_category: ADULT
+    is_medicaid_immigration_status_eligible: true
+  output:
+    is_emergency_medicaid_eligible: false

policyengine_us/tests/policy/baseline/gov/hhs/medicare/savings_programs/category/msp_category.yaml

@@ -0,0 +1,69 @@
+# MSP uses SSI income methodology per 42 U.S.C. 1396d(p)(1)(B):
+# Countable = unearned - $20 (or earned - $85 - 50% remaining)
+# For 2024 individual FPL = $15,060:
+#   QMB: <= 100% = $1,255/month countable
+#   SLMB: 100-120% = $1,255.01-$1,506/month countable
+#   QI: 120-135% = $1,506.01-$1,694.25/month countable
+
+- name: MSP category - QMB (income at 100% FPL)
+  period: 2024-01
+  input:
+    age: 67
+    is_medicare_eligible: true
+    # $12,000 unearned -> ($1,000 - $20) = $980/month countable
+    # $980 < $1,255 (100% FPL) -> QMB
+    ssi_unearned_income: 12_000
+    spm_unit_cash_assets: 5_000
+    spm_unit_is_married: false
+  output:
+    msp_category: QMB
+
+- name: MSP category - SLMB (income between 100-120% FPL)
+  period: 2024-01
+  input:
+    age: 67
+    is_medicare_eligible: true
+    # $16,500 unearned -> ($1,375 - $20) = $1,355/month countable
+    # $1,255 < $1,355 < $1,506 (100-120% FPL) -> SLMB
+    ssi_unearned_income: 16_500
+    spm_unit_cash_assets: 5_000
+    spm_unit_is_married: false
+  output:
+    msp_category: SLMB
+
+- name: MSP category - QI (income between 120-135% FPL)
+  period: 2024-01
+  input:
+    age: 67
+    is_medicare_eligible: true
+    # $19,440 unearned -> ($1,620 - $20) = $1,600/month countable
+    # $1,506 < $1,600 < $1,694.25 (120-135% FPL) -> QI
+    ssi_unearned_income: 19_440
+    spm_unit_cash_assets: 5_000
+    spm_unit_is_married: false
+  output:
+    msp_category: QI
+
+- name: MSP category - NONE (income above 135% FPL)
+  period: 2024-01
+  input:
+    age: 67
+    is_medicare_eligible: true
+    # $21_840 unearned -> ($1,820 - $20) = $1,800/month countable
+    # $1,800 > $1,694.25 (135% FPL) -> NONE
+    ssi_unearned_income: 21_840
+    spm_unit_cash_assets: 5_000
+    spm_unit_is_married: false
+  output:
+    msp_category: NONE
+
+- name: MSP category - NONE (not Medicare eligible)
+  period: 2024-01
+  input:
+    age: 60
+    is_medicare_eligible: false
+    ssi_unearned_income: 10_000
+    spm_unit_cash_assets: 5_000
+    spm_unit_is_married: false
+  output:
+    msp_category: NONE

policyengine_us/tests/policy/baseline/gov/hhs/medicare/savings_programs/eligibility/msp_eligible.yaml

@@ -0,0 +1,62 @@
+# MSP uses SSI income methodology per 42 U.S.C. 1396d(p)(1)(B)
+
+- name: MSP eligible - QMB level (65+, low income, low assets)
+  period: 2024-01
+  input:
+    age: 67
+    is_medicare_eligible: true
+    # $10,000 unearned -> ($833.33 - $20) = $813.33/month countable
+    ssi_unearned_income: 10_000
+    spm_unit_cash_assets: 5_000
+    spm_unit_is_married: false
+  output:
+    msp_eligible: true
+
+- name: MSP eligible - QI level (65+, moderate income, low assets)
+  period: 2024-01
+  input:
+    age: 68
+    is_medicare_eligible: true
+    # $19_200 unearned -> ($1,600 - $20) = $1,580/month countable
+    # $1,580 is between 120% ($1,506) and 135% ($1,694.25) FPL -> QI eligible
+    ssi_unearned_income: 19_200
+    spm_unit_cash_assets: 8_000
+    spm_unit_is_married: false
+  output:
+    msp_eligible: true
+
+- name: MSP not eligible - income too high
+  period: 2024-01
+  input:
+    age: 67
+    is_medicare_eligible: true
+    # $24_000 unearned -> ($2,000 - $20) = $1,980/month countable
+    # $1,980 > $1,694.25 (135% FPL) -> not eligible
+    ssi_unearned_income: 24_000
+    spm_unit_cash_assets: 5_000
+    spm_unit_is_married: false
+  output:
+    msp_eligible: false
+
+- name: MSP not eligible - assets too high
+  period: 2024-01
+  input:
+    age: 67
+    is_medicare_eligible: true
+    ssi_unearned_income: 10_000
+    spm_unit_cash_assets: 15_000  # Over $9,430 limit
+    spm_unit_is_married: false
+    state_code: TX  # Use a state with asset test
+  output:
+    msp_eligible: false
+
+- name: MSP not eligible - not Medicare eligible
+  period: 2024-01
+  input:
+    age: 60  # Under 65
+    is_medicare_eligible: false
+    ssi_unearned_income: 10_000
+    spm_unit_cash_assets: 5_000
+    spm_unit_is_married: false
+  output:
+    msp_eligible: false

policyengine_us/tests/policy/baseline/gov/hhs/medicare/savings_programs/income/msp_fpg.yaml

@@ -0,0 +1,22 @@
+# MSP uses individual (1 person) or couple (2 persons) FPL,
+# not the full SPM unit size per 42 U.S.C. 1396d(p)
+# 2024 FPL: individual = $15,060, couple = $20,440
+# Note: Published limits are $20 higher (FPL + $20 exclusion built in)
+# Our implementation applies $20 exclusion to income instead - mathematically equivalent
+
+- name: Case 1, single person gets individual FPL.
+  period: 2024-01
+  input:
+    spm_unit_is_married: false
+  output:
+    # Individual FPL = $15,060/year, monthly = $1,255
+    msp_fpg: 1_255
+
+- name: Case 2, married couple gets couple FPL.
+  period: 2024-01
+  absolute_error_margin: 0.01
+  input:
+    spm_unit_is_married: true
+  output:
+    # Couple FPL = $20,440/year, monthly = $1,703.33
+    msp_fpg: 1_703.33

policyengine_us/tests/policy/baseline/gov/hhs/medicare/savings_programs/integration.yaml

@@ -0,0 +1,84 @@
+# MSP uses SSI income methodology per 42 U.S.C. 1396d(p)(1)(B)
+# For married couples, MSP uses couple FPL = $20,440 for 2024
+
+- name: MSP integration - married couple, both QMB eligible
+  period: 2024-01
+  input:
+    people:
+      spouse1:
+        age: 68
+        is_medicare_eligible: true
+        # $9,000 unearned each -> ($750 - $20) = $730/month countable each
+        ssi_unearned_income: 9_000
+      spouse2:
+        age: 66
+        is_medicare_eligible: true
+        ssi_unearned_income: 9_000
+    spm_units:
+      spm_unit:
+        members: [spouse1, spouse2]
+        spm_unit_is_married: true
+        spm_unit_cash_assets: 10_000  # Under $14,130 couple limit
+    tax_units:
+      tax_unit:
+        members: [spouse1, spouse2]
+    households:
+      household:
+        members: [spouse1, spouse2]
+  output:
+    msp_eligible: [true, true]
+    msp_category: [QMB, QMB]
+
+- name: MSP integration - single senior, SLMB level
+  period: 2024-01
+  input:
+    people:
+      person1:
+        age: 70
+        is_medicare_eligible: true
+        base_part_a_premium: 0
+        base_part_b_premium: 2_096.40  # $174.70 * 12
+        # $16_500 unearned -> ($1,375 - $20) = $1,355/month countable
+        # $1,255 < $1,355 < $1,506 (100-120% FPL) -> SLMB
+        ssi_unearned_income: 16_500
+    spm_units:
+      spm_unit:
+        members: [person1]
+        spm_unit_is_married: false
+        spm_unit_cash_assets: 8_000
+    tax_units:
+      tax_unit:
+        members: [person1]
+    households:
+      household:
+        members: [person1]
+  output:
+    msp_eligible: [true]
+    msp_category: [SLMB]
+    msp_benefit_value: [174.70]
+    msp: [174.70]
+
+- name: MSP integration - not eligible, assets over limit
+  period: 2024-01
+  input:
+    people:
+      person1:
+        age: 67
+        is_medicare_eligible: true
+        ssi_unearned_income: 10_000
+    spm_units:
+      spm_unit:
+        members: [person1]
+        spm_unit_is_married: false
+        spm_unit_cash_assets: 12_000  # Over $9,430 individual limit
+    tax_units:
+      tax_unit:
+        members: [person1]
+    households:
+      household:
+        members: [person1]
+        state_code: TX  # Use a state with asset test
+  output:
+    msp_eligible: [false]
+    msp_category: [NONE]
+    msp: [0]

policyengine_us/tests/policy/baseline/gov/hhs/medicare/savings_programs/msp_benefit_value.yaml

@@ -0,0 +1,62 @@
+# MSP uses SSI income methodology per 42 U.S.C. 1396d(p)(1)(B)
+
+- name: MSP benefit - QMB (Part A + Part B premiums)
+  period: 2024-01
+  input:
+    age: 67
+    is_medicare_eligible: true
+    # $12,000 unearned -> ($1,000 - $20) = $980/month countable
+    # $980 < $1,255 (100% FPL) -> QMB
+    ssi_unearned_income: 12_000
+    spm_unit_cash_assets: 5_000
+    spm_unit_is_married: false
+    base_part_a_premium: 6_060  # Annual Part A premium ($505/month * 12)
+    base_part_b_premium: 2_096.40  # Annual Part B premium ($174.70/month * 12)
+  output:
+    # (505 + 174.70) = 679.70/month
+    msp_benefit_value: 679.70
+
+- name: MSP benefit - SLMB (Part B premium only)
+  period: 2024-01
+  input:
+    age: 67
+    is_medicare_eligible: true
+    # $16,500 unearned -> ($1,375 - $20) = $1,355/month countable
+    # $1,255 < $1,355 < $1,506 (100-120% FPL) -> SLMB
+    ssi_unearned_income: 16_500
+    spm_unit_cash_assets: 5_000
+    spm_unit_is_married: false
+    base_part_a_premium: 0  # Assume premium-free Part A
+    base_part_b_premium: 2_096.40
+  output:
+    msp_benefit_value: 174.70
+
+- name: MSP benefit - QI (Part B premium only)
+  period: 2024-01
+  input:
+    age: 67
+    is_medicare_eligible: true
+    # $19,440 unearned -> ($1,620 - $20) = $1,600/month countable
+    # $1,506 < $1,600 < $1,694.25 (120-135% FPL) -> QI
+    ssi_unearned_income: 19_440
+    spm_unit_cash_assets: 5_000
+    spm_unit_is_married: false
+    base_part_a_premium: 0
+    base_part_b_premium: 2_096.40
+  output:
+    msp_benefit_value: 174.70
+
+- name: MSP benefit - not eligible (zero benefit)
+  period: 2024-01
+  input:
+    age: 67
+    is_medicare_eligible: true
+    # $24_000 unearned -> ($2,000 - $20) = $1,980/month countable
+    # $1,980 > $1,694.25 (135% FPL) -> not eligible
+    ssi_unearned_income: 24_000
+    spm_unit_cash_assets: 5_000
+    spm_unit_is_married: false
+    base_part_a_premium: 0
+    base_part_b_premium: 2_096.40
+  output:
+    msp_benefit_value: 0