DC Medicaid program for immigrants over 21

changelog_entry.yaml

@@ -0,0 +1,5 @@
+- bump: minor
+  changes:
+    added:
+    - DC coverage for undocumented immigrants with income and age restrictions. 
+

policyengine_us/parameters/gov/hhs/medicaid/eligibility/undocumented_immigrant.yaml

@@ -29,7 +29,7 @@ CO:
 CT:
   2021-01-01: false
 DC:
-  2021-01-01: true
+  2021-01-01: false  # DC now handles undocumented coverage through dc_medicaid_eligible
 DE:
   2021-01-01: false
 FL:

policyengine_us/parameters/gov/states/dc/dhcf/medicaid/eligibility/adult_income_limit.yaml

@@ -0,0 +1,12 @@
+description: The District of Columbia limits Medicaid/Alliance for adults (21+) to this percentage of the Federal Poverty Level.
+metadata:
+  unit: /1
+  period: year
+  label: DC Medicaid/Alliance income limit for adults
+  reference:
+    - title: DC Health Care Alliance and Immigrant Children's Program Changes
+      href: https://dhcf.dc.gov/node/1809101
+
+values:
+  2021-01-01: 2.15  # 215% FPL - current Alliance limit
+  2026-01-01: 1.38  # 138% FPL - new limit effective October 1, 2025 (modeled as 2026)

policyengine_us/parameters/gov/states/dc/dhcf/medicaid/eligibility/child_income_limit.yaml

@@ -0,0 +1,11 @@
+description: The District of Columbia limits Medicaid/Alliance for children (0-20) to this percentage of the Federal Poverty Level.
+metadata:
+  unit: /1
+  period: year
+  label: DC Medicaid/Alliance income limit for children
+  reference:
+    - title: DC Health Care Alliance and Immigrant Children's Program Changes
+      href: https://dhcf.dc.gov/node/1809101
+
+values:
+  2021-01-01: 3.24  # 324% FPL - no change mentioned

policyengine_us/parameters/gov/states/dc/dhcf/medicaid/eligibility/child_max_age.yaml

@@ -0,0 +1,11 @@
+description: The District of Columbia considers individuals up to this age as children for Medicaid eligibility purposes.
+metadata:
+  unit: year
+  period: year
+  label: DC Medicaid maximum age for child eligibility
+  reference:
+    - title: DC Health Care Alliance and Immigrant Children's Program Changes
+      href: https://dhcf.dc.gov/node/1809101
+
+values:
+  2021-01-01: 20  # Children aged 0-20 are eligible for higher income limits

policyengine_us/parameters/gov/states/dc/dhcf/medicaid/eligibility/covers_undocumented.yaml

@@ -0,0 +1,11 @@
+description: The District of Columbia provides Medicaid/Alliance coverage to undocumented immigrants.
+metadata:
+  unit: bool
+  period: year
+  label: DC covers undocumented immigrants
+  reference:
+    - title: DC Health Care Alliance and Immigrant Children's Program Changes
+      href: https://dhcf.dc.gov/node/1809101
+
+values:
+  2021-01-01: true

policyengine_us/parameters/gov/states/dc/dhcf/medicaid/eligibility/max_age_new_applicants.yaml

@@ -0,0 +1,12 @@
+description: The District of Columbia limits new Medicaid/Alliance applicants (excluding pregnant women) to this maximum age.
+metadata:
+  unit: year
+  period: year
+  label: DC Medicaid/Alliance maximum age for new applicants
+  reference:
+    - title: DC Health Care Alliance and Immigrant Children's Program Changes
+      href: https://dhcf.dc.gov/node/1809101
+
+values:
+  2021-01-01: .inf  # No age restriction before October 1, 2025
+  2026-01-01: 25    # New applicants 26+ not eligible starting October 1, 2025 (modeled as 2026)

policyengine_us/parameters/gov/states/dc/dhcf/medicaid/eligibility/pregnant_income_limit.yaml

@@ -0,0 +1,11 @@
+description: The District of Columbia limits Medicaid/Alliance for pregnant women to this percentage of the Federal Poverty Level.
+metadata:
+  unit: /1
+  period: year
+  label: DC Medicaid/Alliance income limit for pregnant women
+  reference:
+    - title: DC Health Care Alliance and Immigrant Children's Program Changes
+      href: https://dhcf.dc.gov/node/1809101
+
+values:
+  2021-01-01: 3.24  # 324% FPL for pregnant women regardless of immigration status

policyengine_us/tests/policy/baseline/gov/states/dc/dhcf/medicaid/costs/dc_medicaid_cost.yaml

@@ -0,0 +1,50 @@
+- name: DC Medicaid enrolled adult cost
+  period: 2024
+  absolute_error_margin: 0.01
+  input:
+    age: 30
+    dc_medicaid_enrolled: true
+    state_code: DC
+  output:
+    dc_medicaid_cost: 7_472.53  # DC-specific cost for expansion adults
+
+- name: DC Medicaid enrolled child cost
+  period: 2024
+  absolute_error_margin: 0.01
+  input:
+    age: 10
+    dc_medicaid_enrolled: true
+    state_code: DC
+  output:
+    dc_medicaid_cost: 4_621.95  # DC-specific cost for children
+
+- name: DC Medicaid enrolled disabled person cost
+  period: 2024
+  absolute_error_margin: 0.01
+  input:
+    age: 45
+    is_ssi_recipient_for_medicaid: true
+    dc_medicaid_enrolled: true
+    state_code: DC
+  output:
+    dc_medicaid_cost: 33_295.08  # DC-specific cost for aged/disabled
+
+- name: Not enrolled - zero cost
+  period: 2024
+  input:
+    age: 30
+    dc_medicaid_enrolled: false
+    state_code: DC
+  output:
+    dc_medicaid_cost: 0
+
+- name: DC Medicaid enrolled pregnant woman cost
+  period: 2024
+  absolute_error_margin: 0.01
+  input:
+    age: 25
+    is_pregnant: true
+    dc_medicaid_enrolled: true
+    state_code: DC
+  output:
+    dc_medicaid_cost: 7_551.72  # DC-specific cost for non-expansion adults (pregnant)

policyengine_us/tests/policy/baseline/gov/states/dc/dhcf/medicaid/costs/dc_medicaid_cost_if_enrolled.yaml

@@ -0,0 +1,61 @@
+- name: DC Medicaid adult cost if enrolled
+  period: 2024
+  absolute_error_margin: 0.01
+  input:
+    age: 30
+    dc_medicaid_enrolled: true
+    state_code: DC
+  output:
+    dc_medicaid_cost_if_enrolled: 7_472.53  # DC-specific cost for expansion adults
+
+- name: DC Medicaid child cost if enrolled
+  period: 2024
+  absolute_error_margin: 0.01
+  input:
+    age: 8
+    dc_medicaid_enrolled: true
+    state_code: DC
+  output:
+    dc_medicaid_cost_if_enrolled: 4_621.95  # DC-specific cost for children
+
+- name: DC Medicaid pregnant woman cost if enrolled
+  period: 2024
+  absolute_error_margin: 0.01
+  input:
+    age: 25
+    is_pregnant: true
+    dc_medicaid_enrolled: true
+    state_code: DC
+  output:
+    dc_medicaid_cost_if_enrolled: 7_551.72  # DC-specific cost for non-expansion adults (pregnant)
+
+- name: DC Medicaid elderly person cost if enrolled
+  period: 2024
+  absolute_error_margin: 0.01
+  input:
+    age: 70
+    dc_medicaid_enrolled: true
+    is_ssi_recipient_for_medicaid: true
+    state_code: DC
+  output:
+    dc_medicaid_cost_if_enrolled: 33_295.08  # DC-specific cost for aged/disabled
+
+- name: DC Medicaid young adult cost if enrolled (age 21)
+  period: 2024
+  absolute_error_margin: 0.01
+  input:
+    age: 21  # Age 21 is adult in DC (child_max_age = 20)
+    dc_medicaid_enrolled: true
+    state_code: DC
+  output:
+    dc_medicaid_cost_if_enrolled: 7_472.53  # DC-specific cost for expansion adults (21+)
+
+- name: DC Medicaid age 19 cost if enrolled (child in DC)
+  period: 2024
+  absolute_error_margin: 0.01
+  input:
+    age: 19  # Age 19 is still a child in DC (child_max_age = 20)
+    dc_medicaid_enrolled: true
+    state_code: DC
+  output:
+    dc_medicaid_cost_if_enrolled: 4_621.95  # DC-specific cost for children (age <= 20)

policyengine_us/tests/policy/baseline/gov/states/dc/dhcf/medicaid/eligibility/dc_medicaid_age_eligible.yaml

@@ -0,0 +1,92 @@
+# Minimal unit tests for age eligibility
+- name: Age 25 eligible in 2025
+  period: 2025
+  input:
+    age: 25
+    is_pregnant: false
+    dc_medicaid_enrolled: false
+    state_code: DC
+  output:
+    dc_medicaid_age_eligible: true  # No age restriction yet
+
+- name: Age 30 eligible in 2025
+  period: 2025
+  input:
+    age: 30
+    is_pregnant: false
+    dc_medicaid_enrolled: false
+    state_code: DC
+  output:
+    dc_medicaid_age_eligible: true  # No age restriction yet
+
+- name: Age 25 eligible in 2026
+  period: 2026
+  input:
+    age: 25
+    is_pregnant: false
+    dc_medicaid_enrolled: false
+    state_code: DC
+  output:
+    dc_medicaid_age_eligible: true  # Under 26
+
+- name: Age 30 not eligible in 2026 (new applicant)
+  period: 2026
+  input:
+    age: 30
+    is_pregnant: false
+    dc_medicaid_enrolled: false
+    state_code: DC
+  output:
+    dc_medicaid_age_eligible: false  # Over 25, not enrolled
+
+- name: Age 30 eligible in 2026 (already enrolled)
+  period: 2026
+  input:
+    age: 30
+    is_pregnant: false
+    dc_medicaid_enrolled: true  # Grandfathered
+    state_code: DC
+  output:
+    dc_medicaid_age_eligible: true  # Grandfathered
+
+- name: Pregnant woman any age eligible
+  period: 2026
+  input:
+    age: 35
+    is_pregnant: true
+    dc_medicaid_enrolled: false
+    state_code: DC
+  output:
+    dc_medicaid_age_eligible: true  # Pregnant women exempt
+
+# Age boundary tests at 25/26 threshold in 2026
+
+- name: Boundary - Age exactly 26 NOT eligible in 2026 (new applicant)
+  period: 2026
+  input:
+    age: 26
+    is_pregnant: false
+    dc_medicaid_enrolled: false
+    state_code: DC
+  output:
+    dc_medicaid_age_eligible: false  # Over 25, new applicant
+
+- name: Boundary - Age exactly 26 eligible in 2026 (grandfathered)
+  period: 2026
+  input:
+    age: 26
+    is_pregnant: false
+    dc_medicaid_enrolled: true  # Grandfathered
+    state_code: DC
+  output:
+    dc_medicaid_age_eligible: true  # Grandfathered enrollee
+
+- name: Boundary - Age 0 (newborn) eligible
+  period: 2026
+  input:
+    age: 0
+    is_pregnant: false
+    dc_medicaid_enrolled: false
+    state_code: DC
+  output:
+    dc_medicaid_age_eligible: true  # Newborn eligible

policyengine_us/tests/policy/baseline/gov/states/dc/dhcf/medicaid/eligibility/dc_medicaid_eligible.yaml

@@ -0,0 +1,98 @@
+# Unit tests for overall DC Medicaid/Alliance eligibility
+# DC Alliance is for immigrants not eligible for federal Medicaid
+
+- name: Eligible - undocumented immigrant meeting all criteria
+  period: 2025
+  input:
+    age: 25
+    is_pregnant: false
+    dc_medicaid_enrolled: false
+    immigration_status: UNDOCUMENTED
+    medicaid_income_level: 1.0  # 100% FPL
+    state_code: DC
+  output:
+    dc_medicaid_eligible: true
+
+- name: Eligible - DACA recipient meeting all criteria
+  period: 2025
+  input:
+    age: 25
+    is_pregnant: false
+    dc_medicaid_enrolled: false
+    immigration_status: DACA
+    medicaid_income_level: 1.0  # 100% FPL
+    state_code: DC
+  output:
+    dc_medicaid_eligible: true
+
+- name: Not eligible - US citizen (should use federal Medicaid)
+  period: 2025
+  input:
+    age: 25
+    is_pregnant: false
+    dc_medicaid_enrolled: false
+    immigration_status: CITIZEN
+    medicaid_income_level: 1.0  # 100% FPL
+    state_code: DC
+  output:
+    dc_medicaid_eligible: false
+
+- name: Not eligible - income too high
+  period: 2025
+  input:
+    age: 25
+    is_pregnant: false
+    dc_medicaid_enrolled: false
+    immigration_status: UNDOCUMENTED
+    medicaid_income_level: 2.5  # 250% FPL (above 215% limit)
+    state_code: DC
+  output:
+    dc_medicaid_eligible: false
+
+- name: Not eligible - age too high in 2026 (new applicant)
+  period: 2026
+  input:
+    age: 30
+    is_pregnant: false
+    dc_medicaid_enrolled: false
+    immigration_status: UNDOCUMENTED
+    medicaid_income_level: 1.0  # 100% FPL
+    state_code: DC
+  output:
+    dc_medicaid_eligible: false
+
+- name: Eligible - grandfathered by age (existing enrollee)
+  period: 2026
+  input:
+    age: 30
+    is_pregnant: false
+    dc_medicaid_enrolled: true  # Grandfathered
+    immigration_status: UNDOCUMENTED
+    medicaid_income_level: 1.0  # 100% FPL
+    state_code: DC
+  output:
+    dc_medicaid_eligible: true
+
+- name: Not eligible - LPR should use federal Medicaid
+  period: 2025
+  input:
+    age: 25
+    is_pregnant: false
+    dc_medicaid_enrolled: false
+    immigration_status: LEGAL_PERMANENT_RESIDENT
+    medicaid_income_level: 1.0  # 100% FPL
+    state_code: DC
+  output:
+    dc_medicaid_eligible: false
+
+- name: Eligible - TPS recipient meeting all criteria
+  period: 2025
+  input:
+    age: 25
+    is_pregnant: false
+    dc_medicaid_enrolled: false
+    immigration_status: TPS
+    medicaid_income_level: 1.0  # 100% FPL
+    state_code: DC
+  output:
+    dc_medicaid_eligible: true