Exclude kids with ESI from chip

changelog_entry.yaml

@@ -0,0 +1,4 @@
+- bump: patch
+  changes:
+    fixed:
+      - Exclude individuals with employer-sponsored insurance (ESI) from CHIP eligibility, per federal CHIP requirements.

policyengine_us/tests/policy/baseline/gov/hhs/chip/is_chip_eligible_child.yaml

@@ -0,0 +1,67 @@
+# Tests for is_chip_eligible_child variable
+# Children with ESI should not be eligible for CHIP
+# Using TX which has CHIP limit of 2.06 (206% FPL)
+
+- name: Child eligible for CHIP without ESI
+  period: 2023
+  input:
+    people:
+      child:
+        age: 10
+        is_medicaid_eligible: false
+        medicaid_income_level: 2.0  # 200% FPL - above Medicaid, below TX CHIP limit
+        has_esi: false
+    households:
+      household:
+        state_code: TX
+        members: [child]
+  output:
+    is_chip_eligible_child: true
+
+- name: Child ineligible for CHIP with ESI
+  period: 2023
+  input:
+    people:
+      child:
+        age: 10
+        is_medicaid_eligible: false
+        medicaid_income_level: 2.0  # 200% FPL - would qualify but has ESI
+        has_esi: true
+    households:
+      household:
+        state_code: TX
+        members: [child]
+  output:
+    is_chip_eligible_child: false
+
+- name: Child ineligible - too old
+  period: 2023
+  input:
+    people:
+      adult:
+        age: 20
+        is_medicaid_eligible: false
+        medicaid_income_level: 2.0
+        has_esi: false
+    households:
+      household:
+        state_code: TX
+        members: [adult]
+  output:
+    is_chip_eligible_child: false
+
+- name: Child ineligible - Medicaid eligible
+  period: 2023
+  input:
+    people:
+      child:
+        age: 10
+        is_medicaid_eligible: true
+        medicaid_income_level: 1.0  # 100% FPL - Medicaid eligible
+        has_esi: false
+    households:
+      household:
+        state_code: TX
+        members: [child]
+  output:
+    is_chip_eligible_child: false

policyengine_us/variables/gov/hhs/chip/is_chip_eligible_child.py

@@ -10,6 +10,8 @@ class is_chip_eligible_child(Variable):
     reference = (
         "https://www.ssa.gov/OP_Home/ssact/title21/2110.htm",
         "https://www.medicaid.gov/medicaid/national-medicaid-chip-program-information/medicaid-childrens-health-insurance-program-basic-health-program-eligibility-levels",
+        # Must not have other health insurance coverage
+        "https://www.healthcare.gov/medicaid-chip/childrens-health-insurance-program/",
     )
 
     def formula(person, period, parameters):
@@ -41,10 +43,14 @@ def formula(person, period, parameters):
         income_ratio = person("medicaid_income_level", period)
         income_eligible = income_ratio <= income_limit
 
+        # Must not have other health insurance coverage to qualify for CHIP
+        has_esi = person("has_esi", period)
+
         return (
             is_age_eligible
             & state_has_chip
             & immigration_eligible
             & ~medicaid_eligible
             & income_eligible
+            & ~has_esi
         )

policyengine_us/variables/gov/hhs/chip/is_chip_eligible_standard_pregnant_person.py

@@ -10,6 +10,8 @@ class is_chip_eligible_standard_pregnant_person(Variable):
     reference = (
         "https://www.ssa.gov/OP_Home/ssact/title21/2110.htm",
         "https://www.medicaid.gov/medicaid/national-medicaid-chip-program-information/medicaid-childrens-health-insurance-program-basic-health-program-eligibility-levels",
+        # 42 USC 1397ll defines targeted low-income pregnant woman without uninsured requirement
+        "https://uscode.house.gov/view.xhtml?req=(title:42+section:1397ll+edition:prelim)",
     )
 
     def formula(person, period, parameters):

policyengine_us/variables/gov/hhs/chip/is_chip_fcep_eligible_person.py

@@ -9,6 +9,8 @@ class is_chip_fcep_eligible_person(Variable):
     definition_period = YEAR
     reference = (
         "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",
+        # 42 USC 1397ll defines targeted low-income pregnant woman without uninsured requirement
+        "https://uscode.house.gov/view.xhtml?req=(title:42+section:1397ll+edition:prelim)",
     )
 
     def formula(person, period, parameters):