Reworking HR1 Medicaid Rules

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

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+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/work_requirements/has_medicaid_work_requirement_exemption.yaml

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+- name: Return false if no conditions set
+  period: 2027
+  output:
+    has_medicaid_work_requirement_exemption: false
+
+- name: Return true if is_totally_disabled_veteran
+  period: 2027
+  input:
+    is_totally_disabled_veteran: true
+  output:
+    has_medicaid_work_requirement_exemption: true
+
+- name: Return true if is_medically_frail
+  period: 2027
+  input:
+    is_medically_frail: true
+  output:
+    has_medicaid_work_requirement_exemption: true
+
+

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

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+- 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

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+- 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/variables/gov/hhs/medicaid/eligibility/has_medicaid_work_requirement_exemption.py

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+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 = YEAR
+    reference = "https://www.congress.gov/bill/119th-congress/house-bill/1/text"
+
+    def formula(person, period, parameters):
+        is_totally_disabled_veteran = person("is_totally_disabled_veteran", period)
+        is_medically_frail = person("is_medically_frail", period)
+
+        return (
+            is_totally_disabled_veteran or
+            is_medically_frail
+        )

policyengine_us/variables/gov/hhs/medicaid/eligibility/work_requirements/has_adl_impairment.py

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+from policyengine_us.model_api import *
+
+
+class has_adl_impairment(Variable):
+    # criteria not yet defined by CMS, so treating as simple boolean for now
+    value_type = bool
+    entity = Person
+    label = "Is unable to perform 1 or more Activities of Daily Living"
+    definition_period = YEAR
+    reference = "https://www.congress.gov/bill/119th-congress/house-bill/1/text"
+    default_value = False

policyengine_us/variables/gov/hhs/medicaid/eligibility/work_requirements/has_disabling_mental_disorder.py

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+from policyengine_us.model_api import *
+
+
+class has_disabling_mental_disorder(Variable):
+    # criteria not yet defined by CMS, so treating as simple boolean for now
+    value_type = bool
+    entity = Person
+    label = "Has a disabling mental health condition as defined for HR. 1"
+    definition_period = YEAR
+    reference = "https://www.congress.gov/bill/119th-congress/house-bill/1/text"
+    default_value = False

policyengine_us/variables/gov/hhs/medicaid/eligibility/work_requirements/has_serious_or_complex_medical_condition.py

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+#!/usr/bin/env python3
+
+from policyengine_us.model_api import *
+
+
+class has_serious_or_complex_medical_condition(Variable):
+    # criteria not yet defined by CMS, so treating as simple boolean for now
+    value_type = bool
+    entity = Person
+    label = "Has a serious or complex medical condition"
+    definition_period = YEAR
+    reference = "https://www.congress.gov/bill/119th-congress/house-bill/1/text"
+    default_value = False
+

policyengine_us/variables/gov/hhs/medicaid/eligibility/work_requirements/has_substance_use_disorder.py

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+#!/usr/bin/env python3
+
+from policyengine_us.model_api import *
+
+
+class has_substance_use_disorder(Variable):
+    # criteria not yet defined by CMS, so treating as simple boolean for now
+    value_type = bool
+    entity = Person
+    label = "Substance Use Disorder as a measure of medically frail"
+    definition_period = YEAR
+    reference = "https://www.congress.gov/bill/119th-congress/house-bill/1/text"
+    default_value = False

policyengine_us/variables/gov/hhs/medicaid/eligibility/work_requirements/is_disabled.py

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+#!/usr/bin/env python3
+

policyengine_us/variables/gov/hhs/medicaid/eligibility/work_requirements/is_medically_frail.py

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+from policyengine_us.model_api import *
+
+
+class is_medically_frail(Variable):
+    value_type = bool
+    entity = Person
+    label = "The community engagement rules for Medicaid CE define a few different conditions for medical frailty or special needs"
+    definition_period = YEAR
+    reference = "https://www.congress.gov/bill/119th-congress/house-bill/1/text"
+
+    def formula(person, period, parameters) -> bool:
+        is_blind: bool = person("is_blind", period)
+        is_ssi_disabled: bool = person("is_ssi_disabled", period)
+        has_substance_use_disorder: bool = person("has_substance_use_disorder", period)
+        has_disabling_mental_disorder: bool = person("has_disabling_mental_disorder", period)
+        has_adl_impairment: bool = person("has_adl_impairment", period)
+        has_serious_or_complex_medical_condition: bool = person("has_serious_or_complex_medical_condition", period)
+
+
+        return (
+            is_blind or
+            is_ssi_disabled or
+            has_substance_use_disorder or
+            has_disabling_mental_disorder or
+            has_adl_impairment or
+            has_serious_or_complex_medical_condition
+        )

policyengine_us/variables/gov/hhs/medicaid/eligibility/work_requirements/is_totally_disabled_veteran.py

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+from policyengine_us.model_api import *
+
+
+class is_totally_disabled_veteran(Variable):
+    value_type = bool
+    entity = Person
+    label = "Eligible for Medicaid CE exemption for disabled veterans"
+    definition_period = YEAR
+    reference = "https://www.congress.gov/bill/119th-congress/house-bill/1/text"
+
+    def formula(person, period, parameters):
+        vet_disability_minimum: int = parameters(period).gov.hhs.medicaid.eligibility.work_requirements.total_veteran_disability_minimum
+
+        is_veteran = person("is_veteran", period)
+        veteran_disability_rating = person(
+            "veteran_disability_rating", period
+        )
+
+        return is_veteran and veteran_disability_rating >= vet_disability_minimum
+

policyengine_us/variables/household/demographic/person/veteran_disability_rating.py

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+from policyengine_us.model_api import *
+
+
+class veteran_disability_rating(Variable):
+    value_type = int
+    entity = Person
+    label = "The overall veteran disability rating for the individual"
+    definition_period = YEAR
+    default_value = 0
+    reference = "https://www.law.cornell.edu/uscode/text/38/1155"
+