Add Emergency Medicaid for undocumented immigrants

[daphnehanse11]

Summary

Implements Emergency Medicaid eligibility for individuals who are ineligible for regular Medicaid due to immigration status but meet all other Medicaid eligibility requirements and have an emergency medical condition.

Closes #7003

Regulatory Authority

This implementation is based on:

• 42 USC 1396b(v)(2) - Exception for emergency services for aliens
  • (v)(2)(A): Person is not otherwise eligible due to immigration status
  • (v)(2)(B): Person meets all applicable Medicaid eligibility requirements except immigration status
  • (v)(2)(C): Organ transplant procedures are excluded
• 42 USC 1396b(v)(3) - Definition of emergency medical condition
• 8 USC 1611(b)(1)(A) - Exception for emergency medical care from public benefits restrictions
• 42 CFR 440.255 - Federal regulations on emergency services
• 42 CFR 435.406 - Citizenship and noncitizen eligibility

Eligibility Requirements

Per the statute, Emergency Medicaid eligibility requires all three conditions:

1. Immigration Status: Person is NOT eligible for regular Medicaid due to immigration status (uses existing is_medicaid_immigration_status_eligible variable)
2. Medicaid Requirements: Person meets all other Medicaid eligibility requirements including income and categorical eligibility (uses existing medicaid_category variable)
3. Emergency Condition: Person has an emergency medical condition as defined in 42 USC 1396b(v)(3)

Files Added

Parameters (5 files)

policyengine_us/parameters/gov/hhs/medicaid/emergency_medicaid/
├── index.yaml                        # Metadata (economy: false, household: false)
├── enabled.yaml                      # Program enabled from 1987
├── emergency_condition_definition.yaml  # Statutory definition criteria
├── organ_transplant_exclusion.yaml   # Organ transplant exclusion per (v)(2)(C)
└── uses_medicaid_income_thresholds.yaml  # Income threshold requirement

Variables (2 files)

policyengine_us/variables/gov/hhs/medicaid/emergency_medicaid/
├── has_emergency_medical_condition.py   # Input variable (boolean)
└── is_emergency_medicaid_eligible.py    # Eligibility calculation

Tests (3 files, 57 test cases)

policyengine_us/tests/policy/baseline/gov/hhs/medicaid/emergency_medicaid/
├── has_emergency_medical_condition.yaml  # 3 unit tests
├── is_emergency_medicaid_eligible.yaml   # 34 unit tests
└── integration.yaml                      # 20 integration tests

Test Coverage (57 tests)

Test Category	Count	Description
Unit tests - eligible cases	12	All immigration statuses and Medicaid categories
Unit tests - ineligible (regular Medicaid)	8	Citizens, LPRs, refugees, asylees
Unit tests - no emergency	2	Missing emergency condition
Unit tests - no Medicaid category	3	Income too high
Unit tests - edge cases	9	Pre-1987, condition combinations
Integration tests	20	Full pipeline with household structures
Input variable tests	3	has_emergency_medical_condition

Example Calculation

Scenario: Undocumented adult (age 35) with emergency medical condition and $18,000 income

1. is_medicaid_immigration_status_eligible: false (undocumented)
2. medicaid_category: ADULT (income < 138% FPL in expansion state)
3. has_emergency_medical_condition: true

Result: is_emergency_medicaid_eligible = true

Formula: enabled & has_emergency & (medicaid_category != NONE) & ~immigration_eligible

Implementation Notes

• Uses existing medicaid_category variable which handles all income/categorical eligibility checks
• Uses existing is_medicaid_immigration_status_eligible variable for immigration status
• has_emergency_medical_condition is an input variable (boolean) since emergency conditions are determined by medical providers, not calculated
• Program enabled starting 1987 (OBRA '86 created Emergency Medicaid)
• Parameters marked with economy: false and household: false since this is person-level eligibility

References

• 42 USC 1396b(v) - Emergency services exception
• 8 USC 1611(b)(1)(A) - Emergency medical care exception
• 42 CFR 440.255 - Emergency services regulations
• 42 CFR 435.406 - Noncitizen eligibility

[codecov]

Codecov Report

✅ All modified and coverable lines are covered by tests.
✅ Project coverage is 100.00%. Comparing base (9739e2f) to head (f847eff).
⚠️ Report is 25 commits behind head on main.

Additional details and impacted files

@@             Coverage Diff              @@
##             main     #7031       +/-   ##
============================================
+ Coverage   76.92%   100.00%   +23.07%     
============================================
  Files           1         2        +1     
  Lines          39        22       -17     
  Branches        4         0        -4     
============================================
- Hits           30        22        -8     
+ Misses          8         0        -8     
+ Partials        1         0        -1     

Flag	Coverage Δ
unittests	100.00% <100.00%> (+23.07%)	⬆️

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[daphnehanse11]

not a repeat, this is different than coverage for undocumented immigrants specifically in IL. this is national emergency care

[daphnehanse11]

Fixes Applied

Review Comments Addressed

• ✅ Deleted index.yaml - Unused metadata propagation file
• ✅ Deleted organ_transplant_exclusion.yaml - Unused parameter file
• ✅ Deleted emergency_condition_definition.yaml - Moved criteria to variable comments
• ✅ Updated has_emergency_medical_condition.py - Added documentation comments describing emergency condition criteria per 42 USC 1396b(v)(3)

Verification

• ✅ All 57 emergency_medicaid tests pass
• ✅ Code formatted with black

Ready for re-review.

[hua7450]

Delete has_emergency_medical_condition.yaml, then lgtm