From 5caac33a06e0a91b95e30b78de479114041dd31a Mon Sep 17 00:00:00 2001 From: Daphne Hansell Date: Tue, 23 Dec 2025 13:20:47 -0500 Subject: [PATCH 1/6] Initial commit for Emergency Medicaid for undocumented immigrants implementation Starting implementation of Emergency Medicaid for undocumented immigrants. Documentation and parallel development will follow. Closes #7003 From 1619c5c953e49d3ea2a20d12641732e4c8c3b45c Mon Sep 17 00:00:00 2001 From: Daphne Hansell Date: Tue, 23 Dec 2025 14:13:37 -0500 Subject: [PATCH 2/6] Add Emergency Medicaid eligibility for undocumented immigrants MIME-Version: 1.0 Content-Type: text/plain; charset=UTF-8 Content-Transfer-Encoding: 8bit Implements federal Emergency Medicaid program per 42 USC 1396b(v), which provides limited Medicaid coverage for emergency medical conditions to individuals who would otherwise be eligible for Medicaid but for their immigration status. Key components: - has_emergency_medical_condition: Input variable for emergency condition - is_emergency_medicaid_eligible: Main eligibility determination - Parameters for program configuration and statutory references 🤖 Generated with [Claude Code](https://claude.com/claude-code) Co-Authored-By: Claude Opus 4.5 --- changelog_entry.yaml | 4 + .../emergency_condition_definition.yaml | 16 + .../medicaid/emergency_medicaid/enabled.yaml | 14 + .../medicaid/emergency_medicaid/index.yaml | 4 + .../organ_transplant_exclusion.yaml | 13 + .../uses_medicaid_income_thresholds.yaml | 13 + .../has_emergency_medical_condition.yaml | 29 + .../emergency_medicaid/integration.yaml | 667 ++++++++++++++++++ .../is_emergency_medicaid_eligible.yaml | 376 ++++++++++ .../has_emergency_medical_condition.py | 13 + .../is_emergency_medicaid_eligible.py | 33 + 11 files changed, 1182 insertions(+) create mode 100644 policyengine_us/parameters/gov/hhs/medicaid/emergency_medicaid/emergency_condition_definition.yaml create mode 100644 policyengine_us/parameters/gov/hhs/medicaid/emergency_medicaid/enabled.yaml create mode 100644 policyengine_us/parameters/gov/hhs/medicaid/emergency_medicaid/index.yaml create mode 100644 policyengine_us/parameters/gov/hhs/medicaid/emergency_medicaid/organ_transplant_exclusion.yaml create mode 100644 policyengine_us/parameters/gov/hhs/medicaid/emergency_medicaid/uses_medicaid_income_thresholds.yaml create mode 100644 policyengine_us/tests/policy/baseline/gov/hhs/medicaid/emergency_medicaid/has_emergency_medical_condition.yaml create mode 100644 policyengine_us/tests/policy/baseline/gov/hhs/medicaid/emergency_medicaid/integration.yaml create mode 100644 policyengine_us/tests/policy/baseline/gov/hhs/medicaid/emergency_medicaid/is_emergency_medicaid_eligible.yaml create mode 100644 policyengine_us/variables/gov/hhs/medicaid/emergency_medicaid/has_emergency_medical_condition.py create mode 100644 policyengine_us/variables/gov/hhs/medicaid/emergency_medicaid/is_emergency_medicaid_eligible.py diff --git a/changelog_entry.yaml b/changelog_entry.yaml index e69de29bb2d..243a11b1695 100644 --- a/changelog_entry.yaml +++ b/changelog_entry.yaml @@ -0,0 +1,4 @@ +- bump: minor + changes: + added: + - Add Emergency Medicaid eligibility for undocumented immigrants diff --git a/policyengine_us/parameters/gov/hhs/medicaid/emergency_medicaid/emergency_condition_definition.yaml b/policyengine_us/parameters/gov/hhs/medicaid/emergency_medicaid/emergency_condition_definition.yaml new file mode 100644 index 00000000000..4b4d4ef885b --- /dev/null +++ b/policyengine_us/parameters/gov/hhs/medicaid/emergency_medicaid/emergency_condition_definition.yaml @@ -0,0 +1,16 @@ +description: The United States defines emergency medical condition as a condition manifesting by acute symptoms where absence of immediate medical attention could result in these outcomes. +values: + 1987-01-01: + - PLACING_HEALTH_IN_SERIOUS_JEOPARDY + - SERIOUS_IMPAIRMENT_TO_BODILY_FUNCTIONS + - SERIOUS_DYSFUNCTION_OF_BODILY_ORGAN_OR_PART + +metadata: + unit: list + period: year + label: Emergency Medicaid emergency medical condition definition criteria + reference: + - title: 42 USC 1396b(v)(3) - Definition of Emergency Medical Condition + href: https://www.law.cornell.edu/uscode/text/42/1396b#v_3 + - title: 42 CFR 440.255(c) - Emergency Services Definition + href: https://www.law.cornell.edu/cfr/text/42/440.255#c diff --git a/policyengine_us/parameters/gov/hhs/medicaid/emergency_medicaid/enabled.yaml b/policyengine_us/parameters/gov/hhs/medicaid/emergency_medicaid/enabled.yaml new file mode 100644 index 00000000000..320d9f2428c --- /dev/null +++ b/policyengine_us/parameters/gov/hhs/medicaid/emergency_medicaid/enabled.yaml @@ -0,0 +1,14 @@ +description: The United States provides Emergency Medicaid for individuals who meet Medicaid eligibility requirements but for their immigration status. +values: + 0001-01-01: false + 1987-01-01: true + +metadata: + unit: bool + period: year + label: Emergency Medicaid enabled + reference: + - title: 42 USC 1396b(v)(2) - Exception for Emergency Medical Services + href: https://www.law.cornell.edu/uscode/text/42/1396b#v + - title: 8 USC 1611(b)(1)(A) - Exception for Emergency Medical Care + href: https://www.law.cornell.edu/uscode/text/8/1611#b_1_A diff --git a/policyengine_us/parameters/gov/hhs/medicaid/emergency_medicaid/index.yaml b/policyengine_us/parameters/gov/hhs/medicaid/emergency_medicaid/index.yaml new file mode 100644 index 00000000000..2852e302ad0 --- /dev/null +++ b/policyengine_us/parameters/gov/hhs/medicaid/emergency_medicaid/index.yaml @@ -0,0 +1,4 @@ +metadata: + propagate_metadata_to_children: true + economy: false + household: false diff --git a/policyengine_us/parameters/gov/hhs/medicaid/emergency_medicaid/organ_transplant_exclusion.yaml b/policyengine_us/parameters/gov/hhs/medicaid/emergency_medicaid/organ_transplant_exclusion.yaml new file mode 100644 index 00000000000..3b81dc3a37e --- /dev/null +++ b/policyengine_us/parameters/gov/hhs/medicaid/emergency_medicaid/organ_transplant_exclusion.yaml @@ -0,0 +1,13 @@ +description: The United States excludes organ transplant procedures from Emergency Medicaid coverage. +values: + 1987-01-01: true + +metadata: + unit: bool + period: year + label: Emergency Medicaid organ transplant exclusion + reference: + - title: 42 USC 1396b(v)(2)(C) - Organ Transplant Exclusion + href: https://www.law.cornell.edu/uscode/text/42/1396b#v_2_C + - title: 8 USC 1611(b)(1)(A) - Exception for Emergency Medical Care + href: https://www.law.cornell.edu/uscode/text/8/1611#b_1_A diff --git a/policyengine_us/parameters/gov/hhs/medicaid/emergency_medicaid/uses_medicaid_income_thresholds.yaml b/policyengine_us/parameters/gov/hhs/medicaid/emergency_medicaid/uses_medicaid_income_thresholds.yaml new file mode 100644 index 00000000000..83fa01576f4 --- /dev/null +++ b/policyengine_us/parameters/gov/hhs/medicaid/emergency_medicaid/uses_medicaid_income_thresholds.yaml @@ -0,0 +1,13 @@ +description: The United States requires Emergency Medicaid applicants to meet the same income thresholds as regular Medicaid for their eligibility category. +values: + 1987-01-01: true + +metadata: + unit: bool + period: year + label: Emergency Medicaid uses Medicaid income thresholds + reference: + - title: 42 USC 1396b(v)(2)(B) - Emergency Medicaid Eligibility Requirements + href: https://www.law.cornell.edu/uscode/text/42/1396b#v_2_B + - title: 42 CFR 435.406 - Citizenship and Noncitizen Eligibility + href: https://www.law.cornell.edu/cfr/text/42/435.406 diff --git a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/emergency_medicaid/has_emergency_medical_condition.yaml b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/emergency_medicaid/has_emergency_medical_condition.yaml new file mode 100644 index 00000000000..0952f8e665f --- /dev/null +++ b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/emergency_medicaid/has_emergency_medical_condition.yaml @@ -0,0 +1,29 @@ +# Unit tests for has_emergency_medical_condition input variable +# This is a boolean input variable indicating presence of emergency medical condition +# Per 42 USC 1396b(v)(3), an emergency medical condition is defined as: +# - A medical condition (including emergency labor and delivery) +# - Manifesting itself by acute symptoms of sufficient severity (including severe pain) +# - Such that absence of immediate medical attention could reasonably result in: +# (A) placing the patient's health in serious jeopardy +# (B) serious impairment to bodily functions +# (C) serious dysfunction of any bodily organ or part + +- name: Case 1, person has emergency medical condition. + period: 2025 + input: + has_emergency_medical_condition: true + output: + has_emergency_medical_condition: true + +- name: Case 2, person does not have emergency medical condition. + period: 2025 + input: + has_emergency_medical_condition: false + output: + has_emergency_medical_condition: false + +- name: Case 3, default value (no emergency condition). + period: 2025 + input: {} + output: + has_emergency_medical_condition: false diff --git a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/emergency_medicaid/integration.yaml b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/emergency_medicaid/integration.yaml new file mode 100644 index 00000000000..dfc67e6e773 --- /dev/null +++ b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/emergency_medicaid/integration.yaml @@ -0,0 +1,667 @@ +# Integration tests for Emergency Medicaid +# Per 42 USC 1396b(v), Emergency Medicaid provides coverage for individuals who: +# 1. Are NOT eligible for regular Medicaid due to immigration status +# 2. Meet all other Medicaid eligibility requirements (income, categorical) +# 3. Have an emergency medical condition +# +# References: +# - 42 USC 1396b(v): https://www.law.cornell.edu/uscode/text/42/1396b#v +# - 42 CFR 440.255: https://www.law.cornell.edu/cfr/text/42/440.255 +# - 8 USC 1611(b)(1)(A): https://www.law.cornell.edu/uscode/text/8/1611#b_1_A +# +# 2025 FPL for 1 person in contiguous US: $15,650 +# 133% FPL (Medicaid adult threshold): ~$20,815 +# 138% FPL (with 5% disregard): ~$21,597 + +# ============================================================ +# ELIGIBLE CASES - Integration tests showing full pipeline +# ============================================================ + +- name: Case 1, undocumented single adult with emergency condition and low income. + period: 2025 + absolute_error_margin: 0.01 + input: + people: + person1: + age: 35 + employment_income: 18_000 + immigration_status: UNDOCUMENTED + has_emergency_medical_condition: true + tax_units: + tax_unit: + members: [person1] + spm_units: + spm_unit: + members: [person1] + households: + household: + members: [person1] + # Using CO (Medicaid expansion state) instead of TX (non-expansion) + # CO does NOT cover undocumented immigrants + state_code: CO + output: + # Immigration status check + # Undocumented immigrants are not eligible for regular Medicaid in CO + is_medicaid_immigration_status_eligible: [false] + # Has emergency condition + has_emergency_medical_condition: [true] + # Income: $18,000 < ~$21,597 (138% FPL with 5% disregard), meets income requirement + # Medicaid category should be ADULT (age 35, income-eligible in expansion state) + # Therefore eligible for Emergency Medicaid + is_emergency_medicaid_eligible: [true] + +- name: Case 2, US citizen with emergency condition should get regular Medicaid. + period: 2025 + absolute_error_margin: 0.01 + input: + people: + person1: + age: 30 + employment_income: 18_000 + immigration_status: CITIZEN + has_emergency_medical_condition: true + tax_units: + tax_unit: + members: [person1] + spm_units: + spm_unit: + members: [person1] + households: + household: + members: [person1] + state_code: TX + output: + # Citizens are eligible for regular Medicaid + is_medicaid_immigration_status_eligible: [true] + # Has emergency condition + has_emergency_medical_condition: [true] + # Should NOT be eligible for Emergency Medicaid (gets regular Medicaid instead) + is_emergency_medicaid_eligible: [false] + +- name: Case 3, undocumented adult without emergency condition. + period: 2025 + absolute_error_margin: 0.01 + input: + people: + person1: + age: 40 + employment_income: 15_000 + immigration_status: UNDOCUMENTED + has_emergency_medical_condition: false + tax_units: + tax_unit: + members: [person1] + spm_units: + spm_unit: + members: [person1] + households: + household: + members: [person1] + state_code: FL + output: + # Undocumented, not eligible for regular Medicaid + is_medicaid_immigration_status_eligible: [false] + # No emergency condition + has_emergency_medical_condition: [false] + # Not eligible - missing emergency condition requirement + is_emergency_medicaid_eligible: [false] + +- name: Case 4, undocumented pregnant woman in labor. + period: 2025 + absolute_error_margin: 0.01 + input: + people: + person1: + age: 28 + employment_income: 20_000 + immigration_status: UNDOCUMENTED + is_pregnant: true + has_emergency_medical_condition: true + tax_units: + tax_unit: + members: [person1] + spm_units: + spm_unit: + members: [person1] + households: + household: + members: [person1] + state_code: AZ + output: + # Undocumented, not eligible for regular Medicaid in AZ + is_medicaid_immigration_status_eligible: [false] + # Pregnant with emergency condition (labor and delivery is emergency per statute) + is_pregnant: [true] + has_emergency_medical_condition: [true] + # Income $20,000 is below pregnant woman threshold (typically 133-319% FPL) + # Eligible for Emergency Medicaid for labor and delivery + is_emergency_medicaid_eligible: [true] + +- name: Case 5, undocumented adult with income too high. + period: 2025 + absolute_error_margin: 0.01 + input: + people: + person1: + age: 45 + employment_income: 50_000 + immigration_status: UNDOCUMENTED + has_emergency_medical_condition: true + tax_units: + tax_unit: + members: [person1] + spm_units: + spm_unit: + members: [person1] + households: + household: + members: [person1] + state_code: OH + output: + # Undocumented, not eligible for regular Medicaid + is_medicaid_immigration_status_eligible: [false] + # Has emergency condition + has_emergency_medical_condition: [true] + # Income $50,000 >> ~$20,815 (133% FPL for single adult) + # Does not meet Medicaid income eligibility - medicaid_category should be NONE + # Not eligible for Emergency Medicaid due to income + is_emergency_medicaid_eligible: [false] + +- name: Case 6, DACA recipient with emergency condition. + period: 2025 + absolute_error_margin: 0.01 + input: + people: + person1: + age: 25 + employment_income: 16_000 + immigration_status: DACA + has_emergency_medical_condition: true + tax_units: + tax_unit: + members: [person1] + spm_units: + spm_unit: + members: [person1] + households: + household: + members: [person1] + # Using NV (Medicaid expansion state) instead of GA (non-expansion) + # NV does NOT cover undocumented/DACA immigrants + state_code: NV + output: + # DACA recipients generally not eligible for regular Medicaid in most states + is_medicaid_immigration_status_eligible: [false] + # Has emergency condition + has_emergency_medical_condition: [true] + # Income $16,000 < ~$21,597 (138% FPL with 5% disregard), meets income requirement + # Eligible for Emergency Medicaid + is_emergency_medicaid_eligible: [true] + +- name: Case 7, legal permanent resident should get regular Medicaid. + period: 2025 + absolute_error_margin: 0.01 + input: + people: + person1: + age: 50 + employment_income: 14_000 + immigration_status: LEGAL_PERMANENT_RESIDENT + has_emergency_medical_condition: true + tax_units: + tax_unit: + members: [person1] + spm_units: + spm_unit: + members: [person1] + households: + household: + members: [person1] + state_code: NY + output: + # LPRs are eligible for regular Medicaid + is_medicaid_immigration_status_eligible: [true] + # Has emergency condition + has_emergency_medical_condition: [true] + # Should NOT be eligible for Emergency Medicaid (gets regular Medicaid instead) + is_emergency_medicaid_eligible: [false] + +# ============================================================ +# EDGE CASES - Zero income +# ============================================================ + +- name: Case 8, undocumented adult with zero income and emergency. + period: 2025 + absolute_error_margin: 0.01 + input: + people: + person1: + age: 35 + employment_income: 0 + immigration_status: UNDOCUMENTED + has_emergency_medical_condition: true + tax_units: + tax_unit: + members: [person1] + spm_units: + spm_unit: + members: [person1] + households: + household: + members: [person1] + # Using CO instead of CA (CA covers undocumented immigrants) + # CO is a Medicaid expansion state that does NOT cover undocumented + state_code: CO + output: + # Zero income - definitely meets income requirements + # Undocumented, not eligible for regular Medicaid in CO + is_medicaid_immigration_status_eligible: [false] + # Has emergency condition + has_emergency_medical_condition: [true] + # Should be eligible for Emergency Medicaid + is_emergency_medicaid_eligible: [true] + +# ============================================================ +# EDGE CASES - Multiple people in household +# ============================================================ + +- name: Case 9, mixed household with citizen parent and undocumented child. + period: 2025 + absolute_error_margin: 0.01 + input: + people: + person1: + age: 35 + employment_income: 25_000 + immigration_status: CITIZEN + has_emergency_medical_condition: false + person2: + age: 10 + immigration_status: UNDOCUMENTED + has_emergency_medical_condition: true + tax_units: + tax_unit: + members: [person1, person2] + spm_units: + spm_unit: + members: [person1, person2] + households: + household: + members: [person1, person2] + state_code: TX + output: + # Person1 (citizen) is eligible for regular Medicaid + # Person2 (undocumented child) is NOT eligible for regular Medicaid + is_medicaid_immigration_status_eligible: [true, false] + # Person1 has no emergency, Person2 has emergency + has_emergency_medical_condition: [false, true] + # Person1: Citizen, so not eligible for Emergency Medicaid (gets regular) + # Person2: Undocumented child with emergency, should be eligible + is_emergency_medicaid_eligible: [false, true] + +- name: Case 10, household with two undocumented adults only one with emergency. + period: 2025 + absolute_error_margin: 0.01 + input: + people: + person1: + age: 40 + employment_income: 20_000 + immigration_status: UNDOCUMENTED + has_emergency_medical_condition: true + person2: + age: 38 + employment_income: 15_000 + immigration_status: UNDOCUMENTED + has_emergency_medical_condition: false + tax_units: + tax_unit: + members: [person1, person2] + spm_units: + spm_unit: + members: [person1, person2] + households: + household: + members: [person1, person2] + state_code: NV + output: + # Both undocumented, neither eligible for regular Medicaid + is_medicaid_immigration_status_eligible: [false, false] + # Person1 has emergency, Person2 does not + has_emergency_medical_condition: [true, false] + # Combined income $35,000 for 2-person household + # 2-person FPL = $21,150, 138% FPL = $29,187 + # Income level = $35,000 / $21,150 = 1.65 (165% FPL) > 138% limit + # Both have medicaid_category = NONE due to income exceeding limit + # Neither eligible for Emergency Medicaid (no valid Medicaid category) + is_emergency_medicaid_eligible: [false, false] + +- name: Case 11, household with undocumented parent and citizen child. + period: 2025 + absolute_error_margin: 0.01 + input: + people: + person1: + age: 32 + employment_income: 18_000 + immigration_status: UNDOCUMENTED + has_emergency_medical_condition: true + person2: + age: 5 + immigration_status: CITIZEN + has_emergency_medical_condition: true + tax_units: + tax_unit: + members: [person1, person2] + spm_units: + spm_unit: + members: [person1, person2] + households: + household: + members: [person1, person2] + state_code: FL + output: + # Person1 (undocumented) NOT eligible for regular Medicaid + # Person2 (citizen child) IS eligible for regular Medicaid + is_medicaid_immigration_status_eligible: [false, true] + # Both have emergency conditions + has_emergency_medical_condition: [true, true] + # Person1: FL has no Medicaid expansion (adult income limit = -inf) + # So person1 has medicaid_category = NONE, not eligible for Emergency Medicaid + # Person2: Citizen child - gets regular Medicaid, NOT Emergency Medicaid + is_emergency_medicaid_eligible: [false, false] + +# ============================================================ +# EDGE CASES - Large household +# ============================================================ + +- name: Case 12, large household with mixed immigration status and emergency conditions. + period: 2025 + absolute_error_margin: 0.01 + input: + people: + person1: + age: 45 + employment_income: 40_000 + immigration_status: CITIZEN + has_emergency_medical_condition: false + person2: + age: 42 + immigration_status: UNDOCUMENTED + has_emergency_medical_condition: true + person3: + age: 16 + immigration_status: UNDOCUMENTED + has_emergency_medical_condition: false + person4: + age: 12 + immigration_status: CITIZEN + has_emergency_medical_condition: true + person5: + age: 8 + immigration_status: UNDOCUMENTED + has_emergency_medical_condition: true + tax_units: + tax_unit: + members: [person1, person2, person3, person4, person5] + spm_units: + spm_unit: + members: [person1, person2, person3, person4, person5] + households: + household: + members: [person1, person2, person3, person4, person5] + state_code: AZ + output: + # Person1: Citizen - eligible for regular Medicaid + # Person2: Undocumented - NOT eligible for regular Medicaid + # Person3: Undocumented - NOT eligible for regular Medicaid + # Person4: Citizen - eligible for regular Medicaid + # Person5: Undocumented - NOT eligible for regular Medicaid + is_medicaid_immigration_status_eligible: [true, false, false, true, false] + # Emergency conditions: 1=F, 2=T, 3=F, 4=T, 5=T + has_emergency_medical_condition: [false, true, false, true, true] + # Person1: Citizen, no emergency - NOT eligible for Emergency Medicaid + # Person2: Undocumented, emergency - ELIGIBLE for Emergency Medicaid + # Person3: Undocumented, no emergency - NOT eligible + # Person4: Citizen, emergency - gets regular Medicaid instead + # Person5: Undocumented, emergency - ELIGIBLE for Emergency Medicaid + is_emergency_medicaid_eligible: [false, true, false, false, true] + +# ============================================================ +# EDGE CASES - All immigration status types in household +# ============================================================ + +- name: Case 13, TPS recipient with emergency condition. + period: 2025 + absolute_error_margin: 0.01 + input: + people: + person1: + age: 30 + employment_income: 15_000 + immigration_status: TPS + has_emergency_medical_condition: true + tax_units: + tax_unit: + members: [person1] + spm_units: + spm_unit: + members: [person1] + households: + household: + members: [person1] + state_code: IL + output: + # TPS generally not eligible for regular Medicaid + is_medicaid_immigration_status_eligible: [false] + has_emergency_medical_condition: [true] + # Should be eligible for Emergency Medicaid + is_emergency_medicaid_eligible: [true] + +- name: Case 14, refugee with emergency should get regular Medicaid. + period: 2025 + absolute_error_margin: 0.01 + input: + people: + person1: + age: 28 + employment_income: 12_000 + immigration_status: REFUGEE + has_emergency_medical_condition: true + tax_units: + tax_unit: + members: [person1] + spm_units: + spm_unit: + members: [person1] + households: + household: + members: [person1] + state_code: MI + output: + # Refugees ARE eligible for regular Medicaid + is_medicaid_immigration_status_eligible: [true] + has_emergency_medical_condition: [true] + # Should NOT be eligible for Emergency Medicaid (gets regular instead) + is_emergency_medicaid_eligible: [false] + +- name: Case 15, asylee with emergency should get regular Medicaid. + period: 2025 + absolute_error_margin: 0.01 + input: + people: + person1: + age: 33 + employment_income: 10_000 + immigration_status: ASYLEE + has_emergency_medical_condition: true + tax_units: + tax_unit: + members: [person1] + spm_units: + spm_unit: + members: [person1] + households: + household: + members: [person1] + state_code: WA + output: + # Asylees ARE eligible for regular Medicaid + is_medicaid_immigration_status_eligible: [true] + has_emergency_medical_condition: [true] + # Should NOT be eligible for Emergency Medicaid + is_emergency_medicaid_eligible: [false] + +# ============================================================ +# EDGE CASES - Age boundaries +# ============================================================ + +- name: Case 16, undocumented newborn with emergency. + period: 2025 + absolute_error_margin: 0.01 + input: + people: + person1: + age: 0 + immigration_status: UNDOCUMENTED + has_emergency_medical_condition: true + tax_units: + tax_unit: + members: [person1] + spm_units: + spm_unit: + members: [person1] + households: + household: + members: [person1] + state_code: TX + output: + # Undocumented infant not eligible for regular Medicaid + is_medicaid_immigration_status_eligible: [false] + has_emergency_medical_condition: [true] + # Should be eligible for Emergency Medicaid (if meets Medicaid category) + is_emergency_medicaid_eligible: [true] + +- name: Case 17, undocumented elderly person with emergency. + period: 2025 + absolute_error_margin: 0.01 + input: + people: + person1: + age: 75 + employment_income: 10_000 + immigration_status: UNDOCUMENTED + has_emergency_medical_condition: true + tax_units: + tax_unit: + members: [person1] + spm_units: + spm_unit: + members: [person1] + households: + household: + members: [person1] + state_code: FL + output: + # Undocumented elderly not eligible for regular Medicaid + is_medicaid_immigration_status_eligible: [false] + has_emergency_medical_condition: [true] + # Should be eligible for Emergency Medicaid + is_emergency_medicaid_eligible: [true] + +# ============================================================ +# EDGE CASES - Income boundary conditions +# ============================================================ + +- name: Case 18, undocumented adult at exactly FPL threshold. + period: 2025 + absolute_error_margin: 0.01 + input: + people: + person1: + age: 35 + employment_income: 20_815 + immigration_status: UNDOCUMENTED + has_emergency_medical_condition: true + tax_units: + tax_unit: + members: [person1] + spm_units: + spm_unit: + members: [person1] + households: + household: + members: [person1] + state_code: CO + output: + # Undocumented, not eligible for regular Medicaid + is_medicaid_immigration_status_eligible: [false] + has_emergency_medical_condition: [true] + # Income at 133% FPL threshold (~$20,815 for single adult in 2025) + # Whether eligible depends on exact Medicaid income calculation + is_emergency_medicaid_eligible: [true] + +- name: Case 19, undocumented adult just above FPL threshold. + period: 2025 + absolute_error_margin: 0.01 + input: + people: + person1: + age: 35 + employment_income: 25_000 + immigration_status: UNDOCUMENTED + has_emergency_medical_condition: true + tax_units: + tax_unit: + members: [person1] + spm_units: + spm_unit: + members: [person1] + households: + household: + members: [person1] + state_code: PA + output: + # Undocumented, not eligible for regular Medicaid + is_medicaid_immigration_status_eligible: [false] + has_emergency_medical_condition: [true] + # Income $25,000 > ~$21,597 (138% FPL with 5% disregard) + # Should NOT be eligible - income too high, no Medicaid category + is_emergency_medicaid_eligible: [false] + +# ============================================================ +# EDGE CASES - Disabled and SSI recipients +# ============================================================ + +- name: Case 20, undocumented disabled adult with emergency. + period: 2025 + absolute_error_margin: 0.01 + input: + people: + person1: + age: 55 + employment_income: 0 + is_disabled: true + immigration_status: UNDOCUMENTED + has_emergency_medical_condition: true + tax_units: + tax_unit: + members: [person1] + spm_units: + spm_unit: + members: [person1] + households: + household: + members: [person1] + # Changed from NY to TX because NY covers undocumented immigrants + # TX does not cover undocumented immigrants + state_code: TX + output: + # Undocumented in TX, not eligible for regular Medicaid + is_medicaid_immigration_status_eligible: [false] + has_emergency_medical_condition: [true] + # TX does not expand Medicaid for adults (income limit = -inf) + # So medicaid_category = NONE for adults + # However, disabled people may qualify under senior_or_disabled category + # Need to check if disabled person qualifies for Emergency Medicaid + is_emergency_medicaid_eligible: [true] diff --git a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/emergency_medicaid/is_emergency_medicaid_eligible.yaml b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/emergency_medicaid/is_emergency_medicaid_eligible.yaml new file mode 100644 index 00000000000..45de412de03 --- /dev/null +++ b/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 diff --git a/policyengine_us/variables/gov/hhs/medicaid/emergency_medicaid/has_emergency_medical_condition.py b/policyengine_us/variables/gov/hhs/medicaid/emergency_medicaid/has_emergency_medical_condition.py new file mode 100644 index 00000000000..841bbdc4b4c --- /dev/null +++ b/policyengine_us/variables/gov/hhs/medicaid/emergency_medicaid/has_emergency_medical_condition.py @@ -0,0 +1,13 @@ +from policyengine_us.model_api import * + + +class has_emergency_medical_condition(Variable): + value_type = bool + entity = Person + label = "Has emergency medical condition" + definition_period = YEAR + default_value = False + reference = ( + "https://www.law.cornell.edu/uscode/text/42/1396b#v_3", + "https://www.law.cornell.edu/cfr/text/42/440.255#c", + ) diff --git a/policyengine_us/variables/gov/hhs/medicaid/emergency_medicaid/is_emergency_medicaid_eligible.py b/policyengine_us/variables/gov/hhs/medicaid/emergency_medicaid/is_emergency_medicaid_eligible.py new file mode 100644 index 00000000000..e59e6c31fa9 --- /dev/null +++ b/policyengine_us/variables/gov/hhs/medicaid/emergency_medicaid/is_emergency_medicaid_eligible.py @@ -0,0 +1,33 @@ +from policyengine_us.model_api import * + + +class is_emergency_medicaid_eligible(Variable): + value_type = bool + entity = Person + label = "Eligible for Emergency Medicaid" + definition_period = YEAR + reference = ( + "https://www.law.cornell.edu/uscode/text/42/1396b#v_2", + "https://www.law.cornell.edu/cfr/text/42/435.406", + ) + + def formula(person, period, parameters): + p 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"python_full_version >= '3.11'" }, + { name = "numpy", version = "2.4.0", source = { registry = "https://pypi.org/simple" }, marker = "python_full_version >= '3.11'" }, { name = "python-dateutil" }, { name = "pytz" }, { name = "tzdata" }, @@ -1517,7 +1516,7 @@ dependencies = [ { name = "microdf-python" }, { name = "numexpr" }, { name = "numpy", version = "2.2.6", source = { registry = "https://pypi.org/simple" }, marker = "python_full_version < '3.11'" }, - { name = "numpy", version = "2.3.5", source = { registry = "https://pypi.org/simple" }, marker = "python_full_version >= '3.11'" }, + { name = "numpy", version = "2.4.0", source = { registry = "https://pypi.org/simple" }, marker = "python_full_version >= '3.11'" }, { name = "pandas" }, { name = "plotly" }, { name = "psutil" }, From 82e32a95785bc6c967c48e2e4f2f6d49c77caa3d Mon Sep 17 00:00:00 2001 From: Daphne Hansell Date: Wed, 24 Dec 2025 10:18:05 -0500 Subject: [PATCH 5/6] Address review comments: remove unused parameter files, add documentation comments MIME-Version: 1.0 Content-Type: text/plain; charset=UTF-8 Content-Transfer-Encoding: 8bit - Remove emergency_condition_definition.yaml (unused parameter file) - Remove organ_transplant_exclusion.yaml (unused parameter file) - Remove index.yaml from emergency_medicaid parameters - Add documentation comments to has_emergency_medical_condition.py describing the emergency condition criteria from federal regulations 🤖 Generated with [Claude Code](https://claude.com/claude-code) Co-Authored-By: Claude Opus 4.5 --- .../emergency_condition_definition.yaml | 16 ---------------- .../hhs/medicaid/emergency_medicaid/index.yaml | 4 ---- .../organ_transplant_exclusion.yaml | 13 ------------- .../has_emergency_medical_condition.py | 3 +++ 4 files changed, 3 insertions(+), 33 deletions(-) delete mode 100644 policyengine_us/parameters/gov/hhs/medicaid/emergency_medicaid/emergency_condition_definition.yaml delete mode 100644 policyengine_us/parameters/gov/hhs/medicaid/emergency_medicaid/index.yaml delete mode 100644 policyengine_us/parameters/gov/hhs/medicaid/emergency_medicaid/organ_transplant_exclusion.yaml diff --git a/policyengine_us/parameters/gov/hhs/medicaid/emergency_medicaid/emergency_condition_definition.yaml b/policyengine_us/parameters/gov/hhs/medicaid/emergency_medicaid/emergency_condition_definition.yaml deleted file mode 100644 index 4b4d4ef885b..00000000000 --- a/policyengine_us/parameters/gov/hhs/medicaid/emergency_medicaid/emergency_condition_definition.yaml +++ /dev/null @@ -1,16 +0,0 @@ -description: The United States defines emergency medical condition as a condition manifesting by acute symptoms where absence of immediate medical attention could result in these outcomes. -values: - 1987-01-01: - - PLACING_HEALTH_IN_SERIOUS_JEOPARDY - - SERIOUS_IMPAIRMENT_TO_BODILY_FUNCTIONS - - SERIOUS_DYSFUNCTION_OF_BODILY_ORGAN_OR_PART - -metadata: - unit: list - period: year - label: Emergency Medicaid emergency medical condition definition criteria - reference: - - title: 42 USC 1396b(v)(3) - Definition of Emergency Medical Condition - href: https://www.law.cornell.edu/uscode/text/42/1396b#v_3 - - title: 42 CFR 440.255(c) - Emergency Services Definition - href: https://www.law.cornell.edu/cfr/text/42/440.255#c diff --git a/policyengine_us/parameters/gov/hhs/medicaid/emergency_medicaid/index.yaml b/policyengine_us/parameters/gov/hhs/medicaid/emergency_medicaid/index.yaml deleted file mode 100644 index 2852e302ad0..00000000000 --- a/policyengine_us/parameters/gov/hhs/medicaid/emergency_medicaid/index.yaml +++ /dev/null @@ -1,4 +0,0 @@ -metadata: - propagate_metadata_to_children: true - economy: false - household: false diff --git a/policyengine_us/parameters/gov/hhs/medicaid/emergency_medicaid/organ_transplant_exclusion.yaml b/policyengine_us/parameters/gov/hhs/medicaid/emergency_medicaid/organ_transplant_exclusion.yaml deleted file mode 100644 index 3b81dc3a37e..00000000000 --- a/policyengine_us/parameters/gov/hhs/medicaid/emergency_medicaid/organ_transplant_exclusion.yaml +++ /dev/null @@ -1,13 +0,0 @@ -description: The United States excludes organ transplant procedures from Emergency Medicaid coverage. -values: - 1987-01-01: true - -metadata: - unit: bool - period: year - label: Emergency Medicaid organ transplant exclusion - reference: - - title: 42 USC 1396b(v)(2)(C) - Organ Transplant Exclusion - href: https://www.law.cornell.edu/uscode/text/42/1396b#v_2_C - - title: 8 USC 1611(b)(1)(A) - Exception for Emergency Medical Care - href: https://www.law.cornell.edu/uscode/text/8/1611#b_1_A diff --git a/policyengine_us/variables/gov/hhs/medicaid/emergency_medicaid/has_emergency_medical_condition.py b/policyengine_us/variables/gov/hhs/medicaid/emergency_medicaid/has_emergency_medical_condition.py index 841bbdc4b4c..abf856133e5 100644 --- a/policyengine_us/variables/gov/hhs/medicaid/emergency_medicaid/has_emergency_medical_condition.py +++ b/policyengine_us/variables/gov/hhs/medicaid/emergency_medicaid/has_emergency_medical_condition.py @@ -11,3 +11,6 @@ class has_emergency_medical_condition(Variable): "https://www.law.cornell.edu/uscode/text/42/1396b#v_3", "https://www.law.cornell.edu/cfr/text/42/440.255#c", ) + # Placing the patient's health in serious jeopardy + # Serious impairment to bodily functions + # Serious dysfunction of any bodily organ or part From f847effca3fdaa2b1962190631993684f1a980aa Mon Sep 17 00:00:00 2001 From: Ziming Date: Fri, 26 Dec 2025 12:09:58 -0500 Subject: [PATCH 6/6] delete unused test file and uv upgrade --- .../has_emergency_medical_condition.yaml | 29 ------------------- uv.lock | 6 ++-- 2 files changed, 3 insertions(+), 32 deletions(-) delete mode 100644 policyengine_us/tests/policy/baseline/gov/hhs/medicaid/emergency_medicaid/has_emergency_medical_condition.yaml diff --git a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/emergency_medicaid/has_emergency_medical_condition.yaml b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/emergency_medicaid/has_emergency_medical_condition.yaml deleted file mode 100644 index 0952f8e665f..00000000000 --- a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/emergency_medicaid/has_emergency_medical_condition.yaml +++ /dev/null @@ -1,29 +0,0 @@ -# Unit tests for has_emergency_medical_condition input variable -# This is a boolean input variable indicating presence of emergency medical condition -# Per 42 USC 1396b(v)(3), an emergency medical condition is defined as: -# - A medical condition (including emergency labor and delivery) -# - Manifesting itself by acute symptoms of sufficient severity (including severe pain) -# - Such that absence of immediate medical attention could reasonably result in: -# (A) placing the patient's health in serious jeopardy -# (B) serious impairment to bodily functions -# (C) serious dysfunction of any bodily organ or part - -- name: Case 1, person has emergency medical condition. - 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