Fix MSP spouse deeming and resource scoping

changelog.d/codex-msp-ssi-deeming-assets.fixed.md

@@ -0,0 +1 @@
+Fix MSP rules to use SSI spouse deeming, applicant-plus-spouse resources, strict SLMB/QI boundaries, category-consistent MSP eligibility, and complete 2021-2026 Medicare/MSP premium and resource thresholds.

policyengine_us/parameters/gov/hhs/medicare/part_a/full_premium.yaml

@@ -4,10 +4,22 @@ metadata:
   period: month
   label: Medicare Part A full premium
   reference:
+    - title: 2021 Medicare Parts A & B Premiums and Deductibles
+      href: https://www.cms.gov/newsroom/press-releases/2021-medicare-part-b-premiums-remain-steady
+    - title: 2022 Medicare Parts A & B Premiums and Deductibles
+      href: https://www.cms.gov/newsroom/fact-sheets/2022-medicare-parts-b-premiums-deductibles-2022-medicare-part-d-income-related-monthly-adjustment
+    - title: 2023 Medicare Parts A & B Premiums and Deductibles
+      href: https://www.cms.gov/newsroom/fact-sheets/2023-medicare-parts-b-premiums-and-deductibles-2023-medicare-part-d-income-related-monthly
     - title: 2024 Medicare Parts A & B Premiums and Deductibles
       href: https://www.cms.gov/newsroom/fact-sheets/2024-medicare-parts-b-premiums-and-deductibles
     - title: 2025 Medicare Parts A & B Premiums and Deductibles
       href: https://www.cms.gov/newsroom/fact-sheets/2025-medicare-parts-b-premiums-and-deductibles
+    - title: 2026 Medicare Parts A & B Premiums and Deductibles
+      href: https://www.cms.gov/newsroom/fact-sheets/2026-medicare-parts-b-premiums-deductibles
 values:
+  2021-01-01: 471
+  2022-01-01: 499
+  2023-01-01: 506
   2024-01-01: 505
   2025-01-01: 518
+  2026-01-01: 565

policyengine_us/parameters/gov/hhs/medicare/part_a/reduced_premium.yaml

@@ -4,10 +4,20 @@ metadata:
   period: month
   label: Medicare Part A reduced premium
   reference:
+    - title: 2022 Medicare Parts A & B Premiums and Deductibles
+      href: https://www.cms.gov/newsroom/fact-sheets/2022-medicare-parts-b-premiums-deductibles-2022-medicare-part-d-income-related-monthly-adjustment
+    - title: 2023 Medicare Parts A & B Premiums and Deductibles
+      href: https://www.cms.gov/newsroom/fact-sheets/2023-medicare-parts-b-premiums-and-deductibles-2023-medicare-part-d-income-related-monthly
     - title: 2024 Medicare Parts A & B Premiums and Deductibles
       href: https://www.cms.gov/newsroom/fact-sheets/2024-medicare-parts-b-premiums-and-deductibles
     - title: 2025 Medicare Parts A & B Premiums and Deductibles
       href: https://www.cms.gov/newsroom/fact-sheets/2025-medicare-parts-b-premiums-and-deductibles
+    - title: 2026 Medicare Parts A & B Premiums and Deductibles
+      href: https://www.cms.gov/newsroom/fact-sheets/2026-medicare-parts-b-premiums-deductibles
 values:
+  2021-01-01: 259
+  2022-01-01: 274
+  2023-01-01: 278
   2024-01-01: 278
   2025-01-01: 285
+  2026-01-01: 311

policyengine_us/parameters/gov/hhs/medicare/part_b/base_premium.yaml

@@ -5,12 +5,21 @@ metadata:
   label: Medicare Part B base premium
   reference:
     - title: 2021 Medicare Parts A & B Premiums and Deductibles
-      href: https://www.cms.gov/newsroom/fact-sheets/2021-medicare-parts-b-premiums-and-deductibles
+      href: https://www.cms.gov/newsroom/press-releases/2021-medicare-part-b-premiums-remain-steady
+    - title: 2022 Medicare Parts A & B Premiums and Deductibles
+      href: https://www.cms.gov/newsroom/fact-sheets/2022-medicare-parts-b-premiums-deductibles-2022-medicare-part-d-income-related-monthly-adjustment
+    - title: 2023 Medicare Parts A & B Premiums and Deductibles
+      href: https://www.cms.gov/newsroom/fact-sheets/2023-medicare-parts-b-premiums-and-deductibles-2023-medicare-part-d-income-related-monthly
     - title: 2024 Medicare Parts A & B Premiums and Deductibles
       href: https://www.cms.gov/newsroom/fact-sheets/2024-medicare-parts-b-premiums-and-deductibles
     - title: 2025 Medicare Parts A & B Premiums and Deductibles
       href: https://www.cms.gov/newsroom/fact-sheets/2025-medicare-parts-b-premiums-and-deductibles
+    - title: 2026 Medicare Parts A & B Premiums and Deductibles
+      href: https://www.cms.gov/newsroom/fact-sheets/2026-medicare-parts-b-premiums-deductibles
 values:
   2021-01-01: 148.50
+  2022-01-01: 170.1
+  2023-01-01: 164.9
   2024-01-01: 174.70
   2025-01-01: 185
+  2026-01-01: 202.9

policyengine_us/parameters/gov/hhs/medicare/savings_programs/eligibility/asset/couple.yaml

@@ -2,6 +2,7 @@ description: The Department of Health and Human Services limits resources to thi
 values:
   2024-01-01: 14_130
   2025-01-01: 14_470
+  2026-01-01: 14_910
 
 metadata:
   unit: currency-USD

policyengine_us/parameters/gov/hhs/medicare/savings_programs/eligibility/asset/individual.yaml

@@ -2,6 +2,7 @@ description: The Department of Health and Human Services limits resources to thi
 values:
   2024-01-01: 9_430
   2025-01-01: 9_660
+  2026-01-01: 9_950
 
 metadata:
   unit: currency-USD

policyengine_us/tests/policy/baseline/gov/hhs/medicare/eligibility/base_part_a_premium.yaml

@@ -33,3 +33,39 @@
     medicare_quarters_of_coverage: 40
   output:
     base_part_a_premium: 0
+
+- name: unit test 5 - reduced premium in 2022
+  period: 2022
+  input:
+    age: 65
+    is_medicare_eligible: true
+    medicare_quarters_of_coverage: 35
+  output:
+    base_part_a_premium: 3_288  # $274 * 12 months
+
+- name: unit test 6 - full premium in 2023
+  period: 2023
+  input:
+    age: 65
+    is_medicare_eligible: true
+    medicare_quarters_of_coverage: 20
+  output:
+    base_part_a_premium: 6_072  # $506 * 12 months
+
+- name: unit test 7 - reduced premium in 2026
+  period: 2026
+  input:
+    age: 65
+    is_medicare_eligible: true
+    medicare_quarters_of_coverage: 35
+  output:
+    base_part_a_premium: 3_732  # $311 * 12 months
+
+- name: 2026 Part A full premium for fewer than 30 quarters.
+  period: 2026
+  input:
+    age: 65
+    is_medicare_eligible: true
+    medicare_quarters_of_coverage: 20
+  output:
+    base_part_a_premium: 6_780  # $565 * 12 months

policyengine_us/tests/policy/baseline/gov/hhs/medicare/eligibility/base_part_b_premium.yaml

@@ -13,3 +13,27 @@
     is_medicare_eligible: false
   output:
     base_part_b_premium: 0
+
+- name: unit test 3 - eligible in 2022
+  period: 2022
+  input:
+    age: 65
+    is_medicare_eligible: true
+  output:
+    base_part_b_premium: 2_041.20  # $170.10 * 12 months
+
+- name: unit test 4 - eligible in 2023
+  period: 2023
+  input:
+    age: 65
+    is_medicare_eligible: true
+  output:
+    base_part_b_premium: 1_978.80  # $164.90 * 12 months
+
+- name: unit test 5 - eligible in 2026
+  period: 2026
+  input:
+    age: 65
+    is_medicare_eligible: true
+  output:
+    base_part_b_premium: 2_434.80  # $202.90 * 12 months

policyengine_us/tests/policy/baseline/gov/hhs/medicare/savings_programs/category/is_qi_eligible.yaml

@@ -9,7 +9,20 @@
     # $19,440 unearned -> ($1,620 - $20) = $1,600/month countable
     # $1,506 < $1,600 < $1,694.25 (120-135% FPL) -> QI income range
     ssi_unearned_income: 19_440
-    spm_unit_cash_assets: 5_000
+    bank_account_assets: 5_000
+    spm_unit_is_married: false
+    is_medicaid_eligible: false
+  output:
+    is_qi_eligible: true
+
+- name: QI eligible - income exactly at 120% FPL, no Medicaid
+  period: 2024-01
+  input:
+    age: 67
+    is_medicare_eligible: true
+    # $18,312 unearned -> ($1,526 - $20) = $1,506/month countable
+    ssi_unearned_income: 18_312
+    bank_account_assets: 5_000
     spm_unit_is_married: false
     is_medicaid_eligible: false
   output:
@@ -22,9 +35,22 @@
     is_medicare_eligible: true
     # Income in QI range
     ssi_unearned_income: 19_440
-    spm_unit_cash_assets: 5_000
+    bank_account_assets: 5_000
     spm_unit_is_married: false
     # But eligible for Medicaid
     is_medicaid_eligible: true
   output:
     is_qi_eligible: false
+
+- name: QI not eligible - income exactly at 135% FPL
+  period: 2024-01
+  input:
+    age: 67
+    is_medicare_eligible: true
+    # $20,571 unearned -> ($1,714.25 - $20) = $1,694.25/month countable
+    ssi_unearned_income: 20_571
+    bank_account_assets: 5_000
+    spm_unit_is_married: false
+    is_medicaid_eligible: false
+  output:
+    is_qi_eligible: false

policyengine_us/tests/policy/baseline/gov/hhs/medicare/savings_programs/category/msp_category.yaml

@@ -2,8 +2,8 @@
 # Countable = unearned - $20 (or earned - $85 - 50% remaining)
 # For 2024 individual FPL = $15,060:
 #   QMB: <= 100% = $1,255/month countable
-#   SLMB: 100-120% = $1,255.01-$1,506/month countable
-#   QI: 120-135% = $1,506.01-$1,694.25/month countable
+#   SLMB: > 100% and < 120% FPL
+#   QI: >= 120% and < 135% FPL
 
 - name: MSP category - QMB (income at 100% FPL)
   period: 2024-01
@@ -13,7 +13,7 @@
     # $12,000 unearned -> ($1,000 - $20) = $980/month countable
     # $980 < $1,255 (100% FPL) -> QMB
     ssi_unearned_income: 12_000
-    spm_unit_cash_assets: 5_000
+    bank_account_assets: 5_000
     spm_unit_is_married: false
   output:
     msp_category: QMB
@@ -26,7 +26,7 @@
     # $16,500 unearned -> ($1,375 - $20) = $1,355/month countable
     # $1,255 < $1,355 < $1,506 (100-120% FPL) -> SLMB
     ssi_unearned_income: 16_500
-    spm_unit_cash_assets: 5_000
+    bank_account_assets: 5_000
     spm_unit_is_married: false
   output:
     msp_category: SLMB
@@ -39,13 +39,27 @@
     # $19,440 unearned -> ($1,620 - $20) = $1,600/month countable
     # $1,506 < $1,600 < $1,694.25 (120-135% FPL) -> QI
     ssi_unearned_income: 19_440
-    spm_unit_cash_assets: 5_000
+    bank_account_assets: 5_000
     spm_unit_is_married: false
     # QI requires not being eligible for other Medicaid
     is_medicaid_eligible: false
   output:
     msp_category: QI
 
+- name: MSP category - QI (income exactly at 120% FPL)
+  period: 2024-01
+  input:
+    age: 67
+    is_medicare_eligible: true
+    # $18,312 unearned -> ($1,526 - $20) = $1,506/month countable
+    # Exact 120% FPL belongs to QI, not SLMB
+    ssi_unearned_income: 18_312
+    bank_account_assets: 5_000
+    spm_unit_is_married: false
+    is_medicaid_eligible: false
+  output:
+    msp_category: QI
+
 - name: MSP category - NONE (income above 135% FPL)
   period: 2024-01
   input:
@@ -54,18 +68,32 @@
     # $21_840 unearned -> ($1,820 - $20) = $1,800/month countable
     # $1,800 > $1,694.25 (135% FPL) -> NONE
     ssi_unearned_income: 21_840
-    spm_unit_cash_assets: 5_000
+    bank_account_assets: 5_000
     spm_unit_is_married: false
   output:
     msp_category: NONE
 
+- name: MSP category - NONE (income exactly at 135% FPL)
+  period: 2024-01
+  input:
+    age: 67
+    is_medicare_eligible: true
+    # $20,571 unearned -> ($1,714.25 - $20) = $1,694.25/month countable
+    # Exact 135% FPL is not QI-eligible
+    ssi_unearned_income: 20_571
+    bank_account_assets: 5_000
+    spm_unit_is_married: false
+    is_medicaid_eligible: false
+  output:
+    msp_category: NONE
+
 - name: MSP category - NONE (not Medicare eligible)
   period: 2024-01
   input:
     age: 60
     is_medicare_eligible: false
     ssi_unearned_income: 10_000
-    spm_unit_cash_assets: 5_000
+    bank_account_assets: 5_000
     spm_unit_is_married: false
   output:
     msp_category: NONE

policyengine_us/tests/policy/baseline/gov/hhs/medicare/savings_programs/eligibility/msp_asset_eligible.yaml

@@ -0,0 +1,85 @@
+- name: Case 1, single applicant under the MSP asset limit.
+  period: 2024-01
+  input:
+    age: 67
+    bank_account_assets: 5_000
+    spm_unit_is_married: false
+    state_code: TX
+  output:
+    msp_asset_eligible: true
+
+- name: Case 2, couple resources use the spouses' combined assets.
+  period: 2024-01
+  input:
+    people:
+      person1:
+        age: 68
+        bank_account_assets: 8_000
+      person2:
+        age: 66
+        bank_account_assets: 8_000
+    tax_units:
+      tax_unit:
+        members: [person1, person2]
+    marital_units:
+      marital_unit:
+        members: [person1, person2]
+    spm_units:
+      spm_unit:
+        members: [person1, person2]
+        spm_unit_is_married: true
+    households:
+      household:
+        members: [person1, person2]
+        state_code: TX
+  output:
+    msp_asset_eligible: [false, false]
+
+- name: Case 3, non-spouse household members' assets are excluded.
+  period: 2024-01
+  input:
+    people:
+      person1:
+        age: 67
+        bank_account_assets: 5_000
+      person2:
+        age: 30
+        bank_account_assets: 20_000
+    tax_units:
+      tax_unit:
+        members: [person1]
+    marital_units:
+      marital_unit1:
+        members: [person1]
+      marital_unit2:
+        members: [person2]
+    spm_units:
+      spm_unit:
+        members: [person1, person2]
+        spm_unit_is_married: false
+    households:
+      household:
+        members: [person1, person2]
+        state_code: TX
+  output:
+    msp_asset_eligible: [true, false]
+
+- name: Case 4, 2026 individual asset limit uses the current Medicare.gov value.
+  period: 2026-01
+  input:
+    age: 67
+    bank_account_assets: 9_950
+    spm_unit_is_married: false
+    state_code: TX
+  output:
+    msp_asset_eligible: true
+
+- name: Case 5, 2026 individual asset limit rejects amounts above the current threshold.
+  period: 2026-01
+  input:
+    age: 67
+    bank_account_assets: 9_951
+    spm_unit_is_married: false
+    state_code: TX
+  output:
+    msp_asset_eligible: false