Model historical Arkansas Medicaid work requirements

changelog.d/codex-issue-8272-ar-medicaid-work-requirement.added.md

@@ -0,0 +1 @@
+Add an annual approximation of the 2018-2019 Arkansas Works Medicaid work requirement.

policyengine_us/parameters/gov/states/ar/dhs/medicaid/work_requirements/age_range.yaml

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+description: Arkansas requires adults within these age brackets to meet this Medicaid work requirement approximation under the Arkansas Works program.
+
+metadata:
+  threshold_unit: year
+  amount_unit: bool
+  period: year
+  type: single_amount
+  label: Arkansas Medicaid work requirement age threshold
+  reference:
+    - title: State Data for Medicaid Work Requirements in Arkansas | KFF
+      href: https://www.kff.org/medicaid/issue-brief/state-data-for-medicaid-work-requirements-in-arkansas/
+    - title: State Annual Report January-December 2018 | Arkansas Works Section 1115
+      href: https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/ar/Health-Care-Independence-Program-Private-Option/ar-works-annl-rpt-jan-dec-2018.pdf#page=11
+
+brackets:
+  - threshold:
+      2018-01-01: 0
+    amount:
+      2018-01-01: false
+  - threshold:
+      2018-01-01: 30
+    amount:
+      2018-01-01: true
+  - threshold:
+      2018-01-01: 50
+    amount:
+      2018-01-01: false
+
+# Annual approximation note:
+# - The 2018 phase-in covered ages 30-49.
+# - The 2019 19-29 phase-in is intentionally not modeled here because it was only
+#   partially rolled out before the court halted enforcement, which would overstate
+#   annual effects in default yearly data.

policyengine_us/parameters/gov/states/ar/dhs/medicaid/work_requirements/applies.yaml

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+description: Arkansas limits Medicaid expansion coverage to adults who meet a work requirement under the Arkansas Works program, if this is true.
+
+values:
+  0000-01-01: false
+  2018-01-01: true
+  2020-01-01: false
+
+metadata:
+  unit: bool
+  period: year
+  label: Arkansas Medicaid work requirement applies
+  reference:
+    - title: Arkansas Works | Medicaid
+      href: https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81021
+    - title: State Annual Report January-December 2018 | Arkansas Works Section 1115
+      href: https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/ar/Health-Care-Independence-Program-Private-Option/ar-works-annl-rpt-jan-dec-2018.pdf#page=11
+
+# Annual approximation note:
+# - The underlying waiver operated monthly starting June 1, 2018 and was set aside
+#   by a court in March 2019.
+# - PolicyEngine's default microdata are annual, so this parameter turns the rule on
+#   for calendar years 2018 and 2019 and documents the approximation in code/tests.

policyengine_us/parameters/gov/states/ar/dhs/medicaid/work_requirements/dependent_age_limit.yaml

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+description: Arkansas exempts adults caring for a dependent child at or below this age from the Medicaid work requirement approximation under the Arkansas Works program.
+
+values:
+  2018-01-01: 17
+
+metadata:
+  unit: year
+  period: year
+  label: Arkansas Medicaid work requirement dependent child age limit
+  reference:
+    - title: Arkansas Works Program Updates | Arkansas Code Rule 016.20.18 Ark. Code R. 003
+      href: https://www.law.cornell.edu/regulations/arkansas/016-20-18-Ark-Code-R-003
+    - title: State Data for Medicaid Work Requirements in Arkansas | KFF
+      href: https://www.kff.org/medicaid/issue-brief/state-data-for-medicaid-work-requirements-in-arkansas/

policyengine_us/parameters/gov/states/ar/dhs/medicaid/work_requirements/income_limit.yaml

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+description: Arkansas limits the Medicaid work requirement approximation to adults below this share of the poverty line under the Arkansas Works program.
+
+values:
+  2018-01-01: 1
+  2019-01-01: 1.38
+
+metadata:
+  unit: /1
+  period: year
+  label: Arkansas Medicaid work requirement income limit
+  reference:
+    - title: State Data for Medicaid Work Requirements in Arkansas | KFF
+      href: https://www.kff.org/medicaid/issue-brief/state-data-for-medicaid-work-requirements-in-arkansas/
+    - title: State Annual Report January-December 2018 | Arkansas Works Section 1115
+      href: https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/ar/Health-Care-Independence-Program-Private-Option/ar-works-annl-rpt-jan-dec-2018.pdf#page=11

policyengine_us/parameters/gov/states/ar/dhs/medicaid/work_requirements/monthly_hours_threshold.yaml

@@ -0,0 +1,14 @@
+description: Arkansas limits Medicaid expansion coverage to adults completing at least this number of monthly work or community engagement hours under the Arkansas Works program.
+
+values:
+  2018-01-01: 80
+
+metadata:
+  unit: hour
+  period: month
+  label: Arkansas Medicaid work requirement monthly hours threshold
+  reference:
+    - title: State Annual Report January-December 2018 | Arkansas Works Section 1115
+      href: https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/ar/Health-Care-Independence-Program-Private-Option/ar-works-annl-rpt-jan-dec-2018.pdf#page=11
+    - title: An Early Look at Implementation of Medicaid Work Requirements in Arkansas | KFF
+      href: https://www.kff.org/medicaid/issue-brief/an-early-look-at-implementation-of-medicaid-work-requirements-in-arkansas/

policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/is_medicaid_eligible.yaml

@@ -170,3 +170,39 @@
   output:
     medicaid_category: SENIOR_OR_DISABLED
     is_medicaid_eligible: true
+
+- name: Case 4, Arkansas 2018 subject adult is ineligible when the historical work requirement approximation is unmet.
+  period: 2018
+  input:
+    age: 40
+    medicaid_category: ADULT
+    immigration_status: CITIZEN
+    medicaid_income_level: 0.9
+    monthly_hours_worked: 0
+    state_code: AR
+  output:
+    is_medicaid_eligible: false
+
+- name: Case 5, Arkansas 2018 adult above 100 percent FPL remains eligible because the annual approximation does not subject that cohort.
+  period: 2018
+  input:
+    age: 40
+    medicaid_category: ADULT
+    immigration_status: CITIZEN
+    medicaid_income_level: 1.1
+    monthly_hours_worked: 0
+    state_code: AR
+  output:
+    is_medicaid_eligible: true
+
+- name: Case 6, Arkansas 2019 adults ages 19 to 29 remain eligible because the brief phase-in is not modeled annually.
+  period: 2019
+  input:
+    age: 25
+    medicaid_category: ADULT
+    immigration_status: CITIZEN
+    medicaid_income_level: 0.8
+    monthly_hours_worked: 0
+    state_code: AR
+  output:
+    is_medicaid_eligible: true

policyengine_us/tests/policy/baseline/gov/states/ar/dhs/medicaid/eligibility/ar_medicaid_work_requirement_eligible.yaml

@@ -0,0 +1,67 @@
+- name: Case 1, Arkansas 2018 subject adult without hours or exemptions is ineligible under the approximation.
+  period: 2018
+  input:
+    age: 40
+    medicaid_category: ADULT
+    medicaid_income_level: 0.9
+    monthly_hours_worked: 0
+    state_code: AR
+  output:
+    ar_medicaid_work_requirement_eligible: false
+
+- name: Case 2, Arkansas 2018 subject adult meeting 80 monthly hours is eligible.
+  period: 2018
+  input:
+    age: 40
+    medicaid_category: ADULT
+    medicaid_income_level: 0.9
+    monthly_hours_worked: 80
+    state_code: AR
+  output:
+    ar_medicaid_work_requirement_eligible: true
+
+- name: Case 3, Arkansas 2018 caregiver of a dependent child under 18 is exempt.
+  period: 2018
+  input:
+    people:
+      person1:
+        age: 40
+        medicaid_category: ADULT
+        medicaid_income_level: 0.9
+        monthly_hours_worked: 0
+        is_tax_unit_head_or_spouse: true
+      person2:
+        age: 17
+        is_tax_unit_dependent: true
+    tax_units:
+      tax_unit:
+        members: [person1, person2]
+    households:
+      household:
+        members: [person1, person2]
+        state_code: AR
+  output:
+    ar_medicaid_work_requirement_eligible: [true, true]
+
+- name: Case 4, Arkansas 2018 subject adult receiving unemployment compensation is exempt.
+  period: 2018
+  input:
+    age: 40
+    medicaid_category: ADULT
+    medicaid_income_level: 0.9
+    monthly_hours_worked: 0
+    unemployment_compensation: 1_000
+    state_code: AR
+  output:
+    ar_medicaid_work_requirement_eligible: true
+
+- name: Case 5, Arkansas 2019 adults ages 19 to 29 remain eligible because the brief phase-in is not modeled annually.
+  period: 2019
+  input:
+    age: 25
+    medicaid_category: ADULT
+    medicaid_income_level: 0.8
+    monthly_hours_worked: 0
+    state_code: AR
+  output:
+    ar_medicaid_work_requirement_eligible: true

policyengine_us/tests/policy/baseline/gov/states/ar/dhs/medicaid/eligibility/ar_medicaid_work_requirement_subject.yaml

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+- name: Case 1, Arkansas 2018 adults ages 30 to 49 below 100 percent FPL are subject.
+  period: 2018
+  input:
+    age: 40
+    medicaid_category: ADULT
+    medicaid_income_level: 0.9
+    state_code: AR
+  output:
+    ar_medicaid_work_requirement_subject: true
+
+- name: Case 2, Arkansas 2018 adults above 100 percent FPL are not subject in the annual approximation.
+  period: 2018
+  input:
+    age: 40
+    medicaid_category: ADULT
+    medicaid_income_level: 1.1
+    state_code: AR
+  output:
+    ar_medicaid_work_requirement_subject: false
+
+- name: Case 3, Arkansas 2019 adults ages 30 to 49 below 138 percent FPL are subject.
+  period: 2019
+  input:
+    age: 40
+    medicaid_category: ADULT
+    medicaid_income_level: 1.2
+    state_code: AR
+  output:
+    ar_medicaid_work_requirement_subject: true
+
+- name: Case 4, Arkansas 2019 adults ages 19 to 29 are excluded from the annual approximation.
+  period: 2019
+  input:
+    age: 25
+    medicaid_category: ADULT
+    medicaid_income_level: 0.8
+    state_code: AR
+  output:
+    ar_medicaid_work_requirement_subject: false
+
+- name: Case 5, Arkansas 2020 adults are not subject after the court halted enforcement.
+  period: 2020
+  input:
+    age: 40
+    medicaid_category: ADULT
+    medicaid_income_level: 0.8
+    state_code: AR
+  output:
+    ar_medicaid_work_requirement_subject: false

policyengine_us/variables/gov/hhs/medicaid/eligibility/is_medicaid_eligible.py

@@ -7,35 +7,46 @@ class is_medicaid_eligible(Variable):
     label = "Eligible for Medicaid"
     definition_period = YEAR
     reference = (
-        "https://www.law.cornell.edu/uscode/text/42/1396a#a_10"
-        "https://www.kff.org/racial-equity-and-health-policy/fact-sheet/key-facts-on-health-coverage-of-immigrants"
+        "https://www.law.cornell.edu/uscode/text/42/1396a#a_10",
+        "https://www.kff.org/racial-equity-and-health-policy/fact-sheet/key-facts-on-health-coverage-of-immigrants",
     )
 
     def formula(person, period, parameters):
         category = person("medicaid_category", period)
         categorically_eligible = category != category.possible_values.NONE
+        adult_group = category == category.possible_values.ADULT
         immigration_status_eligible = person(
             "is_medicaid_immigration_status_eligible", period
         )
         ca_ffyp_eligible = person("ca_ffyp_eligible", period)
         il_hbi_eligible = person("il_hbi_eligible", period)
 
         p = parameters(period).gov.hhs.medicaid.eligibility
+        federal_work_requirement_eligible = True
         if p.work_requirements.applies:
             work_requirement_eligible = person(
                 "medicaid_work_requirement_eligible", period
             )
-            return (
-                (
-                    categorically_eligible
-                    & immigration_status_eligible
-                    & work_requirement_eligible
-                )
-                | ca_ffyp_eligible
-                | il_hbi_eligible
+            federal_work_requirement_eligible = where(
+                adult_group, work_requirement_eligible, True
+            )
+
+        ar_p = parameters(period).gov.states.ar.dhs.medicaid.work_requirements
+        ar_work_requirement_eligible = True
+        if ar_p.applies:
+            state = person.household("state_code_str", period)
+            ar_work_requirement_eligible = where(
+                state == "AR",
+                person("ar_medicaid_work_requirement_eligible", period),
+                True,
             )
         return (
-            (categorically_eligible & immigration_status_eligible)
+            (
+                categorically_eligible
+                & immigration_status_eligible
+                & federal_work_requirement_eligible
+                & ar_work_requirement_eligible
+            )
             | ca_ffyp_eligible
             | il_hbi_eligible
         )

policyengine_us/variables/gov/states/ar/dhs/medicaid/eligibility/ar_medicaid_work_requirement_eligible.py

@@ -0,0 +1,58 @@
+from policyengine_us.model_api import *
+
+
+class ar_medicaid_work_requirement_eligible(Variable):
+    value_type = bool
+    entity = Person
+    label = (
+        "Eligible under the Arkansas historical Medicaid work requirement approximation"
+    )
+    definition_period = YEAR
+    reference = (
+        "https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81021",
+        "https://www.kff.org/medicaid/issue-brief/state-data-for-medicaid-work-requirements-in-arkansas/",
+        "https://www.law.cornell.edu/regulations/arkansas/016-20-18-Ark-Code-R-003",
+    )
+    defined_for = StateCode.AR
+
+    def formula(person, period, parameters):
+        p = parameters(period).gov.states.ar.dhs.medicaid.work_requirements
+        subject = person("ar_medicaid_work_requirement_subject", period)
+
+        # Arkansas' waiver operated with monthly reporting and three-month lockout
+        # rules, but the default microdata are annual. This approximation only uses
+        # the parts of the waiver that are observable in yearly data. Reporting
+        # compliance, good-cause months, treatment-program participation, and
+        # other administrative exemptions are therefore left out.
+        monthly_hours_worked = person("monthly_hours_worked", period)
+        meets_monthly_work_hours = monthly_hours_worked >= p.monthly_hours_threshold
+
+        age = person("age", period)
+        is_dependent = person("is_tax_unit_dependent", period)
+        is_pregnant = person("is_pregnant", period)
+        is_full_time_student = person("is_full_time_student", period)
+        is_disabled = person("is_disabled", period)
+        is_blind = person("is_blind", period)
+        is_incapable_of_self_care = person("is_incapable_of_self_care", period)
+
+        has_eligible_dependent_child = person.tax_unit.any(
+            is_dependent & (age <= p.dependent_age_limit)
+        )
+        has_disabled_dependent = person.tax_unit.any(
+            is_dependent & (is_disabled | is_blind | is_incapable_of_self_care)
+        )
+        receives_unemployment_compensation = (
+            person("unemployment_compensation", period) > 0
+        )
+        eligible_disabled = is_disabled | is_blind | is_incapable_of_self_care
+
+        observable_exemption = (
+            is_pregnant
+            | is_full_time_student
+            | eligible_disabled
+            | has_eligible_dependent_child
+            | has_disabled_dependent
+            | receives_unemployment_compensation
+        )
+
+        return ~subject | observable_exemption | meets_monthly_work_hours