From 0fc72e13e1bcd9ab707742b8e76f4189dd805f3b Mon Sep 17 00:00:00 2001 From: Daphne Hansell <128793799+daphnehanse11@users.noreply.github.com> Date: Tue, 2 Jun 2026 16:02:02 -0400 Subject: [PATCH 1/3] Add Medicaid medically frail CE exclusion --- changelog.d/8573.added.md | 1 + .../medicaid_work_requirement_eligible.yaml | 22 +++++++++++++++++++ ...s_special_medical_needs_for_medicaid_ce.py | 19 ++++++++++++++++ .../medicaid_work_requirement_eligible.py | 5 +++++ 4 files changed, 47 insertions(+) create mode 100644 changelog.d/8573.added.md create mode 100644 policyengine_us/variables/gov/hhs/medicaid/eligibility/is_medically_frail_or_has_special_medical_needs_for_medicaid_ce.py diff --git a/changelog.d/8573.added.md b/changelog.d/8573.added.md new file mode 100644 index 00000000000..08b08c7f813 --- /dev/null +++ b/changelog.d/8573.added.md @@ -0,0 +1 @@ +Added a medically frail or special medical needs input for Medicaid community engagement exclusions. diff --git a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/medicaid_work_requirement_eligible.yaml b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/medicaid_work_requirement_eligible.yaml index bb0c8633d26..26fa290a5b3 100644 --- a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/medicaid_work_requirement_eligible.yaml +++ b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/medicaid_work_requirement_eligible.yaml @@ -222,3 +222,25 @@ medicaid_community_engagement_pass_through_eligible: false output: medicaid_work_requirement_eligible: false + +- name: Case 25, medically frail adult is excluded from Medicaid community engagement. + period: 2027 + input: + age: 30 + monthly_hours_worked: 0 + is_disabled: false + is_medically_frail_or_has_special_medical_needs_for_medicaid_ce: true + medicaid_community_engagement_pass_through_eligible: false + output: + medicaid_work_requirement_eligible: true + +- name: Case 26, adult remains ineligible without the medically frail exclusion. + period: 2027 + input: + age: 30 + monthly_hours_worked: 0 + is_disabled: false + is_medically_frail_or_has_special_medical_needs_for_medicaid_ce: false + medicaid_community_engagement_pass_through_eligible: false + output: + medicaid_work_requirement_eligible: false diff --git a/policyengine_us/variables/gov/hhs/medicaid/eligibility/is_medically_frail_or_has_special_medical_needs_for_medicaid_ce.py b/policyengine_us/variables/gov/hhs/medicaid/eligibility/is_medically_frail_or_has_special_medical_needs_for_medicaid_ce.py new file mode 100644 index 00000000000..bc68a44933f --- /dev/null +++ b/policyengine_us/variables/gov/hhs/medicaid/eligibility/is_medically_frail_or_has_special_medical_needs_for_medicaid_ce.py @@ -0,0 +1,19 @@ +from policyengine_us.model_api import * + + +class is_medically_frail_or_has_special_medical_needs_for_medicaid_ce(Variable): + value_type = bool + entity = Person + label = ( + "Medically frail or has special medical needs for Medicaid community engagement" + ) + documentation = ( + "Whether this person qualifies for the Medicaid community engagement " + "medically frail or special medical needs exclusion. The full CMS " + "definition depends on state condition lists and case review, so this " + "input lets household situations represent people not captured by " + "narrower disability variables." + ) + definition_period = YEAR + default_value = False + reference = "https://public-inspection.federalregister.gov/2026-11094.pdf" diff --git a/policyengine_us/variables/gov/hhs/medicaid/eligibility/medicaid_work_requirement_eligible.py b/policyengine_us/variables/gov/hhs/medicaid/eligibility/medicaid_work_requirement_eligible.py index f55dfdc40d6..b787dcbeaac 100644 --- a/policyengine_us/variables/gov/hhs/medicaid/eligibility/medicaid_work_requirement_eligible.py +++ b/policyengine_us/variables/gov/hhs/medicaid/eligibility/medicaid_work_requirement_eligible.py @@ -64,6 +64,10 @@ def formula(person, period, parameters): is_blind = person("is_blind", period) is_incapable_of_self_care = person("is_incapable_of_self_care", period) eligible_disabled = is_blind | is_disabled | is_incapable_of_self_care + medically_frail = person( + "is_medically_frail_or_has_special_medical_needs_for_medicaid_ce", + period, + ) # Current and recent incarceration exclusions/exceptions. is_incarcerated = person("is_incarcerated", period) was_recently_incarcerated = person( @@ -85,6 +89,7 @@ def formula(person, period, parameters): | has_disabled | eligible_veteran | eligible_disabled + | medically_frail | is_incarcerated | was_recently_incarcerated ) From d30845aa56948bdaf895fe1be5019834155b6c50 Mon Sep 17 00:00:00 2001 From: Daphne Hansell <128793799+daphnehanse11@users.noreply.github.com> Date: Fri, 5 Jun 2026 12:22:29 -0400 Subject: [PATCH 2/3] Tighten Medicaid frailty source reference --- ...lly_frail_or_has_special_medical_needs_for_medicaid_ce.py | 5 ++++- 1 file changed, 4 insertions(+), 1 deletion(-) diff --git a/policyengine_us/variables/gov/hhs/medicaid/eligibility/is_medically_frail_or_has_special_medical_needs_for_medicaid_ce.py b/policyengine_us/variables/gov/hhs/medicaid/eligibility/is_medically_frail_or_has_special_medical_needs_for_medicaid_ce.py index bc68a44933f..b4106618424 100644 --- a/policyengine_us/variables/gov/hhs/medicaid/eligibility/is_medically_frail_or_has_special_medical_needs_for_medicaid_ce.py +++ b/policyengine_us/variables/gov/hhs/medicaid/eligibility/is_medically_frail_or_has_special_medical_needs_for_medicaid_ce.py @@ -16,4 +16,7 @@ class is_medically_frail_or_has_special_medical_needs_for_medicaid_ce(Variable): ) definition_period = YEAR default_value = False - reference = "https://public-inspection.federalregister.gov/2026-11094.pdf" + reference = ( + "https://www.govinfo.gov/content/pkg/FR-2026-06-03/pdf/2026-11094.pdf#page=125", + "https://www.govinfo.gov/content/pkg/FR-2026-06-03/pdf/2026-11094.pdf#page=59", + ) From 7b4c3eb7bf9aca2b36b5c391fdbe882c5875e026 Mon Sep 17 00:00:00 2001 From: Daphne Hansell <128793799+daphnehanse11@users.noreply.github.com> Date: Tue, 9 Jun 2026 11:18:28 -0400 Subject: [PATCH 3/3] Add statute and CMS guidance to medically frail CE reference Pair the permanent statute (Pub. L. 119-21 sec. 71119, page 242 - "(V) who is medically frail or otherwise has special medical needs") and the CMS community engagement CIB with the existing IFC anchors, for parity with the sibling Medicaid CE exemption variables. Co-Authored-By: Claude Opus 4.8 (1M context) --- ...ically_frail_or_has_special_medical_needs_for_medicaid_ce.py | 2 ++ 1 file changed, 2 insertions(+) diff --git a/policyengine_us/variables/gov/hhs/medicaid/eligibility/is_medically_frail_or_has_special_medical_needs_for_medicaid_ce.py b/policyengine_us/variables/gov/hhs/medicaid/eligibility/is_medically_frail_or_has_special_medical_needs_for_medicaid_ce.py index b4106618424..cb6f2e4b0bd 100644 --- a/policyengine_us/variables/gov/hhs/medicaid/eligibility/is_medically_frail_or_has_special_medical_needs_for_medicaid_ce.py +++ b/policyengine_us/variables/gov/hhs/medicaid/eligibility/is_medically_frail_or_has_special_medical_needs_for_medicaid_ce.py @@ -17,6 +17,8 @@ class is_medically_frail_or_has_special_medical_needs_for_medicaid_ce(Variable): definition_period = YEAR default_value = False reference = ( + "https://www.congress.gov/119/plaws/publ21/PLAW-119publ21.pdf#page=242", + "https://www.medicaid.gov/federal-policy-guidance/downloads/cib12082025.pdf", "https://www.govinfo.gov/content/pkg/FR-2026-06-03/pdf/2026-11094.pdf#page=125", "https://www.govinfo.gov/content/pkg/FR-2026-06-03/pdf/2026-11094.pdf#page=59", )