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1 change: 1 addition & 0 deletions changelog.d/8573.added.md
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Added a medically frail or special medical needs input for Medicaid community engagement exclusions.
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Expand Up @@ -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
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@@ -0,0 +1,22 @@
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://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",
)
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Expand Up @@ -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(
Expand All @@ -85,6 +89,7 @@ def formula(person, period, parameters):
| has_disabled
| eligible_veteran
| eligible_disabled
| medically_frail
| is_incarcerated
| was_recently_incarcerated
)
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