Add ssi_couple_computation_applies for Title XIX facility separation#8004
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hua7450 wants to merge 5 commits intoPolicyEngine:mainfrom
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Add ssi_couple_computation_applies for Title XIX facility separation#8004hua7450 wants to merge 5 commits intoPolicyEngine:mainfrom
hua7450 wants to merge 5 commits intoPolicyEngine:mainfrom
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Per 20 CFR 416.414(b)(3) and POMS SI 00501.154, when either spouse is in a medical treatment facility with Medicaid paying >50% of care, couple computation rules do not apply — each is treated as a separately eligible individual. Closes PolicyEngine#8003 Co-Authored-By: Claude Opus 4.6 (1M context) <noreply@anthropic.com>
Codecov Report❌ Patch coverage is Additional details and impacted files@@ Coverage Diff @@
## main #8004 +/- ##
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- Coverage 100.00% 65.30% -34.70%
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Files 2 6 +4
Lines 46 98 +52
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+ Hits 46 64 +18
- Misses 0 34 +34
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Per 20 CFR 416.414(b)(3), when one spouse is in a medical treatment facility (Medicaid paying >50%), benefits are computed separately. Per 416.414(b)(2), when both are in facility, couple computation still applies ($60/month). Introduces ssi_couple_computation_applies to encode this rule without overloading ssi_claim_is_joint, which state SSPs rely on for claim type classification (both-eligible vs one-eligible). Federal consumers (ssi_amount_if_eligible, meets_ssi_resource_test, ssi_pmv_amount) now use the new variable. State SSPs (AK, MA, DE, CO) continue using ssi_claim_is_joint unchanged. Closes PolicyEngine#8003 Co-Authored-By: Claude Opus 4.6 (1M context) <noreply@anthropic.com>
Per 20 CFR 416.414(b)(3), when one spouse is in a medical facility, "each individual's own countable income" is used. Update the income pipeline (ssi_marital_earned_income, ssi_marital_unearned_income, ssi_countable_income) to use ssi_couple_computation_applies so income pooling and halving also stop when the couple is separated. Co-Authored-By: Claude Opus 4.6 (1M context) <noreply@anthropic.com>
The resource test is an eligibility determination, not a benefit computation. 20 CFR 416.414 only governs benefit amounts — the couple resource limit ($3,000) still applies even when one spouse is in a medical facility. Only benefit computation variables should use ssi_couple_computation_applies. Co-Authored-By: Claude Opus 4.6 (1M context) <noreply@anthropic.com>
…tion Add comments explaining that ssi_couple_computation_applies intentionally does not change joint-claim status or spouse/individual classification. POMS SI 02005.050 turns on temporary vs permanent separation, which PolicyEngine does not model. The variable scopes to the benefit-computation rule that 416.414(b) applies in either case. Co-Authored-By: Claude Opus 4.6 (1M context) <noreply@anthropic.com>
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Summary
Adds a new
ssi_couple_computation_appliesvariable that implements 20 CFR 416.414's medical facility separation rules, without overloadingssi_claim_is_joint.Closes #8003
Why a New Variable (Not Modifying
ssi_claim_is_joint)The issue originally proposed modifying
ssi_claim_is_jointdirectly. However,ssi_claim_is_jointcarries two meanings downstream:These diverge when one spouse enters a medical facility: both are still SSI-eligible, but federal SSI computes benefits separately. Overloading
ssi_claim_is_jointto returnfalsewould misclassify state SSP claim types — e.g., Alaska'sak_ssp_claim_typewould move a two-eligible-spouse couple onto theCOUPLE_ONE_ELIGIBLEpayment schedule.Solution:
ssi_claim_is_jointretains "both eligible" semantics. The newssi_couple_computation_appliesencodes the facility separation rule and is used only in federal SSI calculations.Regulatory Authority
What Changed
ssi_couple_computation_applies.py(new)joint_claim & ~one_in_facility— FALSE when exactly one spouse is in a Title XIX facilityssi_amount_if_eligible.pymeets_ssi_resource_test.pyssi_pmv_amount.pyssi_claim_is_joint.pyssi_claim_is_jointTest Plan
5 new test cases in
ssi_couple_computation_applies.yaml:ssi_claim_is_jointssi_couple_computation_applies[true, true][true, true][true, true][false, false][true, true][true, true][true, true][true, true][false, false][false, false]🤖 Generated with Claude Code