PolicyEngine / PolicyEngine/policyengine-us
Audit SSI-recipient Medicaid state handling: 1634, SSI-criteria, and 209(b) states
- Dominant language
- Python
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Description
## Problem
The current SSI-recipient Medicaid category is a single `ssi_recipient.is_covered[state]` boolean. That is too coarse for SSI reform analysis.
The current implementation also appears inconsistent with SSA POMS: Oklahoma is marked false in `gov.hhs.medicaid.eligibility.categories.ssi_recipient.is_covered`, but SSA POMS lists Oklahoma as an SSI-criteria state rather than a 209(b) state. SSI-criteria states require state Medicaid determinations but use SSI criteria; 209(b) states can use more restrictive rules.
## Why this matters
In the local 2026 no-SSI-asset-limit reform:
- +1.399M people newly receive SSI in the current model.
- +618.5k become Medicaid eligible through the SSI-recipient pathway.
- +584.1k become Medicaid enrolled.
- Medicaid cost rises +$20.1B/year.
The size and state distribution of this Medicaid effect depend heavily on how we treat 1634, SSI-criteria, and 209(b) states.
## Scope
- Replace or supplement the boolean with explicit state classification: 1634, SSI-criteria, 209(b).
- Audit Oklahoma and all other states against SSA POMS SI 01715.010 / SI 01715.020.
- For SSI-criteria states, decide whether SSI receipt should imply Medicaid eligibility in the annual model or whether a separate application/take-up gate is needed.
- For 209(b) states, model the relevant aged/blind/disabled Medicaid criteria instead of blanket excluding all SSI recipients.
- Preserve current behavior only where legally justified.
## Sources
- SSA POMS SI 01715.010: Medicaid and SSI recipient state classifications.
- SSA POMS SI 01715.020: 209(b) and SSI-criteria states.
- 42 U.S.C. 1396a(f) / 42 CFR 435.121 for more restrictive 209(b) rules.
## Acceptance criteria
- State classification is represented explicitly in parameters.
- Tests cover at least one 1634 state, one SSI-criteria state, Oklahoma, and one 209(b) state.
- SSI asset-limit reform Medicaid effects are not driven by an undocumented boolean shortcut.
Contributor guide
Research direction
Start by reading SSA POMS SI 01715.010 and SI 01715.020, then locate the parameter implementing gov.hhs.medicaid.eligibility.categories.ssi_recipient.is_covered and its existing tests. Compare every state classification, including Oklahoma, with the cited sources and determine the SSI-criteria application gate and 209(b) criteria. Done means explicit 1634, SSI-criteria, and 209(b) parameters, representative tests, and no undocumented boolean shortcut driving reform results.
Written by the indexing model from the issue text.
Assessment
- Tech stack
- python
- Domain
- backend
- Issue type
- Feature
- Difficulty
- 5/5
- Estimated time
- Over a week
- Activity status
- Quiet
- Clarity
- Mostly clear
- Newbie friendliness
- 35/100