Model New Hampshire MEAD and MOAD as separate Medicaid buy-in pathways

Follow-up to #8493 and narrower successor to closed #8472. New Hampshire should be modeled as separate named subpathways, or at least a state-specific overlay, because the state has both MEAD and MOAD with different age ranges, legal authorities, income logic, resource treatment, and premium rules.

## Why this is separate from the shared schema

The shared #8493 schema is a good fit for states where the rule is a single disabled-worker buy-in with one age band, one income limit, one asset limit, and maybe one premium formula. New Hampshire is not that simple:

- MEAD is Medicaid for Employed Adults with Disabilities, for ages 18-64.
- MOAD is Medicaid for Employed Older Adults with Disabilities, for age 65+.
- MEAD uses a 450% FPL net-income standard after APTD/ANB treatment and disregards.
- MOAD is authorized separately for older adults; the statute states 250% FPL, while the DHHS fact sheet says a special MOAD disregard makes the effective limit 450% FPG to align with MEAD.
- MEAD resources are based on a 2002 $20,000 individual / $30,000 couple limit updated annually by CPI, not a fixed simple limit.
- Resource exclusions include retirement plans, medical savings accounts, and employability accounts for work-related goods and services.
- MEAD has a premium as a condition of eligibility, with a tiered 7.5% FPL-based structure and a separate full-premium rule when annual AGI exceeds $75,000.
- Employment requires paid work with FICA contributions, or self-employment with SECA documentation.
- MEAD has temporary unemployment continuation rules.

Those differences justify modeling MEAD/MOAD explicitly. A single state row risks mixing adult and older-adult pathways, under-modeling the income disregard, and missing the premium condition.

## Source details

New Hampshire Admin. Code He-W 841.03 for MEAD:

- MEAD applies to applicants age 18 through 64.
- Applicants must meet APTD or ANB general and technical requirements.
- Applicants must meet MEAD medical criteria.
- Applicants must be employed for pay or self-employed for pay at application, during eligibility determination, and during any retroactive coverage period.
- Net income is determined using APTD or ANB treatment and disregards, including spouse income if applicable, and must not exceed 450% of federal poverty guidelines.
- Countable resources must not exceed the 2002 limit of $20,000 individual / $30,000 married couple, updated annually by CPI.
- Employment for pay requires remuneration and FICA contributions.
- Self-employment requires SECA payment documentation.
- Excluded resources include retirement plans, medical savings accounts, and MEAD employability accounts.
- Employability accounts can cover work-related goods and services such as business equipment, training, work-related attendant care, medical devices, tools, transportation, vehicle purchases or modifications, and disability-related medical supplies.
- A MEAD recipient who becomes unemployed but intends to return to work can remain eligible for a 6-month extension in specified circumstances, with one possible additional 6-month extension.
- Cost-free employer or organization health insurance must be used to remain eligible.

New Hampshire RSA 167:3-m for MOAD:

- MOAD is a Medicaid work incentive program for employed older adults with disabilities.
- It is intended to support workers age 65 and older with disabilities.
- It excludes resources accumulated from earnings in a separate account when determining future eligibility for other medical assistance programs.
- It provides continued eligibility during temporary unemployment in specified circumstances.
- It permits self-employment below the federal minimum wage.
- It permits HCBS waiver-eligible people who meet a special income limit to receive assistance through MOAD.
- The statute states MOAD eligibility where income does not exceed 250% FPL and SSI criteria are met.

New Hampshire premium rule He-C 5003.01 for MEAD:

- MEAD recipients must pay a monthly premium as a condition of eligibility.
- Premiums cannot exceed 7.5% of net income for recipients with combined net income at or below 450% FPL.
- No premium below 150% FPL.
- Premiums are tiered based on 150%, 200%, 250%, 300%, 350%, and 400% FPL thresholds.
- If annual adjusted gross income exceeds $75,000, the full premium is 7.5% of AGI.
- Nonpayment for 2 consecutive months without good cause terminates MEAD.

The 2024 DHHS fact sheet summarizes MEAD and MOAD together:

- MEAD is for ages 18-64; MOAD is for ages 65+.
- People must be employed or self-employed for pay, contribute to FICA, meet income/resource criteria, meet ANB/APTD medical criteria or have a listed impairment expected to last 48 months or longer, and enroll in cost-free employer health insurance if offered.
- The fact sheet notes the MOAD net income limit is below 250% FPG, but a special MOAD disregard makes the effective limit 450% FPG, aligning it with MEAD.

## Implementation notes

- Add New Hampshire-specific MEAD and MOAD variables or a subpathway dimension under the shared buy-in category.
- Feed qualifying MEAD and MOAD cases into the shared `WORKING_DISABLED_BUY_IN` Medicaid category from #8493.
- Model age bands separately:
- MEAD: 18-64;
- MOAD: 65+.
- Model MEAD income using net income after APTD/ANB treatment and disregards, not gross MAGI.
- Decide how to represent MOAD's statutory 250% FPL rule and the effective 450% FPG limit from the special disregard.
- Parameterize CPI-updated resource limits, or set annual values from a current state source if CPI reconstruction is too much for the first pass.
- Defer detailed employability-account asset treatment if needed, but document the approximation.
- Decide whether MEAD premiums are implemented in this issue or a linked premium issue, but do not ignore them in eligibility because payment is a condition of eligibility.

## Acceptance criteria

- A New Hampshire disabled worker age 18-64 who meets MEAD employment, income, and resource rules qualifies through MEAD.
- A New Hampshire disabled worker age 65+ is evaluated under MOAD rather than MEAD.
- MEAD and MOAD both map to the shared `WORKING_DISABLED_BUY_IN` Medicaid category.
- Tests cover:
- MEAD age boundary at 18 and 65;
- MOAD age 65+;
- income above ordinary ABD limits but within MEAD/MOAD buy-in limits;
- resource treatment above ordinary ABD limits but within the buy-in limits;
- a MEAD premium case above 150% FPL if premiums are included in the PR.
- Source comments explain the 250% statutory MOAD limit vs the effective 450% FPG note from the DHHS fact sheet.

## Sources

- N.H. Admin. Code He-W 841.03, Medicaid for Employed Adults with Disabilities (MEAD): https://regulations.justia.com/states/new-hampshire/he/subtitle-he-w/chapter-he-w-800/part-he-w-841/section-he-w-841-03/
- N.H. Rev. Stat. 167:3-m, MOAD Work Incentive Program: https://law.justia.com/codes/new-hampshire/title-xii/chapter-167/section-167-3-m/
- N.H. Admin. Code He-C 5003.01, Premium Schedule for MEAD: https://www.law.cornell.edu/regulations/new-hampshire/N-H-Admin-Code-SS-He-C-5003.01
- New Hampshire DHHS Program Fact Sheet 2024: https://nhlwaa.org/wp-content/uploads/2024/05/DHHS-Program-Fact-Sheet-2024.pdf

Related: #8493, #8472, #8102, #8497.