Add reported health coverage rule inputs

changelog.d/health-coverage-rules.added.md

@@ -0,0 +1 @@
+Added reported current health coverage inputs and ACA/Medicaid coverage reconciliation helpers.

policyengine_us/tests/policy/baseline/gov/aca/eligibility/coverage_report_model_conflict.yaml

@@ -0,0 +1,26 @@
+- name: Case 1, reported Marketplace plus Medicaid conflict is flagged.
+  period: 2025
+  input:
+    reported_has_marketplace_health_coverage_at_interview: true
+    medicaid_enrolled: true
+  output:
+    coverage_report_model_conflict: true
+
+- name: Case 2, Marketplace without conflicting coverage is not flagged.
+  period: 2025
+  input:
+    age: 40
+    medicaid_enrolled: false
+    is_chip_eligible: false
+    medicare_enrolled: false
+    has_esi: false
+    reported_has_marketplace_health_coverage_at_interview: true
+  output:
+    coverage_report_model_conflict: false
+
+- name: Case 3, non-Marketplace coverage without reported Marketplace is not flagged.
+  period: 2025
+  input:
+    reported_has_non_marketplace_direct_purchase_health_coverage_at_interview: true
+  output:
+    coverage_report_model_conflict: false

policyengine_us/tests/policy/baseline/gov/aca/eligibility/has_qualifying_non_marketplace_health_coverage_at_interview.yaml

@@ -0,0 +1,25 @@
+- name: Case 1, Medicaid enrollment counts as qualifying non-Marketplace coverage.
+  period: 2025
+  input:
+    medicaid_enrolled: true
+  output:
+    has_qualifying_non_marketplace_health_coverage_at_interview: true
+
+- name: Case 2, IHS-only coverage does not count as qualifying non-Marketplace coverage.
+  period: 2025
+  input:
+    age: 40
+    medicaid_enrolled: false
+    is_chip_eligible: false
+    medicare_enrolled: false
+    has_esi: false
+    reported_has_indian_health_service_coverage_at_interview: true
+  output:
+    has_qualifying_non_marketplace_health_coverage_at_interview: false
+
+- name: Case 3, off-exchange coverage counts as qualifying non-Marketplace coverage.
+  period: 2025
+  input:
+    reported_has_non_marketplace_direct_purchase_health_coverage_at_interview: true
+  output:
+    has_qualifying_non_marketplace_health_coverage_at_interview: true

policyengine_us/tests/policy/baseline/gov/hhs/medicaid/medicaid_enrolled.yaml

@@ -103,3 +103,28 @@
     is_medicaid_eligible: [true]
     medicaid_enrolled: [true]
     takes_up_medicaid_if_eligible: [true]
+
+- name: Case 5, reported Medicaid coverage preserves CA continuous coverage.
+  period: 2026
+  input:
+    people:
+      person1:
+        age: 35
+        employment_income: 15_000
+        immigration_status: UNDOCUMENTED
+        reported_has_medicaid_health_coverage_at_interview: true
+    tax_units:
+      tax_unit:
+        members: [person1]
+    spm_units:
+      spm_unit:
+        members: [person1]
+    households:
+      household:
+        members: [person1]
+        state_code: CA
+  output:
+    receives_medicaid: [true]
+    is_ca_medicaid_immigration_status_eligible: [true]
+    is_medicaid_eligible: [true]
+    medicaid_enrolled: [true]

policyengine_us/tests/policy/baseline/gov/hhs/medicaid/receives_medicaid.yaml

@@ -0,0 +1,13 @@
+- name: Case 1, reported Medicaid coverage feeds current Medicaid receipt.
+  period: 2026
+  input:
+    reported_has_medicaid_health_coverage_at_interview: true
+  output:
+    receives_medicaid: true
+
+- name: Case 2, Medicaid receipt defaults to false without a reported flag.
+  period: 2026
+  input:
+    reported_has_medicaid_health_coverage_at_interview: false
+  output:
+    receives_medicaid: false

policyengine_us/variables/gov/aca/eligibility/coverage_report_model_conflict.py

@@ -0,0 +1,17 @@
+from policyengine_us.model_api import *
+
+
+class coverage_report_model_conflict(Variable):
+    value_type = bool
+    entity = Person
+    label = "Reported Marketplace coverage conflicts with modeled qualifying non-Marketplace coverage"
+    definition_period = YEAR
+
+    def formula(person, period, parameters):
+        return person(
+            "reported_has_marketplace_health_coverage_at_interview",
+            period,
+        ) & person(
+            "has_qualifying_non_marketplace_health_coverage_at_interview",
+            period,
+        )

policyengine_us/variables/gov/aca/eligibility/has_esi.py

@@ -6,3 +6,9 @@ class has_esi(Variable):
     entity = Person
     label = "Person currently has ESI"
     definition_period = YEAR
+
+    def formula(person, period, parameters):
+        return person(
+            "reported_has_employer_sponsored_health_coverage_at_interview",
+            period,
+        )

policyengine_us/variables/gov/aca/eligibility/has_qualifying_non_marketplace_health_coverage_at_interview.py

@@ -0,0 +1,28 @@
+from policyengine_us.model_api import *
+
+
+class has_qualifying_non_marketplace_health_coverage_at_interview(Variable):
+    value_type = bool
+    entity = Person
+    label = "Person has qualifying non-Marketplace health coverage at interview"
+    definition_period = YEAR
+
+    def formula(person, period, parameters):
+        return (
+            add(
+                person,
+                period,
+                [
+                    "has_esi",
+                    "medicaid_enrolled",
+                    "is_chip_eligible",
+                    "medicare_enrolled",
+                    "reported_has_non_marketplace_direct_purchase_health_coverage_at_interview",
+                    "reported_has_other_means_tested_health_coverage_at_interview",
+                    "reported_has_tricare_health_coverage_at_interview",
+                    "reported_has_champva_health_coverage_at_interview",
+                    "reported_has_va_health_coverage_at_interview",
+                ],
+            )
+            > 0
+        )

policyengine_us/variables/gov/hhs/medicaid/receives_medicaid.py

@@ -15,3 +15,9 @@ class receives_medicaid(Variable):
     This differs from medicaid_enrolled which is computed based on
     eligibility and takeup rate.
     """
+
+    def formula(person, period, parameters):
+        return person(
+            "reported_has_medicaid_health_coverage_at_interview",
+            period,
+        )

policyengine_us/variables/household/expense/health/has_marketplace_health_coverage.py

@@ -4,6 +4,11 @@
 class has_marketplace_health_coverage(Variable):
     value_type = bool
     entity = Person
-    label = "Is eligible for health insurance from an ACA Marketplace plan because has no employer-sponsored health insurance coverage."
+    label = "Person currently has Marketplace health coverage"
     definition_period = YEAR
-    default_value = True
+
+    def formula(person, period, parameters):
+        return person(
+            "reported_has_marketplace_health_coverage_at_interview",
+            period,
+        )

policyengine_us/variables/input/health_coverage.py

@@ -0,0 +1,124 @@
+from policyengine_us.model_api import *
+
+
+class ReportedHealthCoverageAtInterview:
+    value_type = bool
+    entity = Person
+    definition_period = YEAR
+    default_value = False
+
+
+class reported_has_direct_purchase_health_coverage_at_interview(
+    ReportedHealthCoverageAtInterview, Variable
+):
+    label = "Reported direct-purchase health coverage at interview"
+
+
+class reported_has_marketplace_health_coverage_at_interview(
+    ReportedHealthCoverageAtInterview, Variable
+):
+    label = "Reported Marketplace health coverage at interview"
+
+
+class reported_has_subsidized_marketplace_health_coverage_at_interview(
+    ReportedHealthCoverageAtInterview, Variable
+):
+    label = "Reported subsidized Marketplace health coverage at interview"
+
+
+class reported_has_unsubsidized_marketplace_health_coverage_at_interview(
+    ReportedHealthCoverageAtInterview, Variable
+):
+    label = "Reported unsubsidized Marketplace health coverage at interview"
+
+
+class reported_has_non_marketplace_direct_purchase_health_coverage_at_interview(
+    ReportedHealthCoverageAtInterview, Variable
+):
+    label = "Reported non-Marketplace direct-purchase health coverage at interview"
+
+
+class reported_has_employer_sponsored_health_coverage_at_interview(
+    ReportedHealthCoverageAtInterview, Variable
+):
+    label = "Reported employer-sponsored health coverage at interview"
+
+
+class reported_has_medicare_health_coverage_at_interview(
+    ReportedHealthCoverageAtInterview, Variable
+):
+    label = "Reported Medicare health coverage at interview"
+
+
+class reported_has_medicaid_health_coverage_at_interview(
+    ReportedHealthCoverageAtInterview, Variable
+):
+    label = "Reported Medicaid health coverage at interview"
+
+
+class reported_has_means_tested_health_coverage_at_interview(
+    ReportedHealthCoverageAtInterview, Variable
+):
+    label = "Reported means-tested health coverage at interview"
+
+
+class reported_has_chip_health_coverage_at_interview(
+    ReportedHealthCoverageAtInterview, Variable
+):
+    label = "Reported CHIP health coverage at interview"
+
+
+class reported_has_other_means_tested_health_coverage_at_interview(
+    ReportedHealthCoverageAtInterview, Variable
+):
+    label = "Reported other means-tested health coverage at interview"
+
+
+class reported_has_tricare_health_coverage_at_interview(
+    ReportedHealthCoverageAtInterview, Variable
+):
+    label = "Reported TRICARE health coverage at interview"
+
+
+class reported_has_champva_health_coverage_at_interview(
+    ReportedHealthCoverageAtInterview, Variable
+):
+    label = "Reported CHAMPVA health coverage at interview"
+
+
+class reported_has_va_health_coverage_at_interview(
+    ReportedHealthCoverageAtInterview, Variable
+):
+    label = "Reported VA health coverage at interview"
+
+
+class reported_has_indian_health_service_coverage_at_interview(
+    ReportedHealthCoverageAtInterview, Variable
+):
+    label = "Reported Indian Health Service coverage at interview"
+
+
+class reported_has_private_health_coverage_at_interview(
+    ReportedHealthCoverageAtInterview, Variable
+):
+    label = "Reported private health coverage at interview"
+
+
+class reported_has_public_health_coverage_at_interview(
+    ReportedHealthCoverageAtInterview, Variable
+):
+    label = "Reported public health coverage at interview"
+
+
+class reported_is_insured_at_interview(ReportedHealthCoverageAtInterview, Variable):
+    label = "Reported insured at interview"
+
+
+class reported_is_uninsured_at_interview(ReportedHealthCoverageAtInterview, Variable):
+    label = "Reported uninsured at interview"
+
+
+class reported_has_multiple_health_coverage_at_interview(
+    ReportedHealthCoverageAtInterview, Variable
+):
+    label = "Reported multiple health coverage types at interview"