Implement Indiana State Supplementary Payment (SSP)

[hua7450]

Summary

Implements Indiana's State Supplementary Payment (SSP) -- two sub-programs: SAPN (Supplemental Assistance for Personal Needs) for Medicaid facility residents, and RCAP (Residential Care Assistance Program) for licensed residential care facility residents.

Closes #7886

Regulatory Authority

• SSA POMS SI CHI01401.001 -- Indiana State Supplementary Payments
• FSSA Medicaid Policy Manual Chapter 5000 -- SAPN
• 455 IAC 1-3-3 -- RCAP Per Diem Reimbursement Rates
• Gargano v. Lee Alan Bryant Health Care Facilities, Inc. (2012) -- confirms $49.35 per diem since July 2008
• FSSA RCAP Provider Guide (Sept 2017)
• IC 12-10-6-2.1 -- Residential Care Assistance; Eligibility; Personal Allowance
• IC 12-15-32-6.5 -- SAPN Payment Calculation for Federal SSI Recipient
• SSA State Assistance Programs for SSI Recipients, January 2011 -- Indiana

Program Overview

• Administration: State-administered by FSSA (Family and Social Services Administration), Division of Aging
• Funding: 100% state funds
• Statutory basis: Indiana Public Law 46, Acts of 1976 (effective July 1, 1976)
• Current caseload: 3,442 recipients (1,517 licensed residential; 1,925 Medicaid facility) as of January 2011 (SSA 2011 report -- last published edition)
• Total expenditures: $8,453,205.54 (CY 2010)

Eligibility

Requirement	Source	How Modeled
SAPN: Must be SSI-eligible	FSSA Chapter 5000; SSA POMS SI CHI01401.001	is_ssi_eligible
SAPN: Must actually receive SSI (income not too high)	IC 12-15-32-6.5: "recipient of assistance under the federal SSI program"	uncapped_ssi > 0
SAPN: Must be Medicaid-eligible	FSSA Chapter 5000	is_medicaid_eligible
SAPN: Must reside in Medicaid-certified facility	FSSA Chapter 5000; SSA POMS	in_ssp_living_arrangement == MEDICAID_FACILITY
SAPN: Must be age 18+	SSA 2011 Report	age >= age_threshold parameter (18)
RCAP: Must be aged/blind/disabled (SSI criteria)	SSA 2011 Report; IC 12-10-6-2.1	is_ssi_eligible
RCAP: No income limit for eligibility	IC 12-10-6-4: "excess income is not thereby ineligible"	No uncapped_ssi > 0 check
RCAP: Must reside in licensed/unlicensed residential care facility	SSA 2011 Report; 455 IAC 1-3-3	in_ssp_living_arrangement == LICENSED_RESIDENTIAL | UNLICENSED_RESIDENTIAL
RCAP: Must be age 18+	SSA 2011 Report	age >= age_threshold parameter (18)
Must reside in Indiana	State program	defined_for = StateCode.IN
Spouse-for-spouse financial responsibility	SSA 2011 Report	Couple logic via ssi_claim_is_joint

Benefit Amounts

SAPN -- Supplemental Assistance for Personal Needs (SSA POMS SI CHI01401.001; FSSA Chapter 5000)

Category	Monthly Amount	Source
Individual supplement	$22	SSA POMS; SSA 2011 Report
Couple supplement	$44 ($22/person)	SSA 2011 Report
Combined (fed SSI + state): individual	$52 ($30 SSI + $22 SAPN)	SSA 2011 Report Table 1
Combined (fed SSI + state): couple	$104 ($60 SSI + $44 SAPN)	SSA 2011 Report Table 1

Couple treatment: $22 per eligible person ($44 couple = $22 x 2); uses ssi_claim_is_joint for couple detection
COLA: Frozen since July 2002

RCAP -- Residential Care Assistance Program (455 IAC 1-3-3; Gargano v. Lee Alan Bryant (2012))

Category	Per Diem Rate	Effective	Source
Licensed facility (under IC 16-28)	$39.35/day	Jan 2004	455 IAC 1-3-3
Licensed facility (under IC 16-28)	$49.35/day	Jul 2008	Gargano v. Lee Alan Bryant (2012); FSSA Provider Guide
Unlicensed facility	$27.00/day	Jan 2004	455 IAC 1-3-3
Unlicensed facility	$37.00/day	Jul 2008	FSSA Provider Guide ($1,125.41 ÷ 30.4167)
Personal needs allowance	$52/month	Jul 2002	IC 12-10-6-2.1(d)

RCAP benefit formula: max(0, per_diem * 365/12 - federal_SSI)

• The per diem × 365/12 IS the full state standard (PNA is carved out from it, not added on top)
• Licensed state standard (2008+): $49.35 × 365/12 = $1,501.06/month -- matches SSA 2011 combined amount exactly
• Unlicensed state standard (2008+): $37.00 × 365/12 = $1,125.42/month -- matches FSSA Provider Guide
• Federal SSI is subtracted via max(uncapped_ssi, 0)

Note on per diem history: The regulation text on Cornell LII (455 IAC 1-3-3) still shows the 2003 rates ($39.35/$27). The rates were updated administratively in July 2008 per the authority in 455 IAC 1-3-4 (annual review) and IC 12-10-6-1. The regulation was readopted without text amendment in 2009, 2013, and 2019. The $49.35 rate is confirmed by the Indiana Court of Appeals and the FSSA Provider Guide.

COLA: Per diem rates set at $39.35/$27 in Jan 2004, increased to $49.35/$37 in Jul 2008; no changes since

Not Modeled (by design)

What	Source	Why Excluded
Indiana resource limits ($1,500 individual / $2,250 couple)	SSA 2011 Report	Simplified via is_ssi_eligible (uses federal SSI limits $2,000/$3,000 -- slightly less restrictive)
SAPN income-based reduction ($52 - income, range $1-$22)	FSSA Chapter 5000	Modeled as flat $22; most Medicaid facility residents have only $30 SSI income
SAPN not countable for Medicaid	FSSA Chapter 5000	Downstream Medicaid interaction not modeled
RCAP/SAPN excluded from SSI calculations	SSA POMS SI CHI01401.001	SSP benefits not fed back into SSI in our model
RCAP countable income beyond SSI	IC 12-10-6-9	Only federal SSI subtracted; other income sources not yet modeled
$16 sheltered workshop incentive exclusion	SSA 2011 Report	Rare scenario, not simulatable
Tax liability retention allowance	IC 12-10-6-2.1(e)	Complex tax calculation, marginal impact
Couples treated as individuals after 1 month in facility	SSA 2011 Report	Time-dependent transition rule
Higher education award exclusion	IC 12-10-6-13	Narrow exclusion, not simulatable
Life insurance CSV disregard ($10k face value)	SSA 2011 Report	Detailed resource accounting beyond scope

Files

parameters/gov/states/in/fssa/ssp/
  age_threshold.yaml                     # 18 (since 1976)
  personal_needs_allowance.yaml          # $52/month (since July 2002)
  sapn/amount/
    individual.yaml                      # $22/month (since July 2002)
    couple.yaml                          # $44/month (since July 2002)
  rcap/per_diem/
    licensed.yaml                        # $39.35/day (Jan 2004), $49.35/day (Jul 2008)
    unlicensed.yaml                      # $27.00/day (Jan 2004), $37.00/day (Jul 2008)

variables/gov/states/in/fssa/ssp/
  in_ssp.py                              # Top-level: SAPN + RCAP combined (adds)
  in_ssp_eligible.py                     # Overall eligibility (SAPN | RCAP)
  in_ssp_living_arrangement.py           # Enum: MEDICAID_FACILITY, LICENSED_RESIDENTIAL, UNLICENSED_RESIDENTIAL, NONE
  in_ssp_sapn.py                         # SAPN benefit calculation
  in_ssp_sapn_eligible.py                # SAPN eligibility (requires SSI receipt)
  in_ssp_rcap.py                         # RCAP benefit calculation (per diem - federal SSI)
  in_ssp_rcap_eligible.py                # RCAP eligibility (no income test)

tests/policy/baseline/gov/states/in/fssa/ssp/
  in_ssp.yaml                            # 3 combined benefit tests
  in_ssp_sapn.yaml                       # 4 SAPN benefit tests
  in_ssp_sapn_eligible.yaml              # 8 SAPN eligibility tests
  in_ssp_rcap.yaml                       # 7 RCAP benefit tests
  in_ssp_rcap_eligible.yaml              # 8 RCAP eligibility tests
  in_ssp_eligible.yaml                   # 3 overall eligibility tests
  integration.yaml                       # 7 end-to-end integration tests
  edge_cases.yaml                        # 25 edge case tests

Verification TODO

• Verify SAPN payment amounts ($22/$44) against SSA POMS and FSSA Chapter 5000
• Verify RCAP per diem rates -- updated to $49.35/$37 (Jul 2008) per court case and Provider Guide
• Verify personal needs allowance ($52) -- hardcoded in statute IC 12-10-6-2.1(d), confirmed current Jan 2026
• Verify SAPN eligibility -- IC 12-15-32-6.5 requires SSI receipt, not just categorical eligibility
• Verify RCAP has no income limit -- IC 12-10-6-4 explicitly says excess income doesn't disqualify
• Verify RCAP formula -- PNA carved out from state standard, not added on top; matches SSA 2011 data
• CI passes

Test plan

• 65 tests pass (8 test files: 3 eligibility + 3 benefit + 1 integration + 1 edge cases)
• CI passes

[codecov]

Codecov Report

✅ All modified and coverable lines are covered by tests.
✅ Project coverage is 100.00%. Comparing base (ac35815) to head (ccfedb7).
⚠️ Report is 23 commits behind head on main.

Additional details and impacted files

@@            Coverage Diff            @@
##              main     #7887   +/-   ##
=========================================
  Coverage   100.00%   100.00%           
=========================================
  Files            2         7    +5     
  Lines           32       108   +76     
=========================================
+ Hits            32       108   +76     

Flag	Coverage Δ
unittests	100.00% <100.00%> (ø)

Flags with carried forward coverage won't be shown. Click here to find out more.

☔ View full report in Codecov by Sentry.
📢 Have feedback on the report? Share it here.

🚀 New features to boost your workflow:

• ❄️ Test Analytics: Detect flaky tests, report on failures, and find test suite problems.