Implement Iowa State Supplementary Payment (SSP)

[hua7450]

Summary

Implements Iowa's State Supplementary Assistance (SSA) — a state SSI supplement program administered jointly by the Social Security Administration (federally-administered arrangements) and Iowa Department of Health and Human Services (state-administered arrangements). SSA provides six modeled supplement arrangements for low-income aged, blind, and disabled Iowans who receive or would receive federal SSI.

The design uses a single ia_ssa_living_arrangement enum to route each person to one arrangement, and a single ia_ssa payment formula that selects over that enum. There are no per-arrangement supplement variables — one routing variable, one payment variable.

Closes #7733

Regulatory Authority

• Iowa Code Chapter 249 — State Supplementary Assistance (https://www.legis.iowa.gov/docs/code/249.pdf)
• IAC 441 Chapter 51 — Eligibility (https://www.legis.iowa.gov/docs/iac/chapter/01-07-2026.441.51.pdf)
• IAC 441 Chapter 52 — Payment / Assistance Standards (https://www.legis.iowa.gov/docs/iac/chapter/01-07-2026.441.52.pdf)
• IAC 441 Chapter 177 — In-Home Health-Related Care (https://www.legis.iowa.gov/docs/iac/chapter/01-07-2026.441.177.pdf)
• SSA POMS SI 01415.050.F — Federally Administered Optional Supplementary Payment Programs: Iowa (confirms federal-admin split, V-shape SSP math for federally-administered arrangements)
• SSA State Assistance Programs for SSI Recipients — Iowa (January 2011) — https://www.ssa.gov/policy/docs/progdesc/ssi_st_asst/2011/ia.pdf (baseline historical values)
• Iowa HHS General Letter 6-B-46 (effective 1/1/2025) — https://hhs.iowa.gov/media/15607/download
• Iowa HHS SSA current rates page (effective 1/1/2026) — https://hhs.iowa.gov/assistance-programs/state-supplementary-assistance

Program Overview

• Administration split per POMS SI 01415.050.F:
  • Federally-administered (SSA issues combined federal SSI + state supplement): Blind, Dependent Person, Family-Life Home
  • State-administered (Iowa HHS pays separately): Residential Care Facility, In-Home Health-Related Care, Supplement for Medicare/Medicaid Eligibles
• Funding: State funds (supplement paid on top of federal SSI).
• Agency: Iowa Department of Health and Human Services (HHS, formerly DHS; reorganized 2023).
• Current caseload: 5,281 recipients in 2011 per SSA State Assistance Programs report (last year SSA published state-level counts).

Six Modeled Living Arrangements

Arrangement	Administration	Amount (2025)	Source
Blind	Federal SSA	$22/month flat	IAC 441—52.1(4)
Dependent Person (DP)	Federal SSA	5 configs, $1,470–$1,997 standard	IAC 441—52.1(2)
Family-Life Home (FLH)	Federal SSA	Standard $1,129; max state supplement $142	IAC 441—52.1(1)
Residential Care (RCF)	Iowa HHS	$37.60/day × 31 days − client participation, $126 PNA	IAC 441—52.1(3)
In-Home HRC (IHHRC)	Iowa HHS	$480.55 per-person cap minus client participation	IAC 441—177.4(1)(f), 441—177.10(2)(a), 441—177.10(3)
SMME	Iowa HHS	$1/month	IAC 441—52.1(7)

Priority (highest to lowest, enforced in ia_ssa_living_arrangement): RCF → IHHRC → FLH → DP → Blind → SMME → NONE. Iowa is a "concurrent category State" per POMS — recipients receive the highest-priority supplement they qualify for.

Eligibility

Requirement	Source	How Modeled
Aged, blind, or disabled	Iowa Code §249.3; IAC 441—51.1	is_ssi_aged_blind_disabled (ABD categorical component of SSI)
Citizen or qualified noncitizen	IAC 441—51.6; federal SSI rules	is_ssi_qualified_noncitizen | immigration_status == CITIZEN
Must apply for or receive SSI (or would qualify except for income)	IAC 441—51.1, 441—51.2	Categorical + immigration + Iowa resource test (federal income/SSI receipt is not gated; recipients above SSI but below state standard remain eligible per IAC 441—51.1)
Resource limit ($2,000 individual / $3,000 with any spouse)	IAC 441—51.5(2), 51.5(4)	ia_ssa_resources_eligible sums marital-unit resources whenever the claimant lives with a spouse — applied independently of federal SSI's resource test so Iowa's $3,000 marital limit is reachable when the spouse is non-ABD (federal SSI applies $2,000 individual in that case, but Iowa pays based on its own $3,000 limit)
Iowa residence	IAC 441—51.6	defined_for = StateCode.IA
Arrangement-specific:
RCF: post-PNA client participation < 31 × max_per_diem	IAC 441—51.3(3) cross-refs 52.1(3)"a"	ia_ssa_living_arrangement gates on post-PNA client participation
IHHRC: combined marital-unit countable, after SSI FBR disregard, ≤ $480.55 (single) or $961.10 (couple)	IAC 441—177.4(1)(f)	Combined marital-unit income check with FBR disregard, applied symmetrically for single and couple
FLH/DP/Blind: federally-administered V-shape phase-down	POMS SI 01415.050.F	max(0, state_standard − max(countable, FBR)), plus FBR for Blind
SMME: Medicaid + Part B + income > 120% FPL	IAC 441—51.6	ia_ssa_smme_eligible
Full Medicaid (excludes medically-needy/spenddown)	IAC 441—51.6(1)	ia_ssa_has_full_medicaid — explicit input, default_value = False

Benefit Amount Formulas

All arrangements are computed inside ia_ssa, selected by ia_ssa_living_arrangement.

Federally-administered (Blind, DP, FLH) use the standard SSP V-shape:

supplement = max(0, total_standard − max(countable_income, FBR))

Blind's state portion ($22) is added on top of FBR per POMS guidance for the standalone Blind arrangement; DP/FLH standards are the total payment standards. Per IAC 441—52.1(4), the $22 blind allowance is mutually exclusive with other SSP arrangements — a blind FLH resident receives FLH only, not FLH + $22 stacked.

RCF uses cost-based reimbursement:

supplement = max(0, cost_of_care − client_participation)
  where cost_of_care          = min(cost_per_diem, $37.60) × 31
  and   client_participation   = max(0, (countable + SSI) − $126 PNA)

Income eligibility uses the same post-PNA client participation: eligibility holds when client_participation < 31 × max_per_diem.

IHHRC uses cost-based reimbursement minus client participation, per person, per IAC 441—177.10(2)(a):

supplement = max(0, min(cost_of_care, $480.55) − client_participation)
  where client_participation = (combined_marital_countable − FBR_disregard) / marital_unit_size

The per-person cap is always $480.55 per IAC 441—177.10(3); the $961.10 in 441—177.4(1)(f) is the combined-couple income cap, not a payment cap.

SMME is a flat $1/month for people with full Medicaid + Medicare Part B + income above 120% FPL.

Joint-Claim & Couple-Unit Handling

ssi_countable_income returns combined / 2 per spouse for joint SSI claims, while several Iowa thresholds are couple-FBR-level. The implementation handles this explicitly:

• DP (couple configurations): when the configuration includes a spouse (AGED_OR_DISABLED_WITH_SPOUSE_AND_DEPENDENT, BLIND_WITH_AGED_OR_DISABLED_SPOUSE_AND_DEPENDENT, BLIND_WITH_BLIND_SPOUSE_AND_DEPENDENT), the formula compares aggregated marital countable against couple FBR, then splits the resulting supplement equally across spouses in the marital unit so SPM-unit aggregation doesn't double-count when both spouses select the same couple configuration.
• BLIND: any joint SSI claim aggregates marital countable and compares against couple_fbr + N × $22, where N is the number of blind people in the marital unit. The /2 split applies only when both spouses are blind (both route to BLIND); when only one spouse is blind, that spouse keeps the full $22 since the non-blind spouse routes to a different arrangement.
• SMME: joint SSI claims compare aggregated marital countable against the 2-person 120% FPL (not per-spouse halves vs per-spouse FPL).
• FLH Department top-up: replaces the binary state_supplement − max_supplement = $20 with a graduated formula. Department fills the gap from total income to the FLH standard, capped at the published gap. SSI-only recipients get the full top-up; recipients with $10/mo of other unearned income (which absorbs $10 of SSA's $20 GIE) need only a $10 top-up. The defensive cap prevents artificially low ssi_monthly (non-takeup, mid-month transitions) from exploding the supplement.

Historical Coverage

Parameters have multi-tier effective dates with authoritative sources for each:

Tier	Source
2011-01-01	SSA State Assistance Programs for SSI Recipients — Iowa (January 2011), Table 1
2017-01-01	Iowa Administrative Code 01-04-2017 supplement, 441—51.3–51.4, 441—52.1
2018-01-01	Iowa Administrative Code 03-28-2018 rule update for 441—52.1
2025-01-01	Iowa HHS General Letter 6-B-46
2026-01-01	Iowa HHS State Supplementary Assistance Standards current page

Values frozen in the IAC rule text ($22 blind, $142 FLH aged max supplement, $480.55/$961.10 IHHRC caps) are dated 2011-01-01 with SSA 2011 as corroborating source. 2012–2016 and 2019–2024 intermediate values are not encoded; PolicyEngine carries the most recent preceding entry forward.

2026 DP Value Anomaly

The 2026 DP configuration "Blind Client + Aged/Disabled Spouse + Dependent Relative" shows $3,031 on the Iowa HHS SSA rates page — a +53.5% jump over 2025 ($1,975) against a ~2.85% COLA on every other configuration. The COLA-consistent value would be ~$2,031 ($1,975 × 1.0285), and the long-standing "−$22 when only one spouse is blind" footnote ($2,053 − $22 = $2,031) holds for 2011/2017/2018/2025 and breaks if 2026 = $3,031. The most likely explanation is a transposed-digit publication error on the Iowa HHS page.

This implementation deliberately encodes $2,031 instead of the published $3,031, with a YAML comment documenting the rationale. Will revisit and switch to the published value if Iowa HHS issues a correction confirming $3,031 is intentional.

Not Modeled (by design)

What	Source	Why Excluded
Mandatory State Supplement (MSS)	Iowa Code §249.3(1); IAC 441—52.1(6)	Closed December 1973 grandfather cohort; no input data in PolicyEngine
SMME SGA test	IAC 441—51.6(2)	SGA not modeled in PolicyEngine
SMME upper-income cap (Medicaid eligibility group income limit)	IAC 441—51.6(6)	Iowa Medicaid income-limit variable not available; 120% FPL floor IS modeled
Physician certification for IHHRC (Form 470-0673)	IAC 441—177.6	Administrative verification
IHHRC 5-step disregard cascade (unmet medical needs, dependents)	IAC 441—177.4(1)(f)	State-specific disregards require inputs not in PolicyEngine; federal SSI disregards handled via ssi_countable_income
RCF pre-2017-07-01 flat per-diem branch	IAC 441—52.1(3)	Iowa switched to cost-related-only system on 7/1/2017
Part A vs. Part B Medicare distinction for SMME	IAC 441—51.6(4)	PolicyEngine's medicare_enrolled does not distinguish Part A vs B; ia_ssa_has_medicare_part_b is an explicit input (default_value = False)
SSN requirement and apply-for-other-benefits administrative rules	IAC 441—51.2, 441—51.9	Administrative verification
Medically-needy / spenddown Medicaid routed to SMME	IAC 441—51.6(1)	ia_ssa_has_full_medicaid is an explicit input so only full-Medicaid recipients trigger SMME
FLH gross-other-income proxy	GL 6-B-46 p.30	FLH Department top-up uses countable_no_disregard (post-earned-exclusion) as a proxy for gross other income; pre-exclusion gross would be more accurate when recipients have earned income (the $65 + 50% earned exclusions hide gross from the proxy). Flagged for follow-up.

Files

policyengine_us/parameters/gov/states/ia/hhs/ssa/
  blind.yaml
  dp/
    assistance_standard.yaml       # breakdown by ia_ssa_dp_configuration enum
    dependent_income_limit.yaml
  flh/
    state_supplement.yaml
    max_supplement.yaml
  ihhrc/
    max_cost_single.yaml
    max_cost_couple.yaml
  rcf/
    days_multiplier.yaml
    max_per_diem.yaml
    personal_needs_allowance.yaml
  smme/
    amount.yaml
    minimum_income_fpl_multiplier.yaml

policyengine_us/variables/gov/states/ia/hhs/ssa/
  ia_ssa.py                          # single payment formula, selects over living_arrangement
  ia_ssa_living_arrangement.py       # derived enum + priority routing formula
  ia_ssa_living_arrangement_input.py # input enum (FAMILY_LIFE_HOME / RESIDENTIAL_CARE_FACILITY / IN_HOME_HEALTH_RELATED_CARE / NONE)
  ia_ssa_eligible.py                 # ABD + immigration + Iowa resource test (independent of federal SSI resource test)
  ia_ssa_resources_eligible.py       # sums marital-unit resources whenever claimant lives with a spouse
  ia_ssa_countable_income_no_disregard.py  # restores SSI $20 disregard for RCF/IHHRC client participation
  dp/
    ia_ssa_dp_configuration.py
    ia_ssa_dp_has_eligible_dependent.py
    ia_ssa_dp_dependent_countable_income.py
  ihhrc/
    ia_ssa_ihhrc_cost_of_care.py
    ia_ssa_ihhrc_both_need_care.py
  rcf/
    ia_ssa_rcf_cost_per_diem.py
  smme/
    ia_ssa_has_full_medicaid.py      # explicit input, default_value = False
    ia_ssa_has_medicare_part_b.py    # explicit input, default_value = False
    ia_ssa_smme_eligible.py

policyengine_us/tests/policy/baseline/gov/states/ia/hhs/ssa/
  ia_ssa.yaml                        # consolidated payment tests (all 6 arrangements)
  ia_ssa_living_arrangement.yaml     # routing / priority tests
  ia_ssa_eligible.yaml
  ia_ssa_resources_eligible.yaml
  ia_ssa_dp_configuration.yaml

policyengine_us/parameters/gov/household/household_state_benefits.yaml  [adds ia_ssa]
policyengine_us/variables/household/income/spm_unit/spm_unit_benefits.py [adds ia_ssa]
policyengine_us/programs.yaml                                            [IA SSA status → complete]
changelog.d/ia-ssp.added.md

Test plan

• 90 tests pass across 5 YAML files — real federal+state income inputs, 2011/2017/2018/2025/2026 historical tiers, boundary cases for each arrangement, and review-fix regressions (Cases 9–16: BLIND_WITH_DEPENDENT, joint-claim DP marital-unit guard, joint-claim SMME 2-person FPL aggregation, 2011 DP dependent-child coverage, BLIND one-blind joint-couple aggregation, Iowa $3,000 marital resource limit reachable for non-joint married claimant)
• make format clean
• Microsimulation regression test passes
• Branch synced with upstream/main
• CI passes

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Codecov Report

✅ All modified and coverable lines are covered by tests.
✅ Project coverage is 98.16%. Comparing base (cc5bd64) to head (4a12735).
⚠️ Report is 138 commits behind head on main.

Additional details and impacted files

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- Hits        48563      321    -48242     
+ Misses      19140        6    -19134     
+ Partials        7        0        -7     

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[PavelMakarchuk]

Iowa State Supplementary Payment (SSP) — PR #8017 Review

Source Documents

• PDFs reviewed:
  • IAC 441 Chapter 52 (Payment Standards) — https://www.legis.iowa.gov/docs/iac/chapter/01-07-2026.441.52.pdf
  • IAC 441 Chapter 51 (Eligibility) — https://www.legis.iowa.gov/docs/iac/chapter/01-07-2026.441.51.pdf
  • IAC 441 Chapter 177 (IHHRC) — https://www.legis.iowa.gov/docs/iac/chapter/01-07-2026.441.177.pdf
  • SSA "State Assistance Programs for SSI Recipients" — Iowa, January 2011 — https://www.ssa.gov/policy/docs/progdesc/ssi_st_asst/2011/ia.pdf (via Wayback Machine)
  • Iowa HHS General Letter 6-B-46 (effective 2025-01-01) — https://hhs.iowa.gov/media/15607/download
  • Iowa HHS State Supplementary Assistance current rates page (HTML) — https://hhs.iowa.gov/assistance-programs/state-supplementary-assistance
• Year coverage: 2011, 2017, 2018, 2025, 2026
• Scope: Full PR diff (38 files; new state program implementation — 17 variables, 13 parameters, 5 test YAMLs, plus SPM-unit roll-up registration and program registry)

---

Critical (Must Fix)

1. DP supplement formula uses individual FBR for couple configurations and applies an unjustified per-person cap

   • Location: policyengine_us/variables/gov/states/ia/hhs/ssa/ia_ssa.py:39-43; parameters/.../dp/state_supplement.yaml; parameters/.../dp/max_per_person_cap.yaml.
   • The formula is dp_raw = max_(0, (individual_fbr + dp_state_supplement) - countable_or_fbr); dp_amt = min_(dp_raw, p.dp.max_per_person_cap). countable_or_fbr is clamped to individual_fbr ($967) even when the configuration represents an eligible couple — federal SSI for an eligible couple fills to the couple FBR ($1,450), not the individual FBR. The state_supplement YAML is back-calculated against individual_fbr for every configuration, producing wildly inflated raw values that the author then bounds with max_per_person_cap = $503.
   • The $503 cap has no regulatory basis as a payment ceiling — it is the dependent relative's income eligibility limit (per IAC 441-51.5(1) / GL 6-B-46 cover page), repurposed here. max_per_person_cap.yaml and dependent_income_limit.yaml are byte-identical across all four years (379, 387, 503, 518), confirming the conflation.
   • Code-path verifier confirmed: for BLIND_WITH_BLIND_SPOUSE_AND_DEPENDENT 2025 with zero countable income, code returns $503; regulation requires $547 (= $1,997 standard − $1,450 couple FBR). $44/month error, locked in by test ia_ssa.yaml Case 3.
   • Other affected 2025 configurations: BLIND_WITH_DEPENDENT (true $525, code $503); BLIND_WITH_AGED_OR_DISABLED_SPOUSE_AND_DEPENDENT (true $525, code $503).
   • PDF citation: Iowa HHS GL 6-B-46 ("Making the Dependent Person Payment", manual lines 1714–1720): "Only the income of the eligible person or eligible couple is subtracted from the applicable assistance standard." 2025 standards listed at GL pp. 22 (image p. 28).
   • Fix: Parameterize the assistance standard directly per configuration and select individual vs. couple FBR based on whether the configuration includes an eligible spouse, then supplement = max(0, standard − max(countable, applicable_fbr)). Remove max_per_person_cap.

2. $20 SSI general disregard incorrectly included in RCF/FLH/IHHRC client participation

   • Location: ia_ssa.py:22-26, 56-70, 71-80, 90-100; ia_ssa_living_arrangement.py:28-33, 39-66.
   • All three programs derive countable_monthly = ssi_countable_income / 12, but ssi_countable_income already applies the federal $20 general income exclusion (gov.ssa.ssi.income.exclusions.general) inside _apply_ssi_exclusions.py. The Iowa rules enumerate disregards exhaustively and omit the $20 exclusion:
     • RCF — IAC 441-52.1(3)(a) / GL 6-B-46 p. 58: "NOTE: Do not allow the SSI $20 income disregard."
     • FLH — GL 6-B-46 p. 30: "EXCEPTION: Do not allow the $20 income disregard."
     • IHHRC — IAC 441-177.4(1)(f) / GL 6-B-46 p. 36: "EXCEPTION: Do not allow the $20 disregard."
   • Code-path verifier confirmed: test ia_ssa.yaml RCF Case 6 (SS $1,000/mo) expects $311.60; correct value is $291.60. $20/month understatement of client participation = $20/month overstatement of supplement for any recipient with non-SSI unearned income ≥ $20/mo. The same error contaminates the income-eligibility gates (rcf_income_eligible, ihhrc_income_eligible, blind_income_eligible) within $20 of the cap.
   • Fix: Introduce an Iowa-specific ia_ssa_countable_income_no_disregard helper that adds back min(unearned_monthly, $20), and use it in RCF/FLH/IHHRC payment formulas and in the corresponding routing-layer gates.

3. Iowa SSA resource-limit dispatcher under-includes ineligible dependent spouses

   • Location: policyengine_us/variables/gov/states/ia/hhs/ssa/ia_ssa_resources_eligible.py:12-24.
   • Code uses joint = ssi_claim_is_joint to flip both the resource pool (individual vs. marital sum) and the cap ($2,000 vs. $3,000). ssi_claim_is_joint returns True only when both spouses are SSI-categorically-eligible heads/spouses. IAC 441-51.5(2) extends the $3,000 cap whenever the recipient has "a dependent spouse," and 51.5(4) defines that to include an "ineligible spouse … who is financially dependent upon the recipient." Also affects the third sentence of 51.5(2): "recipient, spouse, and dependent child or parent: $3,000."
   • Concrete failure: aged SSI recipient married to a 50-year-old non-disabled spouse with no income → ssi_claim_is_joint = False → tested individually against $2,000 instead of marital-unit against $3,000.
   • Fix: Replace the dispatcher with an Iowa-specific ia_ssa_has_dependent_spouse (or extend an ia_ssa_dp_* variable that already enumerates dependents) and sum resources across all 51.5-covered dependent relatives.

4. Wrong IAC subsection citations (5 locations) — all 4 verifier claims confirmed

   #	File	Wrong	Correct
   1	parameters/.../ssa/smme/minimum_income_fpl_multiplier.yaml (both refs)	441—51.6(6)	441—51.7(6)
   2	parameters/.../ssa/dp/dependent_income_limit.yaml	441—51.4(1)	441—51.5(1)
   3	parameters/.../ssa/dp/max_per_person_cap.yaml	441—51.4(1)	441—51.5(1)
   4	parameters/.../ssa/rcf/days_multiplier.yaml (both refs)	441—51.3(3)	441—51.4(3)
   5	variables/.../ssa/ia_ssa_living_arrangement.py line 39 comment	IAC 441—51.3(3)	IAC 441—51.4(3)

   • 441-51.3 ("Supplementation") and 441-51.6 ("Residence") have no numbered subsections, so the cited references literally do not exist. The correct subsections (51.7(6) for the 120% FPL rule, 51.5(1) for dependent-relative income, 51.4(3) for RCF income eligibility) all match the parameter content verbatim.

5. RCF and IHHRC client-participation formulas omit required regulatory deductions

   • Location: ia_ssa.py:71-100.
   • RCF (IAC 441-52.1(3)(a) / GL 6-B-46 p. 57): Required deduction order is (1) impairment-related work expenses, (2) $65 + ½ remaining earned income, (3) $126 PNA, (4) diversion to spouse at home, (5) diversion to dependent child, (6) unmet medical needs of resident, (7) unmet medical needs of spouse/dependent, (8) first-month previous-living expenses. Code applies only #3.
   • IHHRC (IAC 441-177.4(1)(f) / GL 6-B-46 p. 38): Required deductions are basic SSI standard, $65+½ earned income, dependent SSI standard plus unmet medical needs, ineligible-spouse medical needs, applicant medical needs. Code applies only the basic SSI standard. Entire 177.4(1)(g) child-deeming branch (parental income deemed to a child needing IHHRC, with 1/3 child-support disregard etc.) is unmodeled.
   • PR description acknowledges the "5-step disregard cascade not modeled," but at minimum the $65+½ earned income disregard (a federal SSI primitive already in PE) and the $483-per-dependent diversions are computable and materially affect working/dependent households.
   • Minimum recommended fix: Apply $65+½ earned-income disregard and the dependent diversions for RCF and IHHRC; document the omitted deductions explicitly in variable docstrings.

---

Should Address

1. FLH state_supplement historical (pre-2025) values disagree with SSA published baselines — flh/state_supplement.yaml encodes $142 (2011), $162 (2017), $162 (2018), but the SSA 2011 Iowa baseline (PDF 4 lines 99–115) shows the Iowa FLH state supplement was $344 (aged/disabled individual) / $366 (blind individual) in January 2011. The encoded $142 appears to be the SSA-administered cap, not the historical state supplement. (Regulatory S1.)

2. SMME income test uses SPM-unit FPG instead of individual/couple FPG — smme/ia_ssa_smme_eligible.py:27-29: fpg_monthly = person.spm_unit("spm_unit_fpg", period.this_year) / MONTHS_IN_YEAR. IAC 441-51.7(6) tests the recipient's income against 120% FPL for one (or two if joint claim). A single SSI-eligible aged person living with two adult children (SPM unit of 3) faces a 120% threshold of ~$2,665/mo instead of the correct ~$1,565/mo and would fail the test even though they should pass. Use personal_fpg for individual claims and 2-person FPG for joint claims. (Regulatory S2.)

3. DP max_per_person_cap parameter is duplicative and undocumented — Identical values to dependent_income_limit across all years. Conflates two regulatory concepts. Remove and replace with per-configuration state supplement encoding (related to Critical #1). (Regulatory S3.)

4. DP/Blind/FLH input variables lack formula derivations and microsim defaults — ia_ssa_dp_has_eligible_dependent, ia_ssa_dp_dependent_countable_income, ia_ssa_dp_configuration, ia_ssa_resides_in_family_life_home, ia_ssa_resides_in_residential_care_facility, ia_ssa_needs_in_home_health_related_care, ia_ssa_ihhrc_cost_of_care, ia_ssa_rcf_cost_per_diem are pure user-input variables. In a microsim run on enhanced CPS none will be populated, so DP/FLH/RCF/IHHRC will never fire. Acceptable as a manual-input pathway, but add at least minimal default formulas (e.g., default ia_ssa_has_medicare_part_b to is_medicare_eligible) where a federal PE variable already encodes the concept. (Regulatory S5/S6, Suggestion G1.)

5. 5 input variables omit default_value — ia_ssa_dp_dependent_countable_income, ia_ssa_dp_has_eligible_dependent, ia_ssa_resides_in_family_life_home, ia_ssa_ihhrc_cost_of_care, ia_ssa_needs_in_home_health_related_care, ia_ssa_rcf_cost_per_diem, ia_ssa_resides_in_residential_care_facility. The PR sets default_value = False on ia_ssa_has_full_medicaid and ia_ssa_has_medicare_part_b but is inconsistent for the rest. (Code S2.)

6. FBR acronym in parameter descriptions — dp/state_supplement.yaml and flh/state_supplement.yaml use "(FBR)" in the description field, violating the parameter-patterns "no acronyms" rule. (Code S4.)

7. Period-bridging convention undocumented — ia_ssa.py:29, ia_ssa_living_arrangement.py:37, ia_ssa_smme_eligible.py:16 access YEAR-period inputs (ssi_claim_is_joint, is_ssi_aged_blind_disabled) with period.this_year from MONTH formulas. Technically correct but consider a single explanatory comment near the top of ia_ssa.py. (Code S1.)

8. #page= anchor mismatch in IHHRC max_cost_single.yaml — Reference for 441-177.10(3) uses #page=4 but the rule is on file page 5. (Reference S1.)

9. Iowa Code 249.9A reference missing #page= anchor — rcf/personal_needs_allowance.yaml. (Reference S2.)

10. Iowa HHS GL 6-B-46 download URL has no page anchor — Multiple files cite hhs.iowa.gov/media/15607/download bare. Add #page=1 for explicitness or cite the manual chapter URL. (Reference S3.)

11. Bare HHS landing page reference for 2026 values is insufficient — hhs.iowa.gov/assistance-programs/state-supplementary-assistance is dynamic. Add a Wayback snapshot URL or a (retrieved YYYY-MM-DD) note. (Reference S4.)

12. Income-eligibility gates inherit the $20-disregard error — ia_ssa_living_arrangement.py:39-66: RCF income gate (< $1,165.60), IHHRC gates (<= $480.55 / <= $961.10), and Blind income gate (< $989) all use the contaminated countable_monthly, so cases at or within $20 of the boundary may be mis-classified. (Regulatory S7 — addressed by Critical #2 fix.)

13. No 2011 historical-tier test anywhere — Parameters define 2011-01-01 values (blind, RCF PNA $93, max_per_diem $28.14, dp.state_supplement, flh.max_supplement, etc.) but no test uses period: 2011-01. The 2011→2017 transitions are unverified. (Test C1.)

14. Missing payment test for BLIND_WITH_AGED_OR_DISABLED_SPOUSE_AND_DEPENDENT — Only 4 of 5 non-NONE DP configurations are exercised; this config is the one with the disputed 2026 value, so a payment test pinning 2025 and 2026 is essential. (Test C2.)

15. V-shape boundary at countable == FBR not directly tested — None of the BLIND/DP/FLH cases use a social_security_retirement value engineered to put ssi_countable_income exactly at individual_fbr. (Test C3.)

16. RCF post-PNA client-participation boundary not tested — Existing cases sit far above or far below the $1,165.60 threshold; no case engineered to land just below, exactly at, or one cent above. (Test C4.)

17. IHHRC combined countable equal to caps not tested — ihhrc_countable_after_disregard <= ihhrc_cap uses <=. No case sits exactly at $480.55 single or $961.10 couple. (Test C5.)

18. Missing pair-wise priority routing tests — RCF > IHHRC, RCF > FLH, RCF > DP, RCF > SMME, FLH > DP, FLH > SMME are not directly tested. Cheap to add and protect against select(...) reordering bugs. (Test S9.)

19. SMME 120% FPL boundary partially covered, full-Medicaid vs. medically-needy distinction not covered, FLH blind add-on at 2026 not tested, FLH Department top-up countable_monthly == 0 boundary not tested, ineligible-person variants missing, DP has_eligible_dependent: false with non-NONE configuration not tested. (Test S6, S8, S10, S11, S12, S13.)

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Suggestions

1. 2026 BLIND_WITH_AGED_OR_DISABLED_SPOUSE_AND_DEPENDENT $1,037 is an editorial guess — Iowa HHS publishes $3,031 for 2026; PR encodes $1,037 (state portion) on the theory that $3,031 is a typo. Already disclosed in YAML comment and PR description as intentional. Either confirm with Iowa HHS in writing and add response as comment, or fall back to the published $3,031 with a TODO. Documented as intentional — not blocking. (Regulatory S4 / Code G3 / PDF audit b.1.)

2. Default ia_ssa_has_medicare_part_b to is_medicare_eligible — Would let SMME fire automatically in microsim. (Code G1.)

3. Extract DRY intermediate variables — countable_monthly, ssi_monthly, basic_ssi_disregard, combined_countable are re-derived in both ia_ssa.py and ia_ssa_living_arrangement.py. Consider shared ia_ssa_countable_income_monthly etc. per the variable-patterns "intermediate variables for code reuse" rule. (Code G1.)

4. Add YAML comments in dependent_income_limit.yaml and max_per_person_cap.yaml clarifying they are intentionally not breakdowns — Prevents a future contributor from "fixing" them. (Code S3.)

5. RCF cost_per_diem default to p.rcf.max_per_diem when resident is flagged as in RCF — Behavioral improvement so the default supplement is non-zero. (Code G2.)

6. ia_ssa_resources_eligible description should note monthly recomputation of an annual SSI resource test. (Code G4.)

7. Consolidate 2017/2018 IAC supplement citations with effective-date parentheticals. (Reference G1.)

8. Tighten SSA 2011 footnote-a documentation in dp/state_supplement.yaml. (Reference G2.)

9. Add YAML comment in rcf/days_multiplier.yaml explaining the "31 = largest possible days-in-a-month" derivation. (Reference G3.)

10. HHS rates page lists "Flat per Diem Rate $17.86" — likely informational only post-2017 transition to cost-related per diem. Confirm with author whether to encode. (PDF payment-standards audit c.1.)

11. Standardize absolute_error_margin: 0.01 across YAML test cases. (Test S19.)

12. Test variants: negative income, explicit ssi_claim_is_joint toggling on couples, RCF per-diem exactly at cap, days-multiplier sensitivity, entity-scaffolding cleanup for ia_ssa_dp_configuration.yaml. (Test S14, S15, S16, S17, S20.)

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Investigated and Cleared (False Positives)

• SMME categorical contradiction (PDF eligibility audit Mismatch #1) — Rejected. Federal is_ssi_eligible checks ABD + resources + immigration only; it does NOT encode an income test. The SMME-target population (income > 120% FPL with full Medicaid + Part B + ABD + SSI resource/immigration eligibility) passes is_ssi_eligible and the SMME branch fires correctly. Verified end-to-end with a worked example (aged 70, $1,600/mo income, $1,500 resources → SMME = $1).
• IHHRC $961.10 income cap "missing" (PDF IHHRC audit framing concern) — Rejected. The cap IS enforced — at ia_ssa_living_arrangement.py:64 (routing layer), where eligibility cutoffs belong in this codebase's pattern. The reviewer searched only ia_ssa.py (payment layer) and stopped one file short. Same routing/payment split is used for RCF and Blind in the same file.

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PDF Audit Summary

Category	Count
Confirmed correct (parameters reconciled to PDFs)	27 (8 Ch.52 payment standards, 5 IHHRC 2025 + 2011 baseline values, 7 eligibility/routing rules per Ch.51, 5 DP 2025 standards from GL 6-B-46, 2 SMME)
Mismatches confirmed (deliberate)	1 (2026 DP BLIND_WITH_AGED_OR_DISABLED_SPOUSE_AND_DEPENDENT: repo $1,037 vs HHS $3,031, documented as intentional editorial override)
Mismatches rejected	2 (SMME categorical gate, IHHRC $961.10 income cap routing)
Unmodeled items acknowledged in PR	5+ (5-step IHHRC disregard cascade; RCF disregards #1/2/4-8; child IHHRC deeming branch 177.4(1)(g); first-month proration 177.10(2)(b); 15-day temporary absence rules)
New unmodeled items flagged	8 (FIP application requirement 51.2; supplementation income reduction 51.3; physician-cert / facility-licensing inputs 51.4(1)/(2); RCF couple-room initial-month special rule 51.4(3); dependent earnings $65 work expense 51.5(1); full-month absence rule 51.5(3); SMME living-arrangement enumeration 51.7(5); SSN furnishing 51.9; income from room-and-board 51.8)

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Validation Summary

Check	Result
Regulatory Accuracy	3 critical (DP couple FBR, $20 disregard, RCF/IHHRC missing deductions), 7 should
Reference Quality	4 critical citation errors (3 YAML + 1 covered under critical #4 group), 4 should
Code Patterns	0 critical, 5 should, 4 suggestions
Test Coverage	5 critical gaps, 8 should
PDF Value Audit	0 unintentional mismatches; 1 deliberate (2026 DP override, documented)
CI Status	All 24 checks passing

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Review Severity: REQUEST_CHANGES

Justification: four confirmed code/regulatory bugs materially affect output dollars in real cases — (1) DP couple-FBR formula bug is a $44/month error encoded into a passing test; (2) $20 SSI disregard misapplication understates RCF/FLH/IHHRC client participation by $20/month for any recipient with non-trivial unearned income; (3) resource-limit dispatcher under-includes ineligible dependent spouses, denying eligibility to households entitled to the $3,000 cap; (4) five regulatory citations point to non-existent or unrelated subsections, undermining auditability. The deliberate 2026 DP override is acceptable as documented, but the structural bugs warrant fixes before merge.

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Top Priorities for Author

1. Fix DP couple-FBR / per-person-cap issue — Parameterize assistance standard per configuration; pick individual vs couple FBR based on whether configuration has an eligible spouse; remove max_per_person_cap.
2. Strip $20 disregard for RCF/FLH/IHHRC — Add an ia_ssa_countable_income_no_disregard helper that adds back min(unearned_monthly, $20); use in RCF/FLH/IHHRC payment formulas and routing-layer income gates.
3. Fix resource-limit dispatcher — Replace ssi_claim_is_joint with an Iowa-specific ia_ssa_has_dependent_spouse that covers ineligible-but-financially-dependent spouses per IAC 441-51.5(4).
4. Correct IAC subsection citations (5 locations) — smme/minimum_income_fpl_multiplier.yaml (51.6(6)→51.7(6)); dp/dependent_income_limit.yaml and dp/max_per_person_cap.yaml (51.4(1)→51.5(1)); rcf/days_multiplier.yaml (51.3(3)→51.4(3)); ia_ssa_living_arrangement.py:39 comment (51.3(3)→51.4(3)).
5. Add minimum-recommended deductions — $65+½ earned-income disregard and dependent diversions for RCF and IHHRC.