Block ACA eligibility after Medicaid work requirement failure

changelog.d/6174.fixed.md

@@ -0,0 +1 @@
+- Treated people denied Medicaid by work requirements as ineligible for ACA marketplace premium payment and premium tax credits.

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

@@ -24,6 +24,46 @@
     pays_aca_premium: false
     is_aca_ptc_eligible: false
 
+- name: Failing Medicaid work requirements prevents ACA premium payment
+  period: 2027
+  input:
+    age: 40
+    medicaid_category: ADULT
+    immigration_status: CITIZEN
+    monthly_hours_worked: 0
+    employment_income: 0
+    medicaid_community_engagement_pass_through_eligible: false
+    is_aca_eshi_eligible: false
+    is_chip_eligible: false
+    is_medicare_eligible: false
+    aca_magi_fraction: 2.5
+  output:
+    medicaid_work_requirement_eligible: false
+    is_medicaid_eligible: false
+    is_medicaid_ineligible_due_to_work_requirement: true
+    pays_aca_premium: false
+    is_aca_ptc_eligible: false
+
+- name: Non-Medicaid adult who fails work hours can still pay ACA premium
+  period: 2027
+  input:
+    age: 40
+    medicaid_category: NONE
+    immigration_status: CITIZEN
+    monthly_hours_worked: 0
+    employment_income: 0
+    medicaid_community_engagement_pass_through_eligible: false
+    is_aca_eshi_eligible: false
+    is_chip_eligible: false
+    is_medicare_eligible: false
+    aca_magi_fraction: 2.5
+  output:
+    medicaid_work_requirement_eligible: false
+    is_medicaid_eligible: false
+    is_medicaid_ineligible_due_to_work_requirement: false
+    pays_aca_premium: true
+    is_aca_ptc_eligible: true
+
 - name: Married filing separately can pay ACA premium without PTC
   period: 2026
   input:

policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/is_medicaid_ineligible_due_to_work_requirement.yaml

@@ -0,0 +1,51 @@
+- name: Federal applicable adult is barred when work requirements apply and are unmet
+  period: 2027
+  input:
+    age: 40
+    medicaid_category: ADULT
+    immigration_status: CITIZEN
+    monthly_hours_worked: 0
+    employment_income: 0
+    medicaid_community_engagement_pass_through_eligible: false
+  output:
+    medicaid_work_requirement_eligible: false
+    is_medicaid_work_requirement_applicable_adult: true
+    is_medicaid_ineligible_due_to_work_requirement: true
+
+- name: Federal applicable adult is not barred when work requirements are met
+  period: 2027
+  input:
+    age: 40
+    medicaid_category: ADULT
+    immigration_status: CITIZEN
+    monthly_hours_worked: 80
+  output:
+    medicaid_work_requirement_eligible: true
+    is_medicaid_work_requirement_applicable_adult: true
+    is_medicaid_ineligible_due_to_work_requirement: false
+
+- name: Arkansas expansion adult is barred when state work requirements apply and are unmet
+  period: 2018
+  input:
+    age: 40
+    medicaid_category: ADULT
+    immigration_status: CITIZEN
+    medicaid_income_level: 0.9
+    monthly_hours_worked: 0
+    state_code: AR
+  output:
+    ar_medicaid_work_requirement_eligible: false
+    is_medicaid_ineligible_due_to_work_requirement: true
+
+- name: Arkansas expansion adult is not barred when state work requirements are met
+  period: 2018
+  input:
+    age: 40
+    medicaid_category: ADULT
+    immigration_status: CITIZEN
+    medicaid_income_level: 0.9
+    monthly_hours_worked: 80
+    state_code: AR
+  output:
+    ar_medicaid_work_requirement_eligible: true
+    is_medicaid_ineligible_due_to_work_requirement: false

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

@@ -14,6 +14,7 @@ def formula(person, period, parameters):
 
         INELIGIBLE_COVERAGE = [
             "is_medicaid_eligible",
+            "is_medicaid_ineligible_due_to_work_requirement",
             "is_chip_eligible",
             "is_basic_health_program_eligible",
             "is_aca_eshi_eligible",

policyengine_us/variables/gov/hhs/medicaid/eligibility/is_medicaid_ineligible_due_to_work_requirement.py

@@ -0,0 +1,42 @@
+from policyengine_us.model_api import *
+
+
+class is_medicaid_ineligible_due_to_work_requirement(Variable):
+    value_type = bool
+    entity = Person
+    label = "Ineligible for Medicaid due to a work requirement"
+    definition_period = YEAR
+    reference = "https://www.congress.gov/bill/119th-congress/house-bill/1/text"
+
+    def formula(person, period, parameters):
+        category = person("medicaid_category", period)
+        federal_medicaid_eligible = (
+            category != category.possible_values.NONE
+        ) & person("is_medicaid_immigration_status_eligible", period)
+
+        federal_barred = False
+        p = parameters(period).gov.hhs.medicaid.eligibility.work_requirements
+        if p.applies:
+            applicable_adult = person(
+                "is_medicaid_work_requirement_applicable_adult", period
+            )
+            work_requirement_eligible = person(
+                "medicaid_work_requirement_eligible", period
+            )
+            federal_barred = (
+                federal_medicaid_eligible
+                & applicable_adult
+                & ~work_requirement_eligible
+            )
+
+        ar_barred = False
+        ar_p = parameters(period).gov.states.ar.dhs.medicaid.work_requirements
+        if ar_p.applies:
+            in_ar = person.household("state_code_str", period) == "AR"
+            ar_barred = (
+                in_ar
+                & federal_medicaid_eligible
+                & ~person("ar_medicaid_work_requirement_eligible", period)
+            )
+
+        return federal_barred | ar_barred