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
• Indiana RCAP page

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 actually receive SSI	IC 12-15-32-6.5; FSSA PM 5000 § 5005.00.00	ssi > 0
SAPN: Must be Medicaid enrolled	FSSA PM 5000 § 5005.00.00: "receiving Medicaid"	medicaid_enrolled
SAPN: Must reside in federal Medicaid facility	FSSA PM 5000; 20 CFR § 416.414	ssi_federal_living_arrangement == MEDICAL_TREATMENT_FACILITY
SAPN: Must be age 18+	SSA 2011 Report	age >= age_threshold parameter (18)
RCAP: Must be Medicaid recipient or SSI recipient	SSA 2011: "adult Medicaid or SSI recipients"; Indiana RCAP page	(ssi > 0) | medicaid_enrolled
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

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

SAPN formula: min(PNA - actual_SSI - ssi_countable_income, $22), floored at $0. Uses ssi_countable_income as proxy for Medicaid post-eligibility countable income (405 IAC 7-1-1).
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)

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
Personal needs allowance	$52/month	Jul 2002	IC 12-10-6-2.1(d)

RCAP formula: max(0, per_diem * 365/12 - actual_SSI - ssi_countable_income)

Not Modeled (by design)

What	Source	Why Excluded
Indiana resource limits ($1,500/$2,250)	SSA 2011 Report	Simplified via SSI eligibility check
Medicaid post-eligibility income (vs SSI countable)	405 IAC 7-1-1	ssi_countable_income used as proxy; differs when SSI exclusions apply
Couples treated as individuals after 1 month in facility	SSA 2011 Report note b	Time-dependent transition rule
$16 sheltered workshop incentive exclusion	SSA 2011 Report	Rare scenario
Tax liability retention allowance	IC 12-10-6-2.1(e)	Complex tax calculation

Files

parameters/gov/states/in/fssa/ssp/
variables/gov/states/in/fssa/ssp/
tests/policy/baseline/gov/states/in/fssa/ssp/

Test plan

• 67 tests pass
• CI passes

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[codecov]

Codecov Report

✅ All modified and coverable lines are covered by tests.
✅ Project coverage is 96.12%. Comparing base (d51a2e2) to head (9051eec).
⚠️ Report is 121 commits behind head on main.

Additional details and impacted files

@@            Coverage Diff             @@
##             main    #7887      +/-   ##
==========================================
+ Coverage   94.54%   96.12%   +1.58%     
==========================================
  Files           7       10       +3     
  Lines         110      155      +45     
  Branches        2        2              
==========================================
+ Hits          104      149      +45     
  Misses          6        6              

Flag	Coverage Δ
unittests	96.12% <100.00%> (+1.58%)	⬆️

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[MaxGhenis]

Follow-up fixes pushed on this branch:\n\n- wired into the shared household/SPM benefit aggregates so Indiana SSP affects downstream outputs\n- corrected the Medicaid-facility SSI path to use the federal payment limit in Indiana SAPN cases\n- updated SAPN to phase down against the personal-needs allowance instead of paying a flat amount, and corrected RCAP to deduct both SSI and countable income\n- added targeted regression coverage for reduced-SSI SAPN cases and RCAP cases with additional countable income\n\nLocal verification: and targeted All checks passed! both passed.

[MaxGhenis]

Follow-up fixes pushed on this branch:

• wired in_ssp into the shared household/SPM benefit aggregates so Indiana SSP affects downstream outputs
• corrected the Medicaid-facility SSI path to use the federal $30 payment limit in Indiana SAPN cases
• updated SAPN to phase down against the $52 personal-needs allowance instead of paying a flat amount, and corrected RCAP to deduct both SSI and countable income
• added targeted regression coverage for reduced-SSI SAPN cases and RCAP cases with additional countable income

Local verification: policyengine_us/tests/policy/baseline/gov/states/in/fssa/ssp/integration.yaml and targeted ruff check both passed.

[PavelMakarchuk]

Program Review: PR #7887 -- Implement Indiana State Supplementary Payment (SSP)

Source Documents

• POMS: SI CHI01401.001 (effective 10/05/2022)
• FSSA: Medicaid Policy Manual Chapter 5000
• IAC: 455 IAC 1-3-3 (filed June 5, 2003)
• Statutes: IC 12-15-32-6.5, IC 12-10-6-2.1
• Legislative: HEA 1001-2007, Section 233 ($10/day per diem increase)
• CI: All 9 checks passing (lint, baseline, states, structural, reform, coverage)

---

Critical (Must Fix)

None.

The reference validator flagged 4 items as "critical," but after cross-referencing with the regulatory reviewer's analysis, none represent actual value errors:

• Per diem rates ($49.35/$37): The VALUES are correct. The regulatory reviewer confirmed these are the original 455 IAC 1-3-3 rates ($39.35/$27) plus the $10/day increase from HEA 1001-2007, Section 233 (effective July 1, 2008). The parameter files correctly include both the original and updated values with proper effective dates. The issue is that the CITED regulation (455 IAC 1-3-3) only shows the old rates -- this is a reference quality issue, not a value error. Reclassified to Should Address #1.

• SAPN couple $44: The VALUE is correct. The regulatory reviewer confirmed $44 from POMS ($22 individual x 2). The reference validator could not find an explicit $44 figure in accessible sources because POMS states "$22.00 supplemental payment" for individuals and the couple amount is derived. Reclassified to Should Address #2.

• SSA 2011 page 403 / Justia 403: These are broken links, not wrong values. All underlying values are independently corroborated by POMS and/or Medicaid PM 5000. Reclassified to Should Address #3.

---

Should Address

1. Cite the correct source for updated per diem rates. The parameter files cite 455 IAC 1-3-3 for the $49.35 (licensed) and $37 (unlicensed) rates, but that regulation only contains the original $39.35/$27 rates. Add a reference to HEA 1001-2007, Section 233 (or the corresponding session law) as the authority for the $10/day increase effective July 2008. The Findlaw case citation (Gargano v. Lee Alan Bryant) returns 403 Forbidden and cannot serve as a verifiable reference.

   • Files: rcap/per_diem/licensed.yaml, rcap/per_diem/unlicensed.yaml

2. Add explicit source for SAPN couple amount ($44). POMS SI CHI01401.001 states the individual amount ($22) but does not explicitly mention a couple amount. Either (a) find and cite the specific POMS section or state regulation that states $44, or (b) add a note in the parameter description that the couple amount is 2x the individual amount per standard SSP couple treatment.

   • File: sapn/amount/couple.yaml

3. Replace broken reference URLs. Two widely-cited URLs return HTTP 403:

   • https://www.ssa.gov/policy/docs/progdesc/ssi_st_asst/2011/in.html -- affects 5 parameters and 6 variables. Replace with a working URL (Wayback Machine archive or updated SSA location) or the primary Indiana legal authority.
   • https://law.justia.com/codes/indiana/title-12/article-10/chapter-6/section-12-10-6-2-1/ -- affects age_threshold.yaml, personal_needs_allowance.yaml, in_ssp_rcap_eligible.py. Replace with the official Indiana General Assembly URL (https://iga.in.gov/laws/2024/ic/titles/12#12-10-6-2.1).

4. Add SAPN partial benefit test. No test covers the scenario where pna - ssi_monthly - countable_income falls between $0 and $22 (i.e., a partial SAPN benefit below the $22 cap). For example: SSI monthly = $35, countable income monthly = $10, giving $52 - $35 - $10 = $7. This verifies the min_ cap is not always the binding constraint.

5. Add Medicaid-only RCAP integration test. All existing RCAP integration tests use is_ssi_eligible: true. Add a test for the Medicaid-only eligibility path: person is is_ssi_aged_blind_disabled: true, is_medicaid_eligible: true, NOT SSI-eligible, in a licensed residential facility. Expected RCAP = full state standard ($1,501.06) since SSI monthly = 0.

---

Suggestions

1. Remove "daily per diem" redundancy in descriptions. "Per diem" already means "per day." Change "daily per diem rate" to "per diem rate" in rcap/per_diem/licensed.yaml and rcap/per_diem/unlicensed.yaml.

2. Add PDF page anchors. Three PDF references lack #page= anchors:

   • Medicaid_PM_5000.pdf in sapn/amount/individual.yaml -- add #page=2 (Section 5005.05.00)
   • RCAP-Provider-Guide.pdf in rcap/per_diem/licensed.yaml and unlicensed.yaml -- add appropriate #page=XX

3. Prefer official .gov sources over third-party legal databases. Several references use law.justia.com (third-party) instead of iga.in.gov (official Indiana), and law.cornell.edu instead of www.in.gov/legislative/iac/.

4. Add more specific section identifiers to reference titles. For example, SAPN individual reference title could be "SI CHI01401.001 Section B.2.b -- $22.00 supplemental payment" rather than the generic program title.

5. Add dedicated test file for in_ssp_living_arrangement. This variable has a formula with select() logic but no dedicated test file. It is exercised indirectly through integration and eligibility tests, which is acceptable, but a dedicated test would verify each arrangement type explicitly.

6. Add SAPN couple partial amount test. Test where combined budgeted income produces a couple amount between $0 and $44 (e.g., both spouses with SSI = $30/month and countable income = $5/month each, giving couple_amount = $34, per-person = $17).

7. Add test for both residential facility flags set simultaneously. Tests select() priority when both in_resides_in_licensed_residential_facility and in_resides_in_unlicensed_residential_facility are true (licensed should win).

8. Consider verifying the 1976-07-01 effective date for age_threshold. This is an unusually old effective date. If this comes from IC 12-10-6-2.1, the statute may have been enacted or amended at a different date.

---

Validation Summary

Check	Result
SAPN individual amount ($22)	PASS -- confirmed by POMS and Medicaid PM 5000
SAPN couple amount ($44)	PASS (value) -- $22 x 2, confirmed by regulatory reviewer via POMS; explicit citation should be added
Personal needs allowance ($52)	PASS -- confirmed by POMS and Medicaid PM 5000
RCAP licensed per diem ($49.35)	PASS (value) -- $39.35 + $10 increase (HEA 1001-2007); cite correct source
RCAP unlicensed per diem ($37)	PASS (value) -- $27 + $10 increase (HEA 1001-2007); cite correct source
Age threshold (18)	PASS (value) -- plausible, consistent with regulatory language; cited sources return 403
SAPN formula logic	PASS -- correctly implements min(PNA - SSI - income, max) with floor at 0
SAPN couple logic	PASS -- correct income pooling and per-person split
RCAP formula logic	PASS -- correctly implements max(state_standard - SSI - income, 0)
SAPN eligibility criteria	PASS -- SSI recipient + Medicaid + medical facility + age 18+ + IN resident
RCAP eligibility criteria	PASS -- ABD + (SSI or Medicaid) + residential facility + age 18+ + IN resident
Mutual exclusivity (SAPN/RCAP)	PASS -- enforced by living arrangement enum
Period handling	PASS -- correct use of period.this_year for stock/boolean, period for flow variables
Code patterns (adds, where, select, max_, min_)	PASS -- all PolicyEngine patterns used correctly
Variable naming (in_ssp_ prefix)	PASS -- consistent throughout
No hardcoded policy values	PASS -- all values from parameters
Federal/state separation	PASS -- reuses existing SSI/Medicaid variables, only creates state-specific logic
Parameter-variable cross-reference	PASS -- no orphaned parameters
Wiring (household_state_benefits, spm_unit_benefits)	PASS -- correctly added
Changelog fragment	PASS -- changelog.d/in-ssp.added.md with type added
Test coverage (67 cases)	PASS -- comprehensive with minor gaps noted above
CI	PASS -- all 9 checks green
Reference format (tuples, no documentation field)	PASS
Accessible references	PARTIAL -- 2 URLs return 403 Forbidden

---

File Inventory

Parameters (6 files):

• policyengine_us/parameters/gov/states/in/fssa/ssp/age_threshold.yaml
• policyengine_us/parameters/gov/states/in/fssa/ssp/personal_needs_allowance.yaml
• policyengine_us/parameters/gov/states/in/fssa/ssp/rcap/per_diem/licensed.yaml
• policyengine_us/parameters/gov/states/in/fssa/ssp/rcap/per_diem/unlicensed.yaml
• policyengine_us/parameters/gov/states/in/fssa/ssp/sapn/amount/couple.yaml
• policyengine_us/parameters/gov/states/in/fssa/ssp/sapn/amount/individual.yaml

Variables (9 files):

• policyengine_us/variables/gov/states/in/fssa/ssp/in_resides_in_licensed_residential_facility.py
• policyengine_us/variables/gov/states/in/fssa/ssp/in_resides_in_unlicensed_residential_facility.py
• policyengine_us/variables/gov/states/in/fssa/ssp/in_ssp.py
• policyengine_us/variables/gov/states/in/fssa/ssp/in_ssp_eligible.py
• policyengine_us/variables/gov/states/in/fssa/ssp/in_ssp_living_arrangement.py
• policyengine_us/variables/gov/states/in/fssa/ssp/in_ssp_rcap.py
• policyengine_us/variables/gov/states/in/fssa/ssp/in_ssp_rcap_eligible.py
• policyengine_us/variables/gov/states/in/fssa/ssp/in_ssp_sapn.py
• policyengine_us/variables/gov/states/in/fssa/ssp/in_ssp_sapn_eligible.py

Tests (8 files, 67 test cases):

• policyengine_us/tests/policy/baseline/gov/states/in/fssa/ssp/edge_cases.yaml (25 cases)
• policyengine_us/tests/policy/baseline/gov/states/in/fssa/ssp/in_ssp.yaml (3 cases)
• policyengine_us/tests/policy/baseline/gov/states/in/fssa/ssp/in_ssp_eligible.yaml (3 cases)
• policyengine_us/tests/policy/baseline/gov/states/in/fssa/ssp/in_ssp_rcap.yaml (7 cases)
• policyengine_us/tests/policy/baseline/gov/states/in/fssa/ssp/in_ssp_rcap_eligible.yaml (8 cases)
• policyengine_us/tests/policy/baseline/gov/states/in/fssa/ssp/in_ssp_sapn.yaml (4 cases)
• policyengine_us/tests/policy/baseline/gov/states/in/fssa/ssp/in_ssp_sapn_eligible.yaml (8 cases)
• policyengine_us/tests/policy/baseline/gov/states/in/fssa/ssp/integration.yaml (9 cases)

Other modified files:

• changelog.d/in-ssp.added.md
• policyengine_us/parameters/gov/household/household_state_benefits.yaml
• policyengine_us/variables/household/income/spm_unit/spm_unit_benefits.py

---

Review Severity: COMMENT

All parameter values are correct per regulatory analysis. No code logic errors found. The issues are reference quality (broken URLs, citing old regulation text for updated rates) and minor test coverage gaps. None are blocking.

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