diff --git a/changelog.d/hub-premium-input-contract-1010.fixed.md b/changelog.d/hub-premium-input-contract-1010.fixed.md
new file mode 100644
index 00000000000..b8f2ac1c020
--- /dev/null
+++ b/changelog.d/hub-premium-input-contract-1010.fixed.md
@@ -0,0 +1 @@
+Document disjoint pretax and non-pretax health premium inputs, include employee-paid pretax premiums in applicable benefit and New Jersey medical deductions, exclude pretax premiums from SSI wages and North Dakota renter-refund income. Preserve Minnesota Supplemental Aid gross income for eligibility and guardian fees while applying SSI salary-reduction exclusions to countable income.
diff --git a/policyengine_us/tests/core/test_premium_input_contract.py b/policyengine_us/tests/core/test_premium_input_contract.py
new file mode 100644
index 00000000000..7c33e9e9004
--- /dev/null
+++ b/policyengine_us/tests/core/test_premium_input_contract.py
@@ -0,0 +1,232 @@
+"""Premium payment methods are disjoint inputs with consumer-specific treatment.
+
+Moving employee-paid premiums from non-pretax payments to pretax payroll
+deductions leaves total medical spending unchanged. SNAP, HUD,
+child-care deductions, Orange County General Relief and New Jersey
+medical expenses count both payment methods. Michigan's wage exclusion
+and non-pretax premium deduction likewise leave household resources unchanged
+with other benefit amounts held fixed.
+North Dakota excludes pretax premiums from income and deducts non-pretax
+premiums as medical expenses, also leaving renters' refund income unchanged.
+
+Federal taxable and FICA wages, ACA/Medicaid MAGI, and tax deductions that
+exclude pretax premiums distinguish the payment methods. SSI also excludes
+qualified salary-reduction premiums from wages before its earned-income
+disregard. The SGA work-earnings test retains payroll premium deductions.
+Program premiums and
+eligibility are held fixed here: changing MAGI can otherwise legitimately change
+Marketplace, CHIP or Medicaid premiums, obscuring the spending invariant.
+
+Each generated batch uses fresh vectorized simulations across several states;
+no calculated arrays are shared between the two situations or across examples.
+"""
+
+import numpy as np
+from hypothesis import HealthCheck, example, given, settings
+from hypothesis import strategies as st
+
+from policyengine_us import Simulation
+from policyengine_us.system import system
+
+
+YEAR = 2026
+MONTH = "2026-01"
+STATES = ("CA", "MO", "PA", "NJ", "OH", "MI", "ND")
+
+
+@st.composite
+def premium_transfers(draw):
+    total = draw(st.integers(0, 12_000))
+    pretax = draw(st.integers(0, total))
+    transfer = draw(st.integers(0, total - pretax))
+    return total, pretax, transfer
+
+
+def _situation(batch, moved):
+    people = {}
+    tax_units = {}
+    spm_units = {}
+    households = {}
+    marital_units = {}
+    for row, (total, initial_pretax, transfer) in enumerate(batch):
+        pretax = initial_pretax + (transfer if moved else 0)
+        non_pretax = total - pretax
+        for state, size in ((state, size) for state in STATES for size in (1, 2)):
+            key = f"{state}_{size}_{row}"
+            people[key] = {
+                "age": {YEAR: 40},
+                "is_tax_unit_head": {YEAR: True},
+                "is_ssi_aged_blind_disabled": {YEAR: True},
+                "employment_income": {YEAR: 250_000},
+                "pre_tax_health_insurance_premiums": {YEAR: pretax},
+                # These are alternative representations used by different
+                # consumers, not additive premiums within the non-pretax set.
+                "health_insurance_premiums": {YEAR: non_pretax},
+                "health_insurance_premiums_without_medicare_part_b": {YEAR: non_pretax},
+                "other_health_insurance_premiums": {YEAR: non_pretax},
+                "other_medical_expenses": {YEAR: 300},
+                "over_the_counter_health_expenses": {YEAR: 100},
+                "medicare_enrolled": {YEAR: False},
+                "is_medicare_eligible": {YEAR: False},
+                "medicare_part_a_premium": {YEAR: 0},
+                "medicare_part_b_premium": {YEAR: 0},
+                "income_adjusted_part_d_premium_surcharge": {YEAR: 0},
+                "employer_sponsored_insurance_premiums": {YEAR: 0},
+                "self_employed_health_insurance_ald_person": {YEAR: 0},
+                "general_assistance": {YEAR: 0},
+                # Hold other benefits fixed for the Michigan invariant.
+                "ssi": {YEAR: 0},
+                "ca_oc_general_relief_countable_earned_income": {MONTH: 5_000},
+                "ca_oc_general_relief_gross_unearned_income": {MONTH: 0},
+                "ca_oc_general_relief_receives_other_cash_assistance": {MONTH: False},
+            }
+            members = [key]
+            if size == 2:
+                spouse = f"{key}_spouse"
+                people[spouse] = {
+                    **people[key],
+                    "is_tax_unit_head": {YEAR: False},
+                    "is_tax_unit_spouse": {YEAR: True},
+                }
+                members.append(spouse)
+            marital_units[key] = {"members": members}
+            tax_units[key] = {
+                "members": members,
+                "chip_premium": {YEAR: 0},
+                "medicaid_premium": {YEAR: 0},
+                "marketplace_net_premium": {YEAR: 0},
+                "above_the_line_deductions": {YEAR: 0},
+                "self_employed_health_insurance_ald": {YEAR: 0},
+                "dependents_self_employed_health_insurance_ald": {YEAR: 0},
+                "medical_expense_deduction": {YEAR: 0},
+                "tax_unit_itemizes": {YEAR: False},
+                "taxable_income": {YEAR: 300_000},
+                "nj_agi": {YEAR: 50_000},
+                "oh_employer_subsidized_health_plan_eligible": {YEAR: True},
+            }
+            spm_units[key] = {
+                "members": members,
+                "tanf": {YEAR: 0},
+                "mo_ccs_countable_income": {MONTH: 5_000},
+                "pa_ccw_countable_income": {YEAR: 60_000},
+                "pa_ccw_stepparent_deduction": {MONTH: 0},
+            }
+            households[key] = {
+                "members": members,
+                "state_code": {YEAR: state},
+                "in_oc": {YEAR: state == "CA"},
+            }
+    return {
+        "people": people,
+        "tax_units": tax_units,
+        "spm_units": spm_units,
+        "households": households,
+        "marital_units": marital_units,
+        "families": {
+            key: {"members": unit["members"]} for key, unit in marital_units.items()
+        },
+    }
+
+
+@settings(
+    max_examples=8,
+    deadline=None,
+    suppress_health_check=[HealthCheck.too_slow],
+)
+@example(batch=[(0, 0, 0), (12_000, 0, 12_000), (12_000, 6_000, 6_000)])
+@example(batch=[(12_000, 12_000, 0), (1, 0, 1)])
+@given(batch=st.lists(premium_transfers(), min_size=1, max_size=3))
+def test_premium_transfer_respects_each_consumers_tax_treatment(batch):
+    # Each batch contains both single adults and two-person married units.
+    # Reusing the reference system avoids rebuilding the country per example.
+    baseline = Simulation(situation=_situation(batch, False), tax_benefit_system=system)
+    moved = Simulation(situation=_situation(batch, True), tax_benefit_system=system)
+    sizes = np.tile((1, 2), len(batch) * len(STATES))
+    transfer = np.repeat([row[2] for row in batch], len(STATES) * 2)
+    total = np.repeat([row[0] for row in batch], len(STATES) * 2) * sizes
+    states = np.tile(np.repeat(STATES, 2), len(batch))
+    person_transfer = np.repeat(transfer, sizes)
+    person_states = np.repeat(states, sizes)
+    unit_transfer = transfer * sizes
+
+    np.testing.assert_allclose(
+        baseline.calculate("spm_unit_medical_out_of_pocket_expenses", YEAR),
+        total + 400 * sizes,
+        rtol=0,
+        atol=0.02,
+    )
+    # North Dakota starts from raw market wages, excludes the pretax
+    # contribution once, and deducts only the remaining medical expenses.
+    np.testing.assert_allclose(
+        baseline.calculate("nd_renters_refund_income", YEAR),
+        (250_000 * sizes - total - 300 * sizes) * (states == "ND"),
+        rtol=0,
+        atol=0.02,
+    )
+
+    invariant_consumers = (
+        ("spm_unit_health_insurance_premiums", YEAR),
+        ("spm_unit_medical_out_of_pocket_expenses", YEAR),
+        ("snap_allowable_medical_expenses", YEAR),
+        ("hud_medical_expenses", YEAR),
+        ("mo_ccs_adjusted_income", MONTH),
+        ("pa_ccw_medical_expenses", YEAR),
+        ("pa_ccw_adjusted_income", YEAR),
+        ("ca_oc_general_relief_countable_income_person", MONTH),
+        ("nj_medical_expense_deduction", YEAR),
+        ("mi_household_resources", YEAR),
+        ("nd_renters_refund_income", YEAR),
+        ("ssi_engaged_in_sga", YEAR),
+    )
+    for variable, period in invariant_consumers:
+        np.testing.assert_allclose(
+            moved.calculate(variable, period),
+            baseline.calculate(variable, period),
+            rtol=0,
+            atol=0.02,
+            err_msg=variable,
+        )
+
+    tax_status_sensitive_consumers = (
+        "irs_employment_income",
+        "payroll_tax_gross_wages",
+        "ssi_earned_income",
+        "adjusted_gross_income",
+        "aca_magi",
+        "medicaid_magi",
+        "medicaid_magi_person",
+        "medical_expense_health_insurance_premiums",
+        "medicaid_medically_needy_medical_expenses",
+    )
+    for variable in tax_status_sensitive_consumers:
+        np.testing.assert_allclose(
+            baseline.calculate(variable, YEAR) - moved.calculate(variable, YEAR),
+            person_transfer
+            if system.variables[variable].entity.key == "person"
+            else unit_transfer,
+            rtol=0,
+            atol=0.02,
+            err_msg=variable,
+        )
+
+    # These categorically eligible individuals remain above the earned-income
+    # exclusions. SSI's 50% earned-income disregard halves the wage change.
+    np.testing.assert_allclose(
+        baseline.calculate("ssi_countable_income", YEAR)
+        - moved.calculate("ssi_countable_income", YEAR),
+        person_transfer / 2,
+        rtol=0,
+        atol=0.02,
+    )
+
+    for variable, state in (
+        ("oh_insured_unreimbursed_medical_care_expense_amount", "OH"),
+        ("mo_qualified_health_insurance_premiums", "MO"),
+    ):
+        np.testing.assert_allclose(
+            baseline.calculate(variable, YEAR) - moved.calculate(variable, YEAR),
+            person_transfer * (person_states == state),
+            rtol=0,
+            atol=0.02,
+            err_msg=variable,
+        )
diff --git a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_medical_expenses.yaml b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_medical_expenses.yaml
new file mode 100644
index 00000000000..4cf3c9c0b0f
--- /dev/null
+++ b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_medical_expenses.yaml
@@ -0,0 +1,44 @@
+- name: SSI-based spenddown expenses do not repeat the pretax wage exclusion.
+  period: 2026
+  input:
+    health_insurance_premiums: 1_800
+    pre_tax_health_insurance_premiums: 2_400
+    other_medical_expenses: 300
+    medicare_enrolled: false
+  output:
+    medicaid_medically_needy_medical_expenses: 2_100
+
+- name: SSI-based spenddown retains decomposed non-pretax Medicare premiums.
+  period: 2026
+  input:
+    health_insurance_premiums_without_medicare_part_b: 600
+    medicare_part_b_premium: 1_200
+    medicare_enrolled: true
+    pre_tax_health_insurance_premiums: 2_400
+    other_medical_expenses: 300
+  output:
+    medicaid_medically_needy_medical_expenses: 2_100
+
+- name: Kansas spenddown does not deduct pretax premiums again from countable income.
+  period: 2026
+  input:
+    age: 65
+    is_in_medicaid_medically_needy_category: true
+    is_adult_for_medicaid: false
+    is_optional_senior_or_disabled_for_medicaid: false
+    # Isolate spenddown from the separate SSI-recipient Medicaid pathway.
+    is_ssi_recipient_for_medicaid: false
+    employment_income: 27_020
+    ssi_countable_resources: 1_000
+    state_code: KS
+    health_insurance_premiums: 2_000
+    pre_tax_health_insurance_premiums: 4_000
+    medicare_enrolled: false
+  output:
+    # (27,020 - 4,000 - 12 * (20 + 65)) / 2 = 11,000.
+    is_ssi_aged_blind_disabled: true
+    ssi_earned_income: 23_020
+    ssi_countable_income: 11_000
+    medicaid_medically_needy_medical_expenses: 2_000
+    is_ssi_recipient_for_medicaid: false
+    is_medically_needy_for_medicaid: false
diff --git a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/income/deemed/from_ineligible_parent/medicaid_optional_senior_or_disabled_unearned_income_deemed_from_ineligible_parent.yaml b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/income/deemed/from_ineligible_parent/medicaid_optional_senior_or_disabled_unearned_income_deemed_from_ineligible_parent.yaml
index 985a44b41e4..fe17f4085ea 100644
--- a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/income/deemed/from_ineligible_parent/medicaid_optional_senior_or_disabled_unearned_income_deemed_from_ineligible_parent.yaml
+++ b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/income/deemed/from_ineligible_parent/medicaid_optional_senior_or_disabled_unearned_income_deemed_from_ineligible_parent.yaml
@@ -19,6 +19,50 @@
   output:
     medicaid_optional_senior_or_disabled_unearned_income_deemed_from_ineligible_parent: [6_006, 0]
 
+- name: Optional Medicaid parental deeming inherits the SSI exclusion for qualified pretax premiums.
+  period: 2025
+  absolute_error_margin: 0.01
+  input:
+    people:
+      recipient:
+        age: 12
+        is_ssi_disabled: true
+      sibling:
+        age: 14
+        employment_income: 2_400
+        pre_tax_health_insurance_premiums: 1_200
+      parent:
+        age: 40
+        is_parent: true
+        employment_income: 36_000
+        pre_tax_health_insurance_premiums: 3_600
+    tax_units:
+      tax_unit:
+        members: [recipient, sibling, parent]
+    # A parent and children are not a married couple. Explicit singleton
+    # units prevent default grouping from also applying spousal deeming.
+    marital_units:
+      recipient_unit:
+        members: [recipient]
+      sibling_unit:
+        members: [sibling]
+      parent_unit:
+        members: [parent]
+    households:
+      household:
+        members: [recipient, sibling, parent]
+        state_code: NC
+  output:
+    # 42 USC 1396a(m) uses SSI methodology for this optional pathway.
+    # POMS SI 00820.102C.2: parent wages 32,400; sibling wages 1,200.
+    # 20 CFR 416.1165(b), (d): sibling allocation = 4,596, so
+    # (32,400 - 4,596 - 20 * 12 - 65 * 12) / 2 - 967 * 12 = 1,788 deemed.
+    # Under (e)(1), apply child's general exclusion: 1,788 - 20 * 12 = 1,548.
+    medicaid_optional_senior_or_disabled_unearned_income_deemed_from_ineligible_parent: [1_788, 0, 0]
+    is_ssi_spousal_deeming_applies: [false, false, false]
+    medicaid_optional_senior_or_disabled_income_deemed_from_ineligible_spouse: [0, 0, 0]
+    medicaid_optional_senior_or_disabled_countable_income: [1_548, 0, 0]
+
 # Missouri MHDC deems only a natural or adoptive parent's income, never a
 # stepparent's (DSS MHABD Manual § 0805.020.15), and divides the deemed
 # amount equally among the disabled children applying. Parent status
diff --git a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/income/deemed/from_ineligible_spouse/medicaid_optional_senior_or_disabled_income_deemed_from_ineligible_spouse.yaml b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/income/deemed/from_ineligible_spouse/medicaid_optional_senior_or_disabled_income_deemed_from_ineligible_spouse.yaml
index 10e06a9d943..1724495a64d 100644
--- a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/income/deemed/from_ineligible_spouse/medicaid_optional_senior_or_disabled_income_deemed_from_ineligible_spouse.yaml
+++ b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/income/deemed/from_ineligible_spouse/medicaid_optional_senior_or_disabled_income_deemed_from_ineligible_spouse.yaml
@@ -84,3 +84,39 @@
     # 1,450 - 20 = 1,430 monthly, or 17,160 annually.
     medicaid_optional_senior_or_disabled_countable_income: 17_160
     is_optional_senior_or_disabled_income_eligible: false
+
+- name: Optional Medicaid spouse deeming inherits the SSI exclusion for qualified pretax premiums.
+  period: 2025
+  absolute_error_margin: 0.01
+  input:
+    people:
+      recipient:
+        age: 70
+        is_tax_unit_head: true
+      spouse:
+        age: 60
+        is_tax_unit_spouse: true
+        employment_income: 24_000
+        pre_tax_health_insurance_premiums: 2_400
+      child:
+        age: 14
+        employment_income: 2_400
+        pre_tax_health_insurance_premiums: 1_200
+    tax_units:
+      tax_unit:
+        members: [recipient, spouse, child]
+    marital_units:
+      marital_unit:
+        members: [recipient, spouse]
+    households:
+      household:
+        members: [recipient, spouse, child]
+        state_code: NC
+  output:
+    # 42 USC 1396a(m) uses SSI methodology for this optional pathway.
+    # POMS SI 00820.102C.2: spouse wages 21,600; child wages 1,200.
+    # 20 CFR 416.1163(b), (d): allocation = (1,450 - 967) * 12
+    # - 1,200 = 4,596; remaining spouse wages = 17,004 > 5,796.
+    # (17,004 - 20 * 12 - 65 * 12) / 2 = 7,992 deemed and countable.
+    medicaid_optional_senior_or_disabled_income_deemed_from_ineligible_spouse: [7_992, 0, 0]
+    medicaid_optional_senior_or_disabled_countable_income: [7_992, 0, 0]
diff --git a/policyengine_us/tests/policy/baseline/gov/hhs/medicare/savings_programs/income/msp_countable_income.yaml b/policyengine_us/tests/policy/baseline/gov/hhs/medicare/savings_programs/income/msp_countable_income.yaml
index 6172d39ff87..1c823197a3b 100644
--- a/policyengine_us/tests/policy/baseline/gov/hhs/medicare/savings_programs/income/msp_countable_income.yaml
+++ b/policyengine_us/tests/policy/baseline/gov/hhs/medicare/savings_programs/income/msp_countable_income.yaml
@@ -74,3 +74,42 @@
     # Person2 own income also $12,000 earned, same exclusions => $457.50/mo.
     # Both under 100% FPL (~$1,255/mo) so person1 still qualifies for QMB.
     msp_countable_income: [457.50, 457.50]
+
+- name: MSP excludes qualified salary-reduction health premiums before SSI income exclusions.
+  period: 2025-01
+  absolute_error_margin: 0.01
+  input:
+    age: 70
+    employment_income: 12_000
+    pre_tax_health_insurance_premiums: 2_400
+  output:
+    # 42 USC 1396d(p)(1)(B) uses SSI income methodology.
+    # POMS SI 00820.102C.2: (12,000 - 2,400) / 12 = 800 SSI wages.
+    # 20 CFR 416.1112(c)(4), (5), (7): (800 - 20 - 65) / 2 = 357.50.
+    msp_countable_income: 357.50
+
+- name: MSP combines both Medicare spouses' wages after excluding their pretax premiums.
+  period: 2025-01
+  absolute_error_margin: 0.01
+  input:
+    people:
+      person1:
+        age: 68
+        employment_income: 12_000
+        pre_tax_health_insurance_premiums: 2_400
+      person2:
+        age: 66
+        employment_income: 24_000
+        pre_tax_health_insurance_premiums: 3_600
+    tax_units:
+      tax_unit:
+        members: [person1, person2]
+    marital_units:
+      marital_unit:
+        members: [person1, person2]
+  output:
+    # POMS SI 00820.102C.2 removes each spouse's salary reduction.
+    # 42 USC 1396d(p)(1)(B) and 20 CFR 416.1160(a)(1) combine the wages:
+    # (12,000 - 2,400 + 24,000 - 3,600) / 12 = 2,500 monthly.
+    # Apply the couple's exclusions once: (2,500 - 20 - 65) / 2 = 1,207.50.
+    msp_countable_income: [1_207.50, 1_207.50]
diff --git a/policyengine_us/tests/policy/baseline/gov/hud/hud_medical_expenses.yaml b/policyengine_us/tests/policy/baseline/gov/hud/hud_medical_expenses.yaml
new file mode 100644
index 00000000000..b46ec776815
--- /dev/null
+++ b/policyengine_us/tests/policy/baseline/gov/hud/hud_medical_expenses.yaml
@@ -0,0 +1,38 @@
+- name: HUD medical expenses sum disjoint premiums across household members.
+  period: 2026
+  input:
+    people:
+      head:
+        health_insurance_premiums: 1_800
+        pre_tax_health_insurance_premiums: 2_400
+        other_medical_expenses: 300
+        medicare_enrolled: false
+      spouse:
+        health_insurance_premiums: 600
+        pre_tax_health_insurance_premiums: 1_200
+        other_medical_expenses: 200
+        medicare_enrolled: false
+    spm_units:
+      spm_unit:
+        members: [head, spouse]
+  output:
+    hud_medical_expenses: 6_500
+
+- name: HUD adds payroll premiums to decomposed non-pretax Medicare premiums.
+  period: 2026
+  input:
+    health_insurance_premiums_without_medicare_part_b: 600
+    medicare_part_b_premium: 1_200
+    medicare_enrolled: true
+    pre_tax_health_insurance_premiums: 2_400
+    other_medical_expenses: 300
+  output:
+    hud_medical_expenses: 4_500
+
+- name: HUD medical expenses include premiums paid entirely through payroll.
+  period: 2026
+  input:
+    pre_tax_health_insurance_premiums: 2_400
+    medicare_enrolled: false
+  output:
+    hud_medical_expenses: 2_400
diff --git a/policyengine_us/tests/policy/baseline/gov/local/ca/oc/general_relief/income/ca_oc_general_relief_countable_income_person.yaml b/policyengine_us/tests/policy/baseline/gov/local/ca/oc/general_relief/income/ca_oc_general_relief_countable_income_person.yaml
index f2ebaf09e15..329bc59713f 100644
--- a/policyengine_us/tests/policy/baseline/gov/local/ca/oc/general_relief/income/ca_oc_general_relief_countable_income_person.yaml
+++ b/policyengine_us/tests/policy/baseline/gov/local/ca/oc/general_relief/income/ca_oc_general_relief_countable_income_person.yaml
@@ -37,3 +37,22 @@
   output:
     # Earned 1,000 x (1 - 0.2) = 800; less 100 spousal support = 700.
     ca_oc_general_relief_countable_income_person: 700
+
+- name: Pretax and after-tax premiums reduce countable gross earned income once.
+  period: 2026-01
+  input:
+    employment_income: 1_000 * 12
+    health_insurance_premiums: 40 * 12
+    pre_tax_health_insurance_premiums: 60 * 12
+    in_oc: true
+  output:
+    ca_oc_general_relief_countable_income_person: 700
+
+- name: Moving all premiums to pretax payroll leaves countable income unchanged.
+  period: 2026-01
+  input:
+    employment_income: 1_000 * 12
+    pre_tax_health_insurance_premiums: 100 * 12
+    in_oc: true
+  output:
+    ca_oc_general_relief_countable_income_person: 700
diff --git a/policyengine_us/tests/policy/baseline/gov/ssa/ssi/eligibility/income/deemed/from_ineligible_parent.yaml b/policyengine_us/tests/policy/baseline/gov/ssa/ssi/eligibility/income/deemed/from_ineligible_parent.yaml
index 745c14c4690..96f3e7376a9 100644
--- a/policyengine_us/tests/policy/baseline/gov/ssa/ssi/eligibility/income/deemed/from_ineligible_parent.yaml
+++ b/policyengine_us/tests/policy/baseline/gov/ssa/ssi/eligibility/income/deemed/from_ineligible_parent.yaml
@@ -74,3 +74,45 @@
         members: [jacks_mother, jacks_father]
   output:
     ssi_countable_income: [372, 0, 0, 0, 0] # 31 * 12
+
+- name: Parental deeming excludes parent's and sibling's pretax premiums before allocations.
+  period: 2025
+  absolute_error_margin: 0.01
+  input:
+    people:
+      recipient:
+        age: 12
+        is_ssi_disabled: true
+      sibling:
+        age: 14
+        employment_income: 2_400
+        pre_tax_health_insurance_premiums: 1_200
+      parent:
+        age: 40
+        is_parent: true
+        employment_income: 36_000
+        pre_tax_health_insurance_premiums: 3_600
+    tax_units:
+      tax_unit:
+        members: [recipient, sibling, parent]
+    # A parent and children are not a married couple. Explicit singleton
+    # units prevent default grouping from also applying spousal deeming.
+    marital_units:
+      recipient_unit:
+        members: [recipient]
+      sibling_unit:
+        members: [sibling]
+      parent_unit:
+        members: [parent]
+  output:
+    # POMS SI 00820.102C.2: parent wages 32,400; sibling wages 1,200.
+    # 20 CFR 416.1165(b): sibling allocation = (1,450 - 967) * 12
+    # - 1,200 = 4,596, leaving parent wages of 27,804.
+    # Under (d), (27,804 - 20 * 12 - 65 * 12) / 2 - 967 * 12 = 1,788.
+    # Under (e)(1), child's countable unearned income = 1,788 - 20 * 12 = 1,548.
+    ssi_earned_income: [0, 1_200, 32_400]
+    ssi_ineligible_child_allocation: [0, 4_596, 0]
+    ssi_unearned_income_deemed_from_ineligible_parent: [1_788, 0, 0]
+    is_ssi_spousal_deeming_applies: [false, false, false]
+    ssi_income_deemed_from_ineligible_spouse: [0, 0, 0]
+    ssi_countable_income: [1_548, 0, 0]
diff --git a/policyengine_us/tests/policy/baseline/gov/ssa/ssi/eligibility/income/deemed/from_ineligible_spouse.yaml b/policyengine_us/tests/policy/baseline/gov/ssa/ssi/eligibility/income/deemed/from_ineligible_spouse.yaml
index 5f286c46b0c..64125417f99 100644
--- a/policyengine_us/tests/policy/baseline/gov/ssa/ssi/eligibility/income/deemed/from_ineligible_spouse.yaml
+++ b/policyengine_us/tests/policy/baseline/gov/ssa/ssi/eligibility/income/deemed/from_ineligible_spouse.yaml
@@ -57,3 +57,39 @@
     ssi_countable_income: [1_776, 0] # 148 * 12
 
 # Example 4 skipped as it relates to sponsored aliens.
+
+- name: Spousal deeming excludes spouse and child's qualified pretax premiums before allocations.
+  period: 2025
+  absolute_error_margin: 0.01
+  input:
+    people:
+      recipient:
+        age: 70
+        is_tax_unit_head: true
+      spouse:
+        age: 60
+        is_tax_unit_spouse: true
+        employment_income: 24_000
+        pre_tax_health_insurance_premiums: 2_400
+      child:
+        age: 14
+        employment_income: 2_400
+        pre_tax_health_insurance_premiums: 1_200
+    tax_units:
+      tax_unit:
+        members: [recipient, spouse, child]
+    marital_units:
+      marital_unit:
+        members: [recipient, spouse]
+  output:
+    # POMS SI 00820.102C.2: spouse wages 21,600; child wages 1,200.
+    # 20 CFR 416.1163(b): child allocation = (1,450 - 967) * 12
+    # - 1,200 = 4,596; spouse's remaining wages = 21,600 - 4,596 = 17,004.
+    # Under (d)(2), 17,004 > 5,796 and couple exclusions apply:
+    # (17,004 - 20 * 12 - 65 * 12) / 2 = 7,992.
+    ssi_earned_income: [0, 21_600, 1_200]
+    ssi_ineligible_child_allocation: [0, 0, 4_596]
+    ssi_earned_income_deemed_from_ineligible_spouse: [17_004, 0, 0]
+    is_ssi_spousal_deeming_applies: [true, false, false]
+    ssi_income_deemed_from_ineligible_spouse: [7_992, 0, 0]
+    ssi_countable_income: [7_992, 0, 0]
diff --git a/policyengine_us/tests/policy/baseline/gov/ssa/ssi/eligibility/income/deemed/ssi_ineligible_child_allocation.yaml b/policyengine_us/tests/policy/baseline/gov/ssa/ssi/eligibility/income/deemed/ssi_ineligible_child_allocation.yaml
index cf2a42e0de8..76164837620 100644
--- a/policyengine_us/tests/policy/baseline/gov/ssa/ssi/eligibility/income/deemed/ssi_ineligible_child_allocation.yaml
+++ b/policyengine_us/tests/policy/baseline/gov/ssa/ssi/eligibility/income/deemed/ssi_ineligible_child_allocation.yaml
@@ -4,3 +4,16 @@
     age: 14
   output:
     ssi_ineligible_child_allocation: 5_040 # (1,261 - 841) * 12
+
+- name: Ineligible child's pretax premiums do not reduce the child allocation as wages.
+  period: 2025
+  absolute_error_margin: 0.01
+  input:
+    age: 14
+    employment_income: 2_400
+    pre_tax_health_insurance_premiums: 1_200
+  output:
+    # POMS SI 00820.102C.2: wages for SSI = 2,400 - 1,200 = 1,200.
+    # 20 CFR 416.1163(b)(1)-(2): (1,450 - 967) * 12 - 1,200 = 4,596.
+    ssi_earned_income: 1_200
+    ssi_ineligible_child_allocation: 4_596
diff --git a/policyengine_us/tests/policy/baseline/gov/ssa/ssi/eligibility/income/ssi_blind_or_disabled_working_student_exclusion.yaml b/policyengine_us/tests/policy/baseline/gov/ssa/ssi/eligibility/income/ssi_blind_or_disabled_working_student_exclusion.yaml
index a576a272015..2e3b42da0f3 100644
--- a/policyengine_us/tests/policy/baseline/gov/ssa/ssi/eligibility/income/ssi_blind_or_disabled_working_student_exclusion.yaml
+++ b/policyengine_us/tests/policy/baseline/gov/ssa/ssi/eligibility/income/ssi_blind_or_disabled_working_student_exclusion.yaml
@@ -63,3 +63,43 @@
     ssi_earned_income: 20_000
   output:
     ssi_blind_or_disabled_working_student_exclusion: 433.33 # 5,200/12
+
+- name: Student earned-income exclusion applies to wages after qualified pretax premiums.
+  period: 2025
+  absolute_error_margin: 0.01
+  input:
+    age: 20
+    is_disabled: true
+    is_ssi_disabled: true
+    meets_ssi_disability_criteria: true
+    is_full_time_student: true
+    employment_income: 9_600
+    pre_tax_health_insurance_premiums: 2_400
+  output:
+    # POMS SI 00820.102C.2: SSI wages = 9,600 - 2,400 = 7,200.
+    # 20 CFR 416.1112(c)(3): min(600, 2,350) * 12 = 7,200,
+    # below the 2025 annual cap of 9,460. No earned income remains.
+    ssi_earned_income: 7_200
+    is_ssi_blind_or_disabled_working_student_exclusion_eligible: true
+    ssi_blind_or_disabled_working_student_exclusion: 7_200
+    ssi_countable_income: 0
+
+- name: Student with pretax premiums reaches the annual exclusion cap before standard exclusions.
+  period: 2025
+  absolute_error_margin: 0.01
+  input:
+    age: 20
+    is_disabled: true
+    is_ssi_disabled: true
+    meets_ssi_disability_criteria: true
+    is_full_time_student: true
+    employment_income: 18_000
+    pre_tax_health_insurance_premiums: 2_400
+  output:
+    # POMS SI 00820.102C.2: SSI wages = 18,000 - 2,400 = 15,600.
+    # 20 CFR 416.1112(c)(3)-(7): student exclusion is capped at 9,460,
+    # then (15,600 - 9,460 - 20 * 12 - 65 * 12) / 2 = 2,560.
+    ssi_earned_income: 15_600
+    is_ssi_blind_or_disabled_working_student_exclusion_eligible: true
+    ssi_blind_or_disabled_working_student_exclusion: 9_460
+    ssi_countable_income: 2_560
diff --git a/policyengine_us/tests/policy/baseline/gov/ssa/ssi/income/ssi_earned_income.yaml b/policyengine_us/tests/policy/baseline/gov/ssa/ssi/income/ssi_earned_income.yaml
index cc9acb9d8db..a8185d00ffe 100644
--- a/policyengine_us/tests/policy/baseline/gov/ssa/ssi/income/ssi_earned_income.yaml
+++ b/policyengine_us/tests/policy/baseline/gov/ssa/ssi/income/ssi_earned_income.yaml
@@ -18,3 +18,56 @@
     sstb_self_employment_income: 100_000
   output:
     ssi_earned_income: 100_000
+
+- name: After-tax health premiums remain part of SSI wages.
+  period: 2025
+  input:
+    employment_income: 12_000
+    health_insurance_premiums: 1_200
+  output:
+    ssi_earned_income: 12_000
+
+- name: Pretax payroll health premiums are excluded from SSI wages.
+  period: 2025
+  input:
+    employment_income: 12_000
+    pre_tax_health_insurance_premiums: 1_200
+  output:
+    ssi_earned_income: 10_800
+
+- name: Only the pretax portion of disjoint premiums is excluded from SSI wages.
+  period: 2025
+  input:
+    employment_income: 12_000
+    health_insurance_premiums: 600
+    pre_tax_health_insurance_premiums: 600
+  output:
+    ssi_earned_income: 11_400
+
+- name: Excess pretax premiums cannot reduce SSI self-employment income.
+  period: 2025
+  input:
+    employment_income: 1_000
+    self_employment_income: 500
+    sstb_self_employment_income: 250
+    pre_tax_health_insurance_premiums: 2_000
+  output:
+    ssi_earned_income: 750
+
+- name: Traditional retirement deferrals remain SSI wages after excluding health premiums.
+  period: 2025
+  input:
+    employment_income: 12_000
+    traditional_401k_contributions: 2_400
+    traditional_403b_contributions: 1_200
+    pre_tax_health_insurance_premiums: 1_200
+  output:
+    ssi_earned_income: 10_800
+
+- name: Employer-paid premiums do not reduce SSI wages.
+  period: 2025
+  input:
+    employment_income: 12_000
+    employer_sponsored_insurance_premiums: 1_200
+  output:
+    ssi_earned_income: 12_000
diff --git a/policyengine_us/tests/policy/baseline/gov/ssa/ssi/income/ssi_engaged_in_sga.yaml b/policyengine_us/tests/policy/baseline/gov/ssa/ssi/income/ssi_engaged_in_sga.yaml
index 4e0cf90c2e8..ecc98e6faa3 100644
--- a/policyengine_us/tests/policy/baseline/gov/ssa/ssi/income/ssi_engaged_in_sga.yaml
+++ b/policyengine_us/tests/policy/baseline/gov/ssa/ssi/income/ssi_engaged_in_sga.yaml
@@ -21,3 +21,35 @@
     is_blind: true
   output:
     ssi_engaged_in_sga: false
+
+- name: Pretax health premiums remain in SGA earnings across the threshold.
+  period: 2026
+  input:
+    employment_income: 21_600
+    pre_tax_health_insurance_premiums: 2_400
+    is_blind: false
+  output:
+    # SSI payment wages are 1,600 monthly; SGA earnings remain 1,800.
+    ssi_earned_income: 19_200
+    ssi_engaged_in_sga: true
+
+- name: After-tax health premiums also remain in SGA earnings.
+  period: 2026
+  input:
+    employment_income: 21_600
+    health_insurance_premiums: 2_400
+    is_blind: false
+  output:
+    ssi_earned_income: 21_600
+    ssi_engaged_in_sga: true
+
+- name: Excess pretax premiums cannot raise SGA earnings above gross wages.
+  period: 2026
+  input:
+    employment_income: 12_000
+    pre_tax_health_insurance_premiums: 24_000
+    is_blind: false
+  output:
+    # Only 12,000 of excluded wages is restored, below the SGA threshold.
+    ssi_earned_income: 0
+    ssi_engaged_in_sga: false
diff --git a/policyengine_us/tests/policy/baseline/gov/states/ct/dss/ssp/premium_input_contract.yaml b/policyengine_us/tests/policy/baseline/gov/states/ct/dss/ssp/premium_input_contract.yaml
new file mode 100644
index 00000000000..b654cf7d663
--- /dev/null
+++ b/policyengine_us/tests/policy/baseline/gov/states/ct/dss/ssp/premium_input_contract.yaml
@@ -0,0 +1,88 @@
+# Salary-reduction premiums are excluded from inherited SSI earned income:
+# https://secure.ssa.gov/poms.nsf/lnx/0500820102 (SI 00820.102C.2).
+# CT earned and unearned disregard rules: UPM 5030.10 and 5030.15;
+# https://www.ssa.gov/policy/docs/progdesc/ssi_st_asst/2011/ct.html
+# Current disregard and need amounts:
+# https://portal.ct.gov/dss/-/media/departments-and-agencies/dss/fact-sheets-and-issue-briefs/fact-sheets/dss-program-standards-chart-effective-010126.pdf
+
+- name: Connecticut SSP applies its earned disregard after the inherited pretax exclusion
+  period: 2026-01
+  absolute_error_margin: 0.01
+  input:
+    people:
+      person:
+        age: 70
+        immigration_status: CITIZEN
+        ssi_countable_resources: 500
+        employment_income: 7_200
+        pre_tax_health_insurance_premiums: 1_200
+        rent: 12_000
+    marital_units:
+      marital_unit:
+        members: [person]
+    tax_units:
+      tax_unit:
+        members: [person]
+    spm_units:
+      spm_unit:
+        members: [person]
+    households:
+      household:
+        members: [person]
+        state_code: CT
+  output:
+    ssi_earned_income: 500  # $600 - $100.
+    ssi: 786.50  # $994 - ($500 - $20 - $65)/2.
+    ct_ssp_gross_income: 1_286.50  # $500 SSI wages + $786.50 SSI.
+    ct_ssp_earned_income_disregard: 282.50  # $65 + ($500 - $65)/2.
+    ct_ssp_unearned_income_disregard: 562
+    # ($786.50 - $562) + ($500 - $282.50) = $442.
+    ct_ssp_countable_income: 442
+    ct_ssp_need_standard: 597.35  # $400 shelter + $197.35 personal needs.
+    ct_ssp_income_eligible: true
+    ct_ssp_eligible_person: true
+    ct_ssp_person: 155.35  # $597.35 - $442.
+    ct_ssp: 155.35
+
+- name: Connecticut SSP blind earned disregard uses earnings after the pretax exclusion
+  period: 2026-01
+  absolute_error_margin: 0.01
+  input:
+    people:
+      person:
+        age: 50
+        is_blind: true
+        immigration_status: CITIZEN
+        ssi_countable_resources: 500
+        employment_income: 3_600
+        pre_tax_health_insurance_premiums: 1_200
+        ct_ssp_lives_with_others: true
+        ct_ssp_has_therapeutic_diet: true
+        rent: 6_000
+    marital_units:
+      marital_unit:
+        members: [person]
+    tax_units:
+      tax_unit:
+        members: [person]
+    spm_units:
+      spm_unit:
+        members: [person]
+    households:
+      household:
+        members: [person]
+        state_code: CT
+  output:
+    ssi_earned_income: 200  # $300 - $100.
+    ssi: 936.50  # $994 - ($200 - $20 - $65)/2.
+    ct_ssp_gross_income: 1_136.50  # $200 SSI wages + $936.50 SSI.
+    ct_ssp_earned_income_disregard: 142.50  # $85 + ($200 - $85)/2.
+    ct_ssp_unearned_income_disregard: 629.90
+    # ($936.50 - $629.90) + ($200 - $142.50) = $364.10.
+    ct_ssp_countable_income: 364.10
+    # $200 shelter + $197.35 personal needs + $36.20 therapeutic diet.
+    ct_ssp_need_standard: 433.55
+    ct_ssp_income_eligible: true
+    ct_ssp_eligible_person: true
+    ct_ssp_person: 69.45  # $433.55 - $364.10.
+    ct_ssp: 69.45
diff --git a/policyengine_us/tests/policy/baseline/gov/states/mn/dhs/msa/premium_input_contract.yaml b/policyengine_us/tests/policy/baseline/gov/states/mn/dhs/msa/premium_input_contract.yaml
new file mode 100644
index 00000000000..4b95f69554c
--- /dev/null
+++ b/policyengine_us/tests/policy/baseline/gov/states/mn/dhs/msa/premium_input_contract.yaml
@@ -0,0 +1,145 @@
+# SSI salary-reduction treatment: POMS SI 00820.102C.2.
+# MSA countable exclusions: Minn. Stat. 256D.435 subds. 4a, 5, and 6.
+# MSA gross income: Minn. Stat. 256D.35 subd. 10. Rule 9500.1206 subp. 15a
+# describes GA conventions, adopted for non-SSI MSA recipients by CM 0017.
+# Guardian cap: Minn. Stat. 256D.44 subd. 5(d).
+# https://secure.ssa.gov/poms.nsf/lnx/0500820102
+# https://www.revisor.mn.gov/statutes/cite/256D.435
+# https://www.revisor.mn.gov/statutes/cite/256D.35
+# https://www.revisor.mn.gov/rules/9500.1206/
+# https://www.revisor.mn.gov/statutes/cite/256D.44
+
+- name: MSA excludes pretax premiums from countable income and restores them for guardian fees
+  period: 2026-01
+  absolute_error_margin: 0.01
+  input:
+    people:
+      person:
+        age: 70
+        immigration_status: CITIZEN
+        ssi_countable_resources: 500
+        employment_income: 20_400  # $1,700/month before salary reduction.
+        pre_tax_health_insurance_premiums: 1_200
+        social_security: 3_000
+        mn_msa_has_guardian: true
+    marital_units:
+      marital_unit:
+        members: [person]
+    tax_units:
+      tax_unit:
+        members: [person]
+    spm_units:
+      spm_unit:
+        members: [person]
+    households:
+      household:
+        members: [person]
+        state_code: MN
+  output:
+    ssi_earned_income: 1_600  # $1,700 - $100.
+    # Countable = ($1,600 - $65)/2 + ($250 - $20) = $997.50/month.
+    ssi_countable_income: 997.50
+    ssi: 0  # Countable $997.50 exceeds the $994 FBR.
+    mn_msa_gross_income: 1_950  # $1,700 gross wages + $250 Social Security.
+    mn_msa_gross_income_eligible: true  # $1,950 <= 3 * $994.
+    mn_msa_guardian_fee: 97.50  # min(5% * $1,950, $100).
+    mn_msa_net_income_eligible: true
+    mn_msa_eligible_person: true
+    mn_msa_assistance_standard: 1_055
+    mn_msa_person: 155  # $1,055 + $97.50 - $997.50.
+    mn_msa: 155
+
+- name: MSA SSI track substitutes the FBR and keeps pretax premiums in guardian gross income
+  period: 2026-01
+  absolute_error_margin: 0.01
+  input:
+    people:
+      person:
+        age: 70
+        immigration_status: CITIZEN
+        ssi_countable_resources: 500
+        employment_income: 7_200
+        pre_tax_health_insurance_premiums: 1_200
+        mn_msa_has_guardian: true
+    marital_units:
+      marital_unit:
+        members: [person]
+    tax_units:
+      tax_unit:
+        members: [person]
+    spm_units:
+      spm_unit:
+        members: [person]
+    households:
+      household:
+        members: [person]
+        state_code: MN
+  output:
+    ssi_earned_income: 500  # $600 - $100.
+    ssi: 786.50  # $994 - ($500 - $20 - $65)/2.
+    # CM 0017 uses the full FBR: gross = $600 + $994, rather than the SSI check.
+    mn_msa_gross_income: 1_594
+    mn_msa_gross_income_eligible: true
+    mn_msa_guardian_fee: 79.70  # 5% * $1,594.
+    mn_msa_net_income_eligible: true
+    mn_msa_eligible_person: true
+    mn_msa_person: 160.70  # $1,055 + $79.70 - ($994 - $20).
+    mn_msa: 160.70
+
+- name: MSA gross test includes pretax premiums at the individual limit
+  period: 2026-01
+  input:
+    age: 70
+    state_code: MN
+    employment_income: 35_784
+    pre_tax_health_insurance_premiums: 1_200
+  output:
+    ssi_earned_income: 2_882  # $2,982 - $100.
+    ssi: 0
+    mn_msa_gross_income: 2_982
+    mn_msa_gross_income_eligible: true  # $2,982 = 3 * $994.
+
+- name: MSA gross test includes pretax premiums one dollar above the individual limit
+  period: 2026-01
+  input:
+    age: 70
+    state_code: MN
+    employment_income: 35_796
+    pre_tax_health_insurance_premiums: 1_200
+  output:
+    ssi_earned_income: 2_883  # $2,983 - $100.
+    ssi: 0
+    mn_msa_gross_income: 2_983
+    mn_msa_gross_income_eligible: false  # $2,983 > 3 * $994.
+
+- name: MSA gross couple limit includes both spouses salary reductions
+  period: 2026-01
+  input:
+    people:
+      person1:
+        age: 70
+        employment_income: 35_796
+        pre_tax_health_insurance_premiums: 1_200
+      person2:
+        age: 68
+        employment_income: 35_784
+        pre_tax_health_insurance_premiums: 1_200
+    marital_units:
+      marital_unit:
+        members: [person1, person2]
+    tax_units:
+      tax_unit:
+        members: [person1, person2]
+    spm_units:
+      spm_unit:
+        members: [person1, person2]
+    households:
+      household:
+        members: [person1, person2]
+        state_code: MN
+  output:
+    ssi_earned_income: [2_883, 2_882]
+    ssi: [0, 0]
+    mn_msa_gross_income: [2_983, 2_982]
+    # Both are aged: $5,965 gross exceeds the couple limit 6 * $994 = $5,964.
+    mn_msa_gross_income_eligible: [false, false]
diff --git a/policyengine_us/tests/policy/baseline/gov/states/mo/dese/ccs/income/mo_ccs_adjusted_income.yaml b/policyengine_us/tests/policy/baseline/gov/states/mo/dese/ccs/income/mo_ccs_adjusted_income.yaml
index 10ac417a1b4..30c47ef1f99 100644
--- a/policyengine_us/tests/policy/baseline/gov/states/mo/dese/ccs/income/mo_ccs_adjusted_income.yaml
+++ b/policyengine_us/tests/policy/baseline/gov/states/mo/dese/ccs/income/mo_ccs_adjusted_income.yaml
@@ -61,3 +61,24 @@
   output:
     # Countable 500/mo; premiums 1,000/mo; max(500 - 1,000, 0) = 0.
     mo_ccs_adjusted_income: 0
+
+- name: Pretax and after-tax premiums are each deducted once from gross wages.
+  period: 2026-01
+  input:
+    state_code: MO
+    employment_income: 36_000
+    health_insurance_premiums: 2_400
+    pre_tax_health_insurance_premiums: 3_600
+  output:
+    mo_ccs_countable_income: 3_000
+    mo_ccs_adjusted_income: 2_500
+
+- name: Moving all premiums to pretax payroll leaves adjusted income unchanged.
+  period: 2026-01
+  input:
+    state_code: MO
+    employment_income: 36_000
+    pre_tax_health_insurance_premiums: 6_000
+  output:
+    mo_ccs_countable_income: 3_000
+    mo_ccs_adjusted_income: 2_500
diff --git a/policyengine_us/tests/policy/baseline/gov/states/nd/tax/property/renters_refund/nd_renters_refund_income.yaml b/policyengine_us/tests/policy/baseline/gov/states/nd/tax/property/renters_refund/nd_renters_refund_income.yaml
index 9dcdb1e7932..a8a8257979a 100644
--- a/policyengine_us/tests/policy/baseline/gov/states/nd/tax/property/renters_refund/nd_renters_refund_income.yaml
+++ b/policyengine_us/tests/policy/baseline/gov/states/nd/tax/property/renters_refund/nd_renters_refund_income.yaml
@@ -63,6 +63,64 @@
   output:
     nd_renters_refund_income: 12_000
 
+- name: Case 4, after-tax premiums reduce renter refund income as medical expenses.
+  absolute_error_margin: 0.01
+  period: 2025
+  input:
+    age: 40
+    state_code: ND
+    employment_income: 40_000
+    health_insurance_premiums: 6_000
+    pre_tax_health_insurance_premiums: 0
+  output:
+    market_income: 40_000
+    itemized_medical_expenses: 6_000
+    nd_renters_refund_income: 34_000
+
+- name: Case 5, mixed premiums reduce renter refund income once through each disjoint route.
+  absolute_error_margin: 0.01
+  period: 2025
+  input:
+    age: 40
+    state_code: ND
+    employment_income: 40_000
+    health_insurance_premiums: 3_000
+    pre_tax_health_insurance_premiums: 3_000
+  output:
+    market_income: 40_000
+    irs_employment_income: 37_000
+    itemized_medical_expenses: 3_000
+    nd_renters_refund_income: 34_000
+
+- name: Case 6, pretax premiums reduce renter refund income as excluded wage income.
+  absolute_error_margin: 0.01
+  period: 2025
+  input:
+    age: 40
+    state_code: ND
+    employment_income: 40_000
+    health_insurance_premiums: 0
+    pre_tax_health_insurance_premiums: 6_000
+  output:
+    market_income: 40_000
+    irs_employment_income: 34_000
+    itemized_medical_expenses: 0
+    nd_renters_refund_income: 34_000
+
+- name: Case 7, employer-paid premiums do not reduce renter refund income.
+  absolute_error_margin: 0.01
+  period: 2025
+  input:
+    age: 40
+    state_code: ND
+    employment_income: 40_000
+    health_insurance_premiums: 0
+    pre_tax_health_insurance_premiums: 0
+    employer_sponsored_insurance_premiums: 6_000
+  output:
+    market_income: 40_000
+    nd_renters_refund_income: 40_000
+
 - name: North Dakota renter refund deducts medical expenses actually paid from gross income
   period: 2025
   input:
@@ -136,3 +194,21 @@
   output:
     itemized_medical_expenses_applied_exclusion: 0
     nd_renters_refund_income: 30_000
+
+- name: North Dakota combines the pretax income exclusion with paid SE medical costs
+  period: 2025
+  absolute_error_margin: 0.01
+  input:
+    age: 40
+    state_code: ND
+    employment_income: 10_000
+    self_employment_income: 30_000
+    health_insurance_premiums: 6_000
+    pre_tax_health_insurance_premiums: 3_000
+    other_medical_expenses: 500
+    self_employed_health_insurance_ald: 1_000
+  output:
+    itemized_medical_expenses: 5_500
+    itemized_medical_expenses_applied_exclusion: 1_000
+    # 40,000 - 3,000 - (5,500 + 1,000) = 30,500.
+    nd_renters_refund_income: 30_500
diff --git a/policyengine_us/tests/policy/baseline/gov/states/nj/tax/income/deductions/nj_medical_expense_deduction.yaml b/policyengine_us/tests/policy/baseline/gov/states/nj/tax/income/deductions/nj_medical_expense_deduction.yaml
index 6aa0d6ff82c..5e3482dc63a 100644
--- a/policyengine_us/tests/policy/baseline/gov/states/nj/tax/income/deductions/nj_medical_expense_deduction.yaml
+++ b/policyengine_us/tests/policy/baseline/gov/states/nj/tax/income/deductions/nj_medical_expense_deduction.yaml
@@ -82,6 +82,61 @@
     nj_agi: 50_000
     nj_medical_expense_deduction: 1_000
 
+- name: New Jersey allows after-tax premiums above two percent of gross income
+  period: 2025
+  absolute_error_margin: 0.01
+  input:
+    age: 40
+    employment_income: 40_000
+    health_insurance_premiums: 6_000
+    pre_tax_health_insurance_premiums: 0
+    state_code: NJ
+  output:
+    nj_agi: 40_000
+    nj_medical_expense_deduction: 5_200
+
+- name: New Jersey counts disjoint payroll and after-tax premiums once each
+  period: 2025
+  absolute_error_margin: 0.01
+  input:
+    age: 40
+    employment_income: 40_000
+    health_insurance_premiums: 3_000
+    pre_tax_health_insurance_premiums: 3_000
+    state_code: NJ
+  output:
+    nj_agi: 40_000
+    irs_employment_income: 37_000
+    nj_medical_expense_deduction: 5_200
+
+- name: New Jersey allows federally pretax payroll premiums included in state wages
+  period: 2025
+  absolute_error_margin: 0.01
+  input:
+    age: 40
+    employment_income: 40_000
+    health_insurance_premiums: 0
+    pre_tax_health_insurance_premiums: 6_000
+    state_code: NJ
+  output:
+    nj_agi: 40_000
+    irs_employment_income: 34_000
+    nj_medical_expense_deduction: 5_200
+
+- name: Employer-paid premiums are not employee medical expenses in New Jersey
+  period: 2025
+  absolute_error_margin: 0.01
+  input:
+    age: 40
+    employment_income: 40_000
+    health_insurance_premiums: 0
+    pre_tax_health_insurance_premiums: 0
+    employer_sponsored_insurance_premiums: 6_000
+    state_code: NJ
+  output:
+    nj_agi: 40_000
+    nj_medical_expense_deduction: 0
+
 - name: New Jersey counts self-employed premiums once across its medical deductions
   period: 2025
   input:
@@ -151,3 +206,21 @@
     # Separate SE deduction 1,000 + general medical premiums 1,000 = 2,000.
     # https://pub.njleg.gov/bills/9899/PL99/222_.HTM
     nj_medical_expense_deduction: 2_000
+
+- name: New Jersey combines pretax premiums with separately deducted SE premiums
+  period: 2025
+  absolute_error_margin: 0.01
+  input:
+    age: 40
+    state_code: NJ
+    employment_income: 10_000
+    self_employment_income: 30_000
+    health_insurance_premiums: 6_000
+    pre_tax_health_insurance_premiums: 3_000
+    other_medical_expenses: 500
+    self_employed_health_insurance_ald: 1_000
+  output:
+    itemized_medical_expenses: 5_500
+    nj_agi: 40_000
+    # 1,000 + (5,500 + 3,000 - 0.02 * 40,000) = 8,700.
+    nj_medical_expense_deduction: 8_700
diff --git a/policyengine_us/tests/policy/baseline/gov/states/pa/dhs/ccw/pa_ccw_adjusted_income.yaml b/policyengine_us/tests/policy/baseline/gov/states/pa/dhs/ccw/pa_ccw_adjusted_income.yaml
index be942e60178..2424d08202e 100644
--- a/policyengine_us/tests/policy/baseline/gov/states/pa/dhs/ccw/pa_ccw_adjusted_income.yaml
+++ b/policyengine_us/tests/policy/baseline/gov/states/pa/dhs/ccw/pa_ccw_adjusted_income.yaml
@@ -141,3 +141,25 @@
     # Adjusted monthly: 5,000 - 587 = 4,413
     # Annual: 4,413 * 12 = 52,956
     pa_ccw_adjusted_income: 52_956
+
+- name: Pretax and after-tax premiums both count toward the medical deduction.
+  period: 2026
+  input:
+    state_code: PA
+    employment_income: 36_000
+    health_insurance_premiums: 2_400
+    pre_tax_health_insurance_premiums: 3_600
+  output:
+    pa_ccw_medical_expenses: 6_000
+    # Gross wages 36,000 less premiums 6,000 above the 3,600 threshold.
+    pa_ccw_adjusted_income: 33_600
+
+- name: Moving all premiums to pretax payroll leaves the medical deduction unchanged.
+  period: 2026
+  input:
+    state_code: PA
+    employment_income: 36_000
+    pre_tax_health_insurance_premiums: 6_000
+  output:
+    pa_ccw_medical_expenses: 6_000
+    pa_ccw_adjusted_income: 33_600
diff --git a/policyengine_us/tests/policy/baseline/gov/usda/snap/income/deductions/snap_allowable_medical_expenses.yaml b/policyengine_us/tests/policy/baseline/gov/usda/snap/income/deductions/snap_allowable_medical_expenses.yaml
new file mode 100644
index 00000000000..3e2d3b7f9e7
--- /dev/null
+++ b/policyengine_us/tests/policy/baseline/gov/usda/snap/income/deductions/snap_allowable_medical_expenses.yaml
@@ -0,0 +1,29 @@
+- name: SNAP medical expenses include disjoint non-pretax and payroll premiums.
+  period: 2026
+  input:
+    health_insurance_premiums: 1_800
+    pre_tax_health_insurance_premiums: 2_400
+    other_medical_expenses: 300
+    over_the_counter_health_expenses: 900
+    medicare_enrolled: false
+  output:
+    snap_allowable_medical_expenses: 4_500
+
+- name: SNAP adds payroll premiums to decomposed non-pretax Medicare premiums.
+  period: 2026
+  input:
+    health_insurance_premiums_without_medicare_part_b: 600
+    medicare_part_b_premium: 1_200
+    medicare_enrolled: true
+    pre_tax_health_insurance_premiums: 2_400
+    other_medical_expenses: 300
+  output:
+    snap_allowable_medical_expenses: 4_500
+
+- name: SNAP medical expenses include premiums paid entirely through payroll.
+  period: 2026
+  input:
+    pre_tax_health_insurance_premiums: 2_400
+    medicare_enrolled: false
+  output:
+    snap_allowable_medical_expenses: 2_400
diff --git a/policyengine_us/tests/policy/baseline/household/income/spm_unit/spm_unit_medical_out_of_pocket_expenses.yaml b/policyengine_us/tests/policy/baseline/household/income/spm_unit/spm_unit_medical_out_of_pocket_expenses.yaml
index 0d5aee02b6f..86061b7a0d9 100644
--- a/policyengine_us/tests/policy/baseline/household/income/spm_unit/spm_unit_medical_out_of_pocket_expenses.yaml
+++ b/policyengine_us/tests/policy/baseline/household/income/spm_unit/spm_unit_medical_out_of_pocket_expenses.yaml
@@ -100,3 +100,37 @@
     marketplace_net_premium: 5_000
     spm_unit_health_insurance_premiums: 5_000
     spm_unit_medical_out_of_pocket_expenses: 5_100
+
+- name: SPM medical expenses include disjoint payroll and non-pretax premiums.
+  period: 2026
+  input:
+    pre_tax_health_insurance_premiums: 2_400
+    other_health_insurance_premiums: 600
+    chip_premium: 0
+    medicaid_premium: 0
+    marketplace_net_premium: 0
+    medicare_part_a_premium: 0
+    medicare_part_b_premium: 0
+    income_adjusted_part_d_premium_surcharge: 0
+    other_medical_expenses: 300
+    over_the_counter_health_expenses: 100
+  output:
+    spm_unit_health_insurance_premiums: 3_000
+    spm_unit_medical_out_of_pocket_expenses: 3_400
+
+- name: Moving all premiums to pretax payroll leaves SPM medical expenses unchanged.
+  period: 2026
+  input:
+    pre_tax_health_insurance_premiums: 3_000
+    other_health_insurance_premiums: 0
+    chip_premium: 0
+    medicaid_premium: 0
+    marketplace_net_premium: 0
+    medicare_part_a_premium: 0
+    medicare_part_b_premium: 0
+    income_adjusted_part_d_premium_surcharge: 0
+    other_medical_expenses: 300
+    over_the_counter_health_expenses: 100
+  output:
+    spm_unit_health_insurance_premiums: 3_000
+    spm_unit_medical_out_of_pocket_expenses: 3_400
diff --git a/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_medical_expenses.py b/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_medical_expenses.py
index cd95bdbce86..e4702532c46 100644
--- a/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_medical_expenses.py
+++ b/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_medical_expenses.py
@@ -6,9 +6,20 @@ class medicaid_medically_needy_medical_expenses(Variable):
     entity = Person
     label = "Medicaid medically needy medical expenses"
     unit = USD
-    documentation = "Medical expenses used for Medicaid medically needy spenddown."
+    documentation = (
+        "Annual expense proxy for SSI-based Medicaid medically needy spenddown. "
+        "Includes non-pretax health premiums and other medical expenses. "
+        "Qualified pretax payroll premiums are excluded through SSI earnings "
+        "rather than deducted again here. State-specific income and expense "
+        "sequencing, including states using gross-income payroll deductions, "
+        "is not modeled by this proxy."
+    )
     definition_period = YEAR
-    reference = "https://www.law.cornell.edu/cfr/text/42/part-435/subpart-D"
+    reference = (
+        "https://www.ecfr.gov/current/title-42/section-435.831#p-435.831(d)",
+        "https://www.ecfr.gov/current/title-42/section-435.831#p-435.831(e)(1)",
+        "https://khap.kdhe.ks.gov/KEESM/July_2026_Output/7000/7500-Determination-of-Financial-Eligibility.htm",
+    )
 
     adds = [
         "medical_expense_health_insurance_premiums",
diff --git a/policyengine_us/variables/gov/hud/hud_medical_expenses.py b/policyengine_us/variables/gov/hud/hud_medical_expenses.py
index bea476968e1..af53ee69dbd 100644
--- a/policyengine_us/variables/gov/hud/hud_medical_expenses.py
+++ b/policyengine_us/variables/gov/hud/hud_medical_expenses.py
@@ -6,11 +6,20 @@ class hud_medical_expenses(Variable):
     entity = SPMUnit
     label = "HUD medical expenses"
     unit = USD
-    documentation = "Medical expenses considered in HUD adjusted income."
+    documentation = (
+        "Medical expenses considered in HUD adjusted income, including "
+        "unreimbursed employee-paid health insurance premiums whether paid "
+        "through pretax payroll deductions or from non-pretax funds."
+    )
     definition_period = YEAR
-    reference = "https://www.law.cornell.edu/cfr/text/24/5.611"
+    reference = (
+        "https://www.ecfr.gov/current/title-24/section-5.603",
+        "https://www.ecfr.gov/current/title-24/section-5.611",
+        "https://www.hud.gov/sites/dfiles/OCHCO/documents/2023-27pihn.pdf#page=37",
+    )
 
     adds = [
         "medical_expense_health_insurance_premiums",
+        "pre_tax_health_insurance_premiums",
         "other_medical_expenses",
     ]
diff --git a/policyengine_us/variables/gov/local/ca/oc/general_relief/income/ca_oc_general_relief_countable_income_person.py b/policyengine_us/variables/gov/local/ca/oc/general_relief/income/ca_oc_general_relief_countable_income_person.py
index 66b1c325fff..9155d19ebf9 100644
--- a/policyengine_us/variables/gov/local/ca/oc/general_relief/income/ca_oc_general_relief_countable_income_person.py
+++ b/policyengine_us/variables/gov/local/ca/oc/general_relief/income/ca_oc_general_relief_countable_income_person.py
@@ -8,8 +8,8 @@ class ca_oc_general_relief_countable_income_person(Variable):
     unit = USD
     definition_period = MONTH
     defined_for = "in_oc"
-    # Sections 70.2.o through 70.2.q (pp. 4-5).
-    reference = "https://www.ssa.ocgov.com/sites/ssa/files/2025-03/Income.pdf#page=4"
+    # Sections 70.2.a(1), .o(4), and .p(1): PDF pages 1, 4.
+    reference = "https://www.ssa.ocgov.com/sites/ssa/files/2025-03/Income.pdf#page=1"
 
     def formula(person, period, parameters):
         # NOTE: Section 70.2.p also allows mandatory federal/state income tax
@@ -24,11 +24,15 @@ def formula(person, period, parameters):
                 "ca_oc_general_relief_gross_unearned_income",
             ],
         )
+        # Section 70.2.o(4) and .p(1) allow medical insurance payments;
+        # 70.2.a(1) counts earnings diverted to a third party as gross income.
+        # Employee pretax premiums therefore remain deductible here.
         deductions = add(
             person,
             period,
             [
                 "health_insurance_premiums",
+                "pre_tax_health_insurance_premiums",
                 "child_support_expense",
                 "alimony_expense",
             ],
diff --git a/policyengine_us/variables/gov/ssa/ssi/eligibility/income/ssi_earned_income.py b/policyengine_us/variables/gov/ssa/ssi/eligibility/income/ssi_earned_income.py
index 8b84426daf1..5c493c0a7c8 100644
--- a/policyengine_us/variables/gov/ssa/ssi/eligibility/income/ssi_earned_income.py
+++ b/policyengine_us/variables/gov/ssa/ssi/eligibility/income/ssi_earned_income.py
@@ -7,5 +7,22 @@ class ssi_earned_income(Variable):
     label = "SSI earned income"
     unit = USD
     definition_period = YEAR
+    reference = "https://secure.ssa.gov/poms.nsf/lnx/0500820102"
+    documentation = (
+        "Earned income for SSI, excluding health insurance premiums paid "
+        "through pretax payroll salary reductions under a qualified "
+        "cafeteria plan. The disjoint after-tax premium inputs do not "
+        "reduce SSI wages."
+    )
 
-    adds = "gov.ssa.ssi.income.sources.earned"
+    def formula(person, period, parameters):
+        sources = parameters(period).gov.ssa.ssi.income.sources.earned
+        earned_income = add(person, period, sources)
+        if "employment_income" not in sources:
+            return earned_income
+        # POMS SI 00820.102C.2 excludes salary-reduction premiums from
+        # wages; C.4 counts ordinary payroll deductions. Limit the exclusion
+        # to wages so it cannot reduce self-employment income.
+        wages = max_(person("employment_income", period), 0)
+        pretax_premiums = max_(person("pre_tax_health_insurance_premiums", period), 0)
+        return earned_income - min_(wages, pretax_premiums)
diff --git a/policyengine_us/variables/gov/ssa/ssi/eligibility/income/ssi_engaged_in_sga.py b/policyengine_us/variables/gov/ssa/ssi/eligibility/income/ssi_engaged_in_sga.py
index 5f41d4d0bca..d116dabb369 100644
--- a/policyengine_us/variables/gov/ssa/ssi/eligibility/income/ssi_engaged_in_sga.py
+++ b/policyengine_us/variables/gov/ssa/ssi/eligibility/income/ssi_engaged_in_sga.py
@@ -6,10 +6,28 @@ class ssi_engaged_in_sga(Variable):
     entity = Person
     label = "Income less than the SGA limit"
     definition_period = YEAR
-    reference = "https://www.ssa.gov/OP_Home/cfr20/416/416-0971.htm"
+    reference = (
+        "https://www.ssa.gov/OP_Home/cfr20/416/416-0971.htm",
+        "https://secure.ssa.gov/poms.nsf/lnx/0410505010",
+    )
+    documentation = (
+        "Whether non-blind work earnings exceed the SGA limit. Payroll "
+        "health insurance premiums remain in these earnings, including "
+        "pretax salary reductions excluded from SSI payment income."
+    )
 
     def formula(person, period, parameters):
         income = person("ssi_earned_income", period)
+        # POMS DI 10505.010A counts payroll insurance premiums for SGA.
+        # Restore exactly the wage-limited premium exclusion made by
+        # ssi_earned_income, preserving the prior gross work-earnings base.
+        sources = parameters(period).gov.ssa.ssi.income.sources.earned
+        if "employment_income" in sources:
+            wages = max_(person("employment_income", period), 0)
+            pretax_premiums = max_(
+                person("pre_tax_health_insurance_premiums", period), 0
+            )
+            income = income + min_(wages, pretax_premiums)
         monthly_income = income / MONTHS_IN_YEAR
         p = parameters(period).gov.ssa.sga
 
diff --git a/policyengine_us/variables/gov/states/mn/dhs/msa/eligibility/mn_msa_gross_income_eligible.py b/policyengine_us/variables/gov/states/mn/dhs/msa/eligibility/mn_msa_gross_income_eligible.py
index e13a80161b3..27de6fc0bc3 100644
--- a/policyengine_us/variables/gov/states/mn/dhs/msa/eligibility/mn_msa_gross_income_eligible.py
+++ b/policyengine_us/variables/gov/states/mn/dhs/msa/eligibility/mn_msa_gross_income_eligible.py
@@ -22,20 +22,7 @@ def formula(person, period, parameters):
         ssi_individual_fbr = parameters(period).gov.ssa.ssi.amount.individual
         categorically_eligible = person("is_ssi_aged_blind_disabled", period.this_year)
         both_eligible = person.marital_unit.sum(categorically_eligible) == 2
-        income = add(
-            person,
-            period,
-            [
-                "ssi_earned_income",
-                "ssi_unearned_income",
-                "ssi_earned_income_deemed_from_ineligible_spouse",
-                "ssi_unearned_income_deemed_from_ineligible_spouse",
-                "ssi_unearned_income_deemed_from_ineligible_parent",
-            ],
-        )
-        ssi = person("ssi", period)
-        ssi_fbr = person("ssi_amount_if_eligible", period)
-        gross = income + where(ssi > 0, ssi_fbr, 0)
+        gross = person("mn_msa_gross_income", period)
         au_income = where(both_eligible, person.marital_unit.sum(gross), gross)
         cap = ssi_individual_fbr * where(
             both_eligible, p.couple_fbr_multiplier, p.individual_fbr_multiplier
diff --git a/policyengine_us/variables/gov/states/mn/dhs/msa/eligibility/mn_msa_net_income_eligible.py b/policyengine_us/variables/gov/states/mn/dhs/msa/eligibility/mn_msa_net_income_eligible.py
index 7543e4d17a8..bd8a807be09 100644
--- a/policyengine_us/variables/gov/states/mn/dhs/msa/eligibility/mn_msa_net_income_eligible.py
+++ b/policyengine_us/variables/gov/states/mn/dhs/msa/eligibility/mn_msa_net_income_eligible.py
@@ -11,6 +11,7 @@ class mn_msa_net_income_eligible(Variable):
     definition_period = MONTH
     defined_for = StateCode.MN
     reference = (
+        "https://www.revisor.mn.gov/statutes/cite/256D.435",
         "https://www.revisor.mn.gov/statutes/cite/256D.44",
         "https://www.dhs.state.mn.us/main/groups/county_access/documents/pub/mndhs-073585.pdf#page=2",
     )
@@ -26,6 +27,8 @@ def formula(person, period, parameters):
         # (federal SSI already consumed the $65 + 1/2 earned disregards).
         # Non-SSI track recipients get the standard $20 + $65 + 1/2
         # disregards on actual earned and unearned income.
+        # Section 256D.435 Subd. 4a adopts SSI income exclusions, including
+        # the salary-reduction premium exclusion already in ssi_earned_income.
         # FLA-D recipients are exempt from the $20 disregard so the formula
         # collapses to FBR + unearned vs PNA.
         arrangement = person("mn_msa_payment_category", period)
diff --git a/policyengine_us/variables/gov/states/mn/dhs/msa/income/mn_msa_gross_income.py b/policyengine_us/variables/gov/states/mn/dhs/msa/income/mn_msa_gross_income.py
new file mode 100644
index 00000000000..a6438e3c287
--- /dev/null
+++ b/policyengine_us/variables/gov/states/mn/dhs/msa/income/mn_msa_gross_income.py
@@ -0,0 +1,47 @@
+from policyengine_us.model_api import *
+
+
+class mn_msa_gross_income(Variable):
+    value_type = float
+    entity = Person
+    label = "Minnesota Supplemental Aid gross income"
+    unit = USD
+    definition_period = MONTH
+    defined_for = StateCode.MN
+    # Section 256D.35 directly defines MSA gross income. Rule 9500.1206
+    # describes GA conventions, which CM 0017 adopts for non-SSI recipients.
+    reference = (
+        "https://www.revisor.mn.gov/statutes/cite/256D.35#stat.256D.35.10",
+        "https://www.revisor.mn.gov/rules/9500.1206/#rule.9500.1206.15a",
+        "https://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=cm_0017",
+    )
+
+    def formula(person, period, parameters):
+        income = add(
+            person,
+            period,
+            [
+                "ssi_earned_income",
+                "ssi_unearned_income",
+                "ssi_earned_income_deemed_from_ineligible_spouse",
+                "ssi_unearned_income_deemed_from_ineligible_spouse",
+                "ssi_unearned_income_deemed_from_ineligible_parent",
+            ],
+        )
+        # MSA gross income is measured before deductions and disregards.
+        # Its net-income calculation adopts SSI exclusions (256D.435),
+        # but the gross test and guardian-fee cap must restore the employee's
+        # salary-reduction premium excluded from their own SSI wages.
+        # Keep the SSI financial-responsibility rules for deemed income.
+        sources = parameters(period).gov.ssa.ssi.income.sources.earned
+        if "employment_income" in sources:
+            wages = max_(person("employment_income", period.this_year), 0)
+            premiums = max_(
+                person("pre_tax_health_insurance_premiums", period.this_year), 0
+            )
+            income += min_(wages, premiums) / MONTHS_IN_YEAR
+
+        # CM 0017 substitutes the full FBR for an SSI recipient's payment.
+        ssi = person("ssi", period)
+        ssi_fbr = person("ssi_amount_if_eligible", period)
+        return income + where(ssi > 0, ssi_fbr, 0)
diff --git a/policyengine_us/variables/gov/states/mn/dhs/msa/mn_msa_person.py b/policyengine_us/variables/gov/states/mn/dhs/msa/mn_msa_person.py
index 997a757ec09..4019169214c 100644
--- a/policyengine_us/variables/gov/states/mn/dhs/msa/mn_msa_person.py
+++ b/policyengine_us/variables/gov/states/mn/dhs/msa/mn_msa_person.py
@@ -12,6 +12,7 @@ class mn_msa_person(Variable):
     definition_period = MONTH
     defined_for = "mn_msa_eligible_person"
     reference = (
+        "https://www.revisor.mn.gov/statutes/cite/256D.435",
         "https://www.revisor.mn.gov/statutes/cite/256D.44",
         "https://www.house.mn.gov/hrd/pubs/pap_MSA.pdf#page=2",
         "https://www.dhs.state.mn.us/main/groups/county_access/documents/pub/mndhs-073585.pdf#page=4",
@@ -24,6 +25,8 @@ def formula(person, period, parameters):
         # mn_msa_net_income_eligible). Keep the two formulas in sync when
         # changing income treatment.
         # MSA inherits federal SSI's $20 / $65 / 1/2 disregards (CM 0018.18).
+        # Section 256D.435 Subd. 4a also adopts SSI income exclusions;
+        # ssi_earned_income already excludes salary-reduction premiums.
         # The SSI track substitutes the federal SSI FBR for the recipient's
         # post-disregard SSI payment so MSA tops up against the FBR rather
         # than the federal payment. FLA-D recipients are exempt from the $20
diff --git a/policyengine_us/variables/gov/states/mn/dhs/msa/payment/mn_msa_guardian_fee.py b/policyengine_us/variables/gov/states/mn/dhs/msa/payment/mn_msa_guardian_fee.py
index 87d919c7654..1cb654a81cd 100644
--- a/policyengine_us/variables/gov/states/mn/dhs/msa/payment/mn_msa_guardian_fee.py
+++ b/policyengine_us/variables/gov/states/mn/dhs/msa/payment/mn_msa_guardian_fee.py
@@ -22,20 +22,7 @@ def formula(person, period, parameters):
         # the marital unit before applying the cap.
         p = parameters(period).gov.states.mn.dhs.msa.special_needs.guardian_fee
         has_guardian = person("mn_msa_has_guardian", period)
-        income = add(
-            person,
-            period,
-            [
-                "ssi_earned_income",
-                "ssi_unearned_income",
-                "ssi_earned_income_deemed_from_ineligible_spouse",
-                "ssi_unearned_income_deemed_from_ineligible_spouse",
-                "ssi_unearned_income_deemed_from_ineligible_parent",
-            ],
-        )
-        ssi = person("ssi", period)
-        ssi_fbr = person("ssi_amount_if_eligible", period)
-        gross = income + where(ssi > 0, ssi_fbr, 0)
+        gross = person("mn_msa_gross_income", period)
         unit_gross = person.marital_unit.sum(gross)
         unit_fee = min_(unit_gross * p.rate, p.max_amount)
         return has_guardian * unit_fee
diff --git a/policyengine_us/variables/gov/states/mo/dese/ccs/income/mo_ccs_adjusted_income.py b/policyengine_us/variables/gov/states/mo/dese/ccs/income/mo_ccs_adjusted_income.py
index af0a1d0c7d1..e28cd45ad1e 100644
--- a/policyengine_us/variables/gov/states/mo/dese/ccs/income/mo_ccs_adjusted_income.py
+++ b/policyengine_us/variables/gov/states/mo/dese/ccs/income/mo_ccs_adjusted_income.py
@@ -8,12 +8,19 @@ class mo_ccs_adjusted_income(Variable):
     definition_period = MONTH
     unit = USD
     defined_for = StateCode.MO
-    reference = "https://www.law.cornell.edu/regulations/missouri/5-CSR-25-200-050"
+    reference = (
+        "https://www.sos.mo.gov/CMSImages/AdRules/csr/current/5csr/5c25-200.pdf#page=2"
+    )
 
     def formula(spm_unit, period, parameters):
         countable_income = spm_unit("mo_ccs_countable_income", period)
         # Medical insurance premiums are the only deduction from monthly gross
         # income (5 CSR 25-200.050(2); Manual sec. 5.7 Deductions from Gross
-        # Income).
-        premiums = add(spm_unit, period, ["health_insurance_premiums"])
+        # Income). The rule includes premiums paid by household members,
+        # whether through pretax payroll deductions or after-tax payments.
+        premiums = add(
+            spm_unit,
+            period,
+            ["health_insurance_premiums", "pre_tax_health_insurance_premiums"],
+        )
         return max_(countable_income - premiums, 0)
diff --git a/policyengine_us/variables/gov/states/nd/tax/property/renters_refund/nd_renters_refund_income.py b/policyengine_us/variables/gov/states/nd/tax/property/renters_refund/nd_renters_refund_income.py
index 7f9aaeaab05..4c0fe2b3557 100644
--- a/policyengine_us/variables/gov/states/nd/tax/property/renters_refund/nd_renters_refund_income.py
+++ b/policyengine_us/variables/gov/states/nd/tax/property/renters_refund/nd_renters_refund_income.py
@@ -24,6 +24,12 @@ class nd_renters_refund_income(Variable):
 
     def formula(tax_unit, period, parameters):
         p = parameters(period).gov.states.nd.tax.property.renters_refund
+        # NDCC 57-02-08.1(5)(c) excludes income excluded by federal or state
+        # law. market_income includes wages before payroll deductions, so
+        # subtract the separate pretax premium input once from this base.
+        # These premiums are disjoint from itemized_medical_expenses,
+        # whose medical definition follows state income tax law.
+        excluded_premiums = add(tax_unit, period, ["pre_tax_health_insurance_premiums"])
         # Restore only premiums excluded from a computed federal subtotal.
         medical_expenses = add(
             tax_unit,
@@ -34,6 +40,8 @@ def formula(tax_unit, period, parameters):
             ],
         )
         return max_(
-            add(tax_unit, period, p.income_sources) - medical_expenses,
+            add(tax_unit, period, p.income_sources)
+            - excluded_premiums
+            - medical_expenses,
             0,
         )
diff --git a/policyengine_us/variables/gov/states/nj/tax/income/deductions/nj_medical_expense_deduction.py b/policyengine_us/variables/gov/states/nj/tax/income/deductions/nj_medical_expense_deduction.py
index b5d778fcfef..2ac5a575634 100644
--- a/policyengine_us/variables/gov/states/nj/tax/income/deductions/nj_medical_expense_deduction.py
+++ b/policyengine_us/variables/gov/states/nj/tax/income/deductions/nj_medical_expense_deduction.py
@@ -20,6 +20,8 @@ class nj_medical_expense_deduction(Variable):
     )
     reference = (
         "https://pub.njleg.gov/bills/9899/PL99/222_.HTM",
+        "https://www.nj.gov/treasury/taxation/njit13.shtml",
+        "https://www.nj.gov/treasury/taxation/pdf/pubs/tb/tb39r.pdf#page=1",
         "https://www.nj.gov/treasury/taxation/pdf/current/1040i.pdf#page=25",
     )
 
@@ -44,8 +46,14 @@ def formula(tax_unit, period, parameters):
             person("self_employed_health_insurance_ald_excluded_premiums", period)
             * person("is_tax_unit_dependent", period)
         )
+        # New Jersey includes salary-reduction cafeteria-plan premiums in
+        # taxable wages (TB-39(R)), so these employee-paid premiums also
+        # qualify for the medical expense deduction. The separate payroll
+        # input is disjoint from the after-tax premium inputs.
         medical_expenses = (
-            tax_unit("itemized_medical_expenses", period) - excluded_dependent_premiums
+            tax_unit("itemized_medical_expenses", period)
+            - excluded_dependent_premiums
+            + add(tax_unit, period, ["pre_tax_health_insurance_premiums"])
         )
         agi = tax_unit("nj_agi", period)
         floor = p.rate * agi
diff --git a/policyengine_us/variables/gov/states/pa/dhs/ccw/income/pa_ccw_medical_expenses.py b/policyengine_us/variables/gov/states/pa/dhs/ccw/income/pa_ccw_medical_expenses.py
index d8e0b7ad524..e2a50d71760 100644
--- a/policyengine_us/variables/gov/states/pa/dhs/ccw/income/pa_ccw_medical_expenses.py
+++ b/policyengine_us/variables/gov/states/pa/dhs/ccw/income/pa_ccw_medical_expenses.py
@@ -6,12 +6,20 @@ class pa_ccw_medical_expenses(Variable):
     entity = SPMUnit
     label = "Pennsylvania CCW medical expenses"
     unit = USD
-    documentation = "Medical expenses deducted from Pennsylvania CCW income."
+    documentation = (
+        "Medical expenses deducted from Pennsylvania CCW income, including "
+        "employee-paid health premiums paid through pretax payroll deductions "
+        "and after-tax payments."
+    )
     definition_period = YEAR
     defined_for = StateCode.PA
-    reference = "https://www.pacodeandbulletin.gov/secure/pacode/data/055/chapter3042/055_3042.pdf#page=18"
+    # PDF pages 59, 61.
+    reference = "https://www.pacodeandbulletin.gov/secure/pacode/data/055/chapter3042/055_3042.pdf#page=59"
 
+    # Appendix A Part I(A) counts wages before health insurance deductions;
+    # Part II(C) permits unreimbursed health care premiums without a tax test.
     adds = [
         "medical_expense_health_insurance_premiums",
+        "pre_tax_health_insurance_premiums",
         "other_medical_expenses",
     ]
diff --git a/policyengine_us/variables/gov/usda/snap/income/deductions/snap_allowable_medical_expenses.py b/policyengine_us/variables/gov/usda/snap/income/deductions/snap_allowable_medical_expenses.py
index fddfa2f03a5..f9767827dd6 100644
--- a/policyengine_us/variables/gov/usda/snap/income/deductions/snap_allowable_medical_expenses.py
+++ b/policyengine_us/variables/gov/usda/snap/income/deductions/snap_allowable_medical_expenses.py
@@ -10,6 +10,7 @@ class snap_allowable_medical_expenses(Variable):
     reference = [
         "https://www.law.cornell.edu/uscode/text/7/2014#e_5",
         "https://www.law.cornell.edu/cfr/text/7/273.9#d_3",
+        "https://www.ecfr.gov/current/title-7/section-273.9#p-273.9(d)(3)(iv)",
     ]
     documentation = (
         "Medical expenses allowable for SNAP's excess medical expense "
@@ -21,10 +22,13 @@ class snap_allowable_medical_expenses(Variable):
         "insurance premiums, Medicare premiums, cost sharing, medical "
         "supplies, transportation, and related services. Current modeling "
         "uses health insurance premiums and other medical expenses, excluding "
-        "general over-the-counter health expenses."
+        "general over-the-counter health expenses. Employee-paid premiums "
+        "include both pretax payroll deductions and the disjoint non-pretax "
+        "premium amounts."
     )
 
     adds = [
         "medical_expense_health_insurance_premiums",
+        "pre_tax_health_insurance_premiums",
         "other_medical_expenses",
     ]
diff --git a/policyengine_us/variables/household/expense/health/health_insurance_premiums.py b/policyengine_us/variables/household/expense/health/health_insurance_premiums.py
index 936031f7fc9..e7ed3b9f651 100644
--- a/policyengine_us/variables/household/expense/health/health_insurance_premiums.py
+++ b/policyengine_us/variables/household/expense/health/health_insurance_premiums.py
@@ -9,7 +9,11 @@ class health_insurance_premiums(Variable):
     definition_period = YEAR
     uprating = "calibration.gov.hhs.cms.moop_per_capita"
     documentation = (
-        "Person-level health insurance premiums supplied directly as an input. "
-        "SPM MOOP and statutory medical expense definitions use decomposed "
-        "premium aggregates."
+        "Annual person-paid health insurance premiums supplied directly as an "
+        "input, excluding premiums paid through pretax payroll deductions and "
+        "employer-paid premiums. Pretax payroll payments belong only in "
+        "pre_tax_health_insurance_premiums; the two sets are disjoint and total "
+        "person-paid premiums equal their sum. This direct non-pretax amount is "
+        "an alternative to the applicable decomposed non-pretax inputs, not an "
+        "additional expense."
     )
diff --git a/policyengine_us/variables/household/expense/health/health_insurance_premiums_without_medicare_part_b.py b/policyengine_us/variables/household/expense/health/health_insurance_premiums_without_medicare_part_b.py
index 92be6e51a96..b9ded858ef9 100644
--- a/policyengine_us/variables/household/expense/health/health_insurance_premiums_without_medicare_part_b.py
+++ b/policyengine_us/variables/household/expense/health/health_insurance_premiums_without_medicare_part_b.py
@@ -7,4 +7,12 @@ class health_insurance_premiums_without_medicare_part_b(Variable):
     label = "Health insurance premiums without Medicare Part B premiums"
     unit = USD
     definition_period = YEAR
+    documentation = (
+        "Annual person-paid health insurance premiums excluding Medicare Part B, "
+        "pretax payroll deductions, and employer-paid premiums. Pretax payroll "
+        "payments belong only in pre_tax_health_insurance_premiums. The pretax "
+        "and non-pretax sets are disjoint; total person-paid premiums equal "
+        "pretax payments plus the applicable non-pretax aggregate. This input is "
+        "the non-Medicare component of the medical expense premium aggregate."
+    )
     uprating = "calibration.gov.hhs.cms.moop_per_capita"
diff --git a/policyengine_us/variables/household/expense/health/long_term_health_insurance_premiums.py b/policyengine_us/variables/household/expense/health/long_term_health_insurance_premiums.py
index 71a9825e4ef..27826f81fc4 100644
--- a/policyengine_us/variables/household/expense/health/long_term_health_insurance_premiums.py
+++ b/policyengine_us/variables/household/expense/health/long_term_health_insurance_premiums.py
@@ -7,4 +7,12 @@ class long_term_health_insurance_premiums(Variable):
     label = "Long-term health insurance premiums"
     unit = USD
     definition_period = YEAR
+    documentation = (
+        "Annual person-paid long-term care insurance premiums excluding pretax "
+        "payroll deductions and employer-paid premiums. Pretax payroll payments "
+        "belong only in pre_tax_health_insurance_premiums. The pretax and non- "
+        "pretax sets are disjoint; total person-paid premiums equal pretax "
+        "payments plus the applicable non-pretax aggregate. This component must "
+        "be counted only once when included in a broader premium input."
+    )
     uprating = "calibration.gov.hhs.cms.moop_per_capita"
diff --git a/policyengine_us/variables/household/expense/health/medical_expense_health_insurance_premiums.py b/policyengine_us/variables/household/expense/health/medical_expense_health_insurance_premiums.py
index dfb010bfed6..307305f4176 100644
--- a/policyengine_us/variables/household/expense/health/medical_expense_health_insurance_premiums.py
+++ b/policyengine_us/variables/household/expense/health/medical_expense_health_insurance_premiums.py
@@ -8,10 +8,13 @@ class medical_expense_health_insurance_premiums(Variable):
     unit = USD
     definition_period = YEAR
     documentation = (
-        "Person-level health insurance premiums counted by statutory medical "
-        "expense definitions. Uses a direct premium input when supplied; "
-        "otherwise combines reported non-Medicare premiums with modeled "
-        "Medicare Part B premiums."
+        "Person-level non-pretax health insurance premiums for medical expense "
+        "definitions. Uses a nonzero direct health_insurance_premiums input; "
+        "otherwise combines non-Medicare premiums with modeled Medicare Part B "
+        "premiums for enrollees. Excludes the disjoint "
+        "pre_tax_health_insurance_premiums input. Consumers whose rules count "
+        "pretax payroll payments add that separate input once; tax deductions "
+        "that exclude them use this aggregate alone."
     )
 
     def formula(person, period, parameters):
diff --git a/policyengine_us/variables/household/expense/health/medicare_part_b_premiums_reported.py b/policyengine_us/variables/household/expense/health/medicare_part_b_premiums_reported.py
index 500970c641d..09a07b4c37e 100644
--- a/policyengine_us/variables/household/expense/health/medicare_part_b_premiums_reported.py
+++ b/policyengine_us/variables/household/expense/health/medicare_part_b_premiums_reported.py
@@ -6,5 +6,14 @@ class medicare_part_b_premiums_reported(Variable):
     entity = Person
     label = "Medicare Part B premiums (reported)"
     definition_period = YEAR
+    documentation = (
+        "Annual reported person-paid Medicare Part B premiums excluding pretax "
+        "payroll deductions and employer-paid premiums. Pretax payroll payments "
+        "belong only in pre_tax_health_insurance_premiums. The pretax and non- "
+        "pretax sets are disjoint; total person-paid premiums equal pretax "
+        "payments plus the applicable non-pretax aggregate. A reported component "
+        "must not be added again when already included in a broader premium "
+        "input."
+    )
     unit = USD
     uprating = "calibration.gov.hhs.cms.moop_per_capita"
diff --git a/policyengine_us/variables/household/expense/health/other_health_insurance_premiums.py b/policyengine_us/variables/household/expense/health/other_health_insurance_premiums.py
index 1f90a92ff02..e409c2e03a9 100644
--- a/policyengine_us/variables/household/expense/health/other_health_insurance_premiums.py
+++ b/policyengine_us/variables/household/expense/health/other_health_insurance_premiums.py
@@ -9,7 +9,11 @@ class other_health_insurance_premiums(Variable):
     definition_period = YEAR
     uprating = "calibration.gov.hhs.cms.moop_per_capita"
     documentation = (
-        "Person-level health insurance premiums not otherwise represented by "
-        "modeled Marketplace, CHIP, Medicaid, Medicare Part A or Part B "
-        "premiums, or the Part D IRMAA surcharge."
+        "Annual person-paid health insurance premiums not otherwise represented "
+        "by modeled Marketplace, CHIP, Medicaid, Medicare Part A or Part B "
+        "premiums, or the Part D IRMAA surcharge. Excludes pretax payroll "
+        "deductions and employer-paid premiums. Pretax payroll payments belong "
+        "only in pre_tax_health_insurance_premiums. The pretax and non-pretax "
+        "sets are disjoint; total person-paid premiums equal their sum, with "
+        "modeled non-pretax components counted once."
     )
diff --git a/policyengine_us/variables/household/expense/health/pre_tax_health_insurance_premiums.py b/policyengine_us/variables/household/expense/health/pre_tax_health_insurance_premiums.py
index 1f1a9e813e4..d908d9bb22c 100644
--- a/policyengine_us/variables/household/expense/health/pre_tax_health_insurance_premiums.py
+++ b/policyengine_us/variables/household/expense/health/pre_tax_health_insurance_premiums.py
@@ -7,9 +7,12 @@ class pre_tax_health_insurance_premiums(Variable):
     label = "Pre-tax health insurance premiums"
     unit = USD
     documentation = (
-        "Health insurance premiums paid through pre-tax payroll deductions. "
-        "This excludes Medicare Part B premiums and other post-tax medical "
-        "out-of-pocket premiums. These are employees' shares of "
+        "Annual employee-paid health insurance premiums paid through pretax "
+        "payroll deductions. Supply these only here: health_insurance_premiums "
+        "and the applicable decomposed premium inputs exclude these payments. The "
+        "pretax and non-pretax sets are disjoint; total employee-paid premiums "
+        "equal their sum. Excludes employer-paid premiums, Medicare Part B "
+        "premiums and other post-tax medical premiums. These are employees' shares of "
         "employer-sponsored insurance premiums, so they are uprated by CMS's "
         "employer-sponsored insurance premium per enrollee, holding the "
         "number of people covered per policy and the employee's share of the "
diff --git a/policyengine_us/variables/household/expense/health/self_employed_health_insurance_premiums.py b/policyengine_us/variables/household/expense/health/self_employed_health_insurance_premiums.py
index 903b966d923..b548d91392b 100644
--- a/policyengine_us/variables/household/expense/health/self_employed_health_insurance_premiums.py
+++ b/policyengine_us/variables/household/expense/health/self_employed_health_insurance_premiums.py
@@ -6,7 +6,14 @@ class self_employed_health_insurance_premiums(Variable):
     entity = Person
     label = "Self-employed health insurance premiums"
     unit = USD
-    documentation = "Health insurance premiums for plans covering individuals who are not covered by any employer-sponsored health insurance."
+    documentation = (
+        "Annual person-paid health insurance premiums for plans covering "
+        "individuals not covered by employer-sponsored health insurance. Excludes "
+        "pretax payroll deductions and employer-paid premiums; pretax payroll "
+        "payments belong only in pre_tax_health_insurance_premiums. The pretax "
+        "and non-pretax sets are disjoint. Defaults to the direct non-pretax "
+        "health_insurance_premiums input for self-employed people."
+    )
     definition_period = YEAR
     defined_for = "is_self_employed"
     adds = ["health_insurance_premiums"]
diff --git a/policyengine_us/variables/household/income/spm_unit/spm_unit_health_insurance_premiums.py b/policyengine_us/variables/household/income/spm_unit/spm_unit_health_insurance_premiums.py
index 6be89db1ae8..9d31a40245b 100644
--- a/policyengine_us/variables/household/income/spm_unit/spm_unit_health_insurance_premiums.py
+++ b/policyengine_us/variables/household/income/spm_unit/spm_unit_health_insurance_premiums.py
@@ -7,14 +7,21 @@ class spm_unit_health_insurance_premiums(Variable):
     label = "SPM unit health insurance premiums"
     unit = USD
     definition_period = YEAR
+    reference = (
+        "https://www2.census.gov/programs-surveys/supplemental-poverty-measure/datasets/spm/spm_techdoc.pdf#page=18",
+        "https://www2.census.gov/library/working-papers/2026/adrm/cbsm/rsm2026-04.pdf#page=65",
+    )
     documentation = (
         "Health insurance premium expenses for an SPM unit, combining a "
         "data-imputed other premium component with modeled premium components "
         "that can respond to policy reforms, including Medicare Part A and "
-        "Part B premiums and the Part D IRMAA surcharge paid out of pocket."
+        "Part B premiums and the Part D IRMAA surcharge paid out of pocket. "
+        "Includes employee-paid pretax payroll premiums in addition to the "
+        "disjoint non-pretax premium components; excludes employer contributions."
     )
 
     adds = [
+        "pre_tax_health_insurance_premiums",
         "other_health_insurance_premiums",
         "chip_premium",
         "medicaid_premium",
diff --git a/policyengine_us/variables/household/income/spm_unit/spm_unit_medical_out_of_pocket_expenses.py b/policyengine_us/variables/household/income/spm_unit/spm_unit_medical_out_of_pocket_expenses.py
index f06025f553f..ba4c6c0cd64 100644
--- a/policyengine_us/variables/household/income/spm_unit/spm_unit_medical_out_of_pocket_expenses.py
+++ b/policyengine_us/variables/household/income/spm_unit/spm_unit_medical_out_of_pocket_expenses.py
@@ -10,8 +10,9 @@ class spm_unit_medical_out_of_pocket_expenses(Variable):
     documentation = (
         "Total medical out-of-pocket expenses at the SPM unit level, "
         "combining health insurance premiums with non-premium medical "
-        "expenses. Health insurance premiums include other health insurance "
-        "premiums plus modeled Marketplace, CHIP, Medicaid, and Medicare "
+        "expenses. Health insurance premiums include pretax payroll premiums "
+        "and disjoint other health insurance premiums plus modeled "
+        "Marketplace, CHIP, Medicaid, and Medicare "
         "Part A and Part B premiums net of Medicare Savings Program coverage "
         "where modeled, plus the Part D IRMAA surcharge. "
         "Non-premium expenses include other medical expenses and "
diff --git a/policyengine_us/variables/input/employer_sponsored_insurance_premiums.py b/policyengine_us/variables/input/employer_sponsored_insurance_premiums.py
index bf21c62d1a2..a727a33f829 100644
--- a/policyengine_us/variables/input/employer_sponsored_insurance_premiums.py
+++ b/policyengine_us/variables/input/employer_sponsored_insurance_premiums.py
@@ -7,7 +7,9 @@ class employer_sponsored_insurance_premiums(Variable):
     label = "Employer-sponsored insurance premiums"
     documentation = (
         "Annual employer-paid health insurance premiums. CBO treats this "
-        "as part of household market income. Uprated by CMS's "
+        "as part of household market income. Excludes employee-paid premiums, "
+        "both pretax payroll deductions in pre_tax_health_insurance_premiums "
+        "and non-pretax payments in the other premium inputs. Uprated by CMS's "
         "employer-sponsored insurance premium per enrollee, so each "
         "policyholder's premium grows with premiums rather than wages. This "
         "is a premium-growth proxy: it holds the number of people covered "