Model the Medicare Part D low-income subsidy as a CBO means-tested transfer

changelog.d/medicare-part-d-lis.added.md

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+Model the Medicare Part D low-income subsidy (Extra Help): statutory eligibility valued at the Trustees' average subsidy per enrollee, and count it as a CBO means-tested transfer.

policyengine_us/parameters/calibration/gov/hhs/medicare/part_d/low_income_subsidy_per_recipient.yaml

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+description: The Medicare Trustees report and project these Part D low-income subsidy payments per low-income subsidy enrollee.
+metadata:
+  unit: currency-USD
+  period: year
+  label: Medicare Part D low-income subsidy per recipient
+  # From 2036, each value is the 2035 value times the growth in Medicare
+  # spending per enrollee, as for the per-enrollee series beside it.
+  uprating: calibration.gov.hhs.medicare.per_capita_cost
+  reference:
+  # Table IV.B9, "Low-income subsidy", "Subsidy amount": incurred payments
+  # per low-income subsidy enrollee, beside the subsidy's enrollment (in
+  # millions). Enrollment times the amount gives Table IV.B10's "Low-income
+  # subsidy" payments, e.g. 14.4 million x $1,254 = $18.1 billion in 2026.
+  # 2016 to 2035 come from the 2026 report (file page 158); 2015, which that
+  # table no longer shows, from the 2025 report (file page 158). The two
+  # reports differ by $1 to $2 in 2021 to 2023 (revised data). 2026 Medicare
+  # Trustees Report, transmitted 2026-06-09, retrieved 2026-10-11, sha256
+  # ffa56b9137006872300b0346149eae1613d09a172b6ba118aad48e66dfc48fa8; 2025
+  # report sha256
+  # 1b3de7a4faeee5ad42059e10740603182b716a5fa7b53b30d360b45b9e474d95.
+  # The average includes enrollees in institutions, whom CBO removes along
+  # with their benefits (Habib 2018, file page 52). CBO's adjusted 2015
+  # totals, $22.6 billion for 10.7 million recipients (file page 51), give
+  # $2,112 per recipient, the same as this table's 2015 average; for 2016
+  # CBO's $26.5 billion (from its own baseline) for 11.1 million gives
+  # $2,387 against $2,126 here.
+  - title: 2026 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds, Table IV.B9
+    href: https://www.cms.gov/oact/tr/2026#page=158
+  - title: 2025 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds, Table IV.B9
+    href: https://www.cms.gov/oact/tr/2025#page=158
+  - title: Habib, How CBO Adjusts for Survey Underreporting of Transfer Income in Its Distributional Analyses, CBO Working Paper 2018-07, Appendix C
+    href: https://www.cbo.gov/system/files/2018-07/54234-workingpaper.pdf#page=51
+values:
+  # Historical.
+  2015-01-01: 2_112
+  2016-01-01: 2_126
+  2017-01-01: 2_156
+  2018-01-01: 2_204
+  2019-01-01: 2_273
+  2020-01-01: 2_507
+  2021-01-01: 2_646
+  2022-01-01: 2_873
+  2023-01-01: 3_092
+  2024-01-01: 2_833
+  # 2025 is the first year of the full Inflation Reduction Act benefit
+  # redesign (2026 report, file page 119), which moved spending from the
+  # subsidy to the direct subsidy (Table IV.B9).
+  2025-01-01: 1_226
+  # Trustees' intermediate estimates.
+  2026-01-01: 1_254
+  2027-01-01: 1_384
+  2028-01-01: 1_459
+  2029-01-01: 1_579
+  2030-01-01: 1_833
+  2031-01-01: 1_922
+  2032-01-01: 1_956
+  2033-01-01: 1_982
+  2034-01-01: 2_014
+  2035-01-01: 2_076

policyengine_us/parameters/gov/hhs/medicare/part_d/low_income_subsidy/eligibility/income_limit.yaml

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+description: Medicare limits the Part D low-income subsidy to people whose countable income is below this share of the federal poverty guideline for their family size.
+values:
+  2006-01-01: 1.5
+
+metadata:
+  unit: /1
+  period: year
+  label: Medicare Part D low-income subsidy income limit
+  reference:
+    - title: 42 U.S.C. § 1395w-114(a)(3)(A)(ii) - Subsidy eligible individual defined
+      href: https://www.law.cornell.edu/uscode/text/42/1395w-114#a_3_A_ii
+    - title: 42 CFR § 423.773(a)(1) - Subsidy eligible individual
+      href: https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-423/subpart-P/section-423.773#p-423.773(a)(1)
+    - title: SSA POMS HI 03020.055 - Income Limits for Subsidy Eligibility
+      href: https://secure.ssa.gov/poms.nsf/lnx/0603020055

policyengine_us/parameters/gov/hhs/medicare/part_d/low_income_subsidy/eligibility/ineligible_jurisdictions.yaml

@@ -0,0 +1,25 @@
+description: Medicare limits the Part D low-income subsidy to residents of the 50 states and the District of Columbia, so residents of these other jurisdictions are ineligible.
+values:
+  2006-01-01:
+    # Territories and freely associated states.
+    - GU
+    - MP
+    - PR
+    - PW
+    - VI
+    # Armed Forces mail codes, which are addresses abroad.
+    - AA
+    - AE
+    - AP
+
+metadata:
+  unit: list
+  period: year
+  label: Medicare Part D low-income subsidy ineligible jurisdictions
+  reference:
+    - title: 42 U.S.C. § 1395w-114(a)(3)(F) - Treatment of territorial residents
+      href: https://www.law.cornell.edu/uscode/text/42/1395w-114#a_3_F
+    - title: 42 CFR § 423.772 - Definitions (State)
+      href: https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-423/subpart-P/section-423.772
+    - title: 20 CFR § 418.3010(b)(11) - Definitions (State)
+      href: https://www.ecfr.gov/current/title-20/chapter-III/part-418/subpart-A/section-418.3010#p-418.3010(b)(11)

policyengine_us/parameters/gov/hhs/medicare/part_d/low_income_subsidy/eligibility/resources/burial_exclusion.yaml

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+description: Medicare excludes this amount per person, for the applicant and a spouse living with them, from countable resources as funds expected to be used for burial under the Part D low-income subsidy.
+values:
+  2006-01-01: 1_500
+
+metadata:
+  unit: currency-USD
+  period: year
+  label: Medicare Part D low-income subsidy burial funds exclusion
+  reference:
+    # SSA applies the exclusion unless the applicant says none of the
+    # resources will go to funeral or burial expenses, without asking for the
+    # funds' value or designation (POMS HI 03030.020 and HI 03030.025).
+    - title: 20 CFR § 418.3425(j) - Burial funds resource exclusion
+      href: https://www.ecfr.gov/current/title-20/chapter-III/part-418/subpart-D/section-418.3425#p-418.3425(j)
+    - title: SSA POMS HI 03030.020 - Resource Exclusions
+      href: https://secure.ssa.gov/poms.nsf/lnx/0603030020
+    - title: SSA POMS HI 03030.025 - Resource Limits for Subsidy Eligibility
+      href: https://secure.ssa.gov/poms.nsf/lnx/0603030025

policyengine_us/parameters/gov/hhs/medicare/part_d/low_income_subsidy/eligibility/resources/limit/couple.yaml

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+description: Medicare limits the Part D low-income subsidy to married people living with their spouse whose combined countable resources do not exceed this amount, before the burial funds exclusion.
+values:
+  2006-01-01: 20_000
+  2007-01-01: 20_410
+  2008-01-01: 20_970
+  2009-01-01: 22_010
+  2011-01-01: 22_260
+  2012-01-01: 23_120
+  2013-01-01: 23_580
+  2014-01-01: 23_860
+  2015-01-01: 24_250
+  2017-01-01: 24_600
+  2018-01-01: 25_150
+  2019-01-01: 25_720
+  2020-01-01: 26_160
+  2021-01-01: 26_520
+  2022-01-01: 27_950
+  2023-01-01: 30_240
+  2024-01-01: 31_360
+  2025-01-01: 32_130
+  2026-01-01: 33_100
+
+metadata:
+  unit: currency-USD
+  period: year
+  label: Medicare Part D low-income subsidy couple resource limit
+  reference:
+    # The statute's alternative resource standard: $20,000 in 2006, raised
+    # each year by the September CPI-U and rounded to $10. Before 2024 it was
+    # the limit for the partial subsidy (the full subsidy had a lower limit);
+    # from 2024 it is the limit for the full subsidy, the only one left. SSA's
+    # table lists both pre-2024 limits; these are the higher ones. SSA's table
+    # excludes the $3,000 couple burial funds exclusion, which is a separate
+    # parameter.
+    - title: 42 U.S.C. § 1395w-114(a)(3)(E)(i) - Alternative resource standard
+      href: https://www.law.cornell.edu/uscode/text/42/1395w-114#a_3_E_i
+    - title: 42 CFR § 423.773(b)(2)(iii) and (d)(2) - Resource thresholds
+      href: https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-423/subpart-P/section-423.773#p-423.773(d)(2)
+    - title: SSA POMS HI 03030.025 - Resource Limits for Subsidy Eligibility
+      href: https://secure.ssa.gov/poms.nsf/lnx/0603030025

policyengine_us/parameters/gov/hhs/medicare/part_d/low_income_subsidy/eligibility/resources/limit/individual.yaml

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+description: Medicare limits the Part D low-income subsidy to unmarried people whose countable resources do not exceed this amount, before the burial funds exclusion.
+values:
+  2006-01-01: 10_000
+  2007-01-01: 10_210
+  2008-01-01: 10_490
+  2009-01-01: 11_010
+  2011-01-01: 11_140
+  2012-01-01: 11_570
+  2013-01-01: 11_800
+  2014-01-01: 11_940
+  2015-01-01: 12_140
+  2017-01-01: 12_320
+  2018-01-01: 12_600
+  2019-01-01: 12_890
+  2020-01-01: 13_110
+  2021-01-01: 13_290
+  2022-01-01: 14_010
+  2023-01-01: 15_160
+  2024-01-01: 15_720
+  2025-01-01: 16_100
+  2026-01-01: 16_590
+
+metadata:
+  unit: currency-USD
+  period: year
+  label: Medicare Part D low-income subsidy individual resource limit
+  reference:
+    # The statute's alternative resource standard: $10,000 in 2006, raised
+    # each year by the September CPI-U and rounded to $10. Before 2024 it was
+    # the limit for the partial subsidy (the full subsidy had a lower limit);
+    # from 2024 it is the limit for the full subsidy, the only one left. SSA's
+    # table lists both pre-2024 limits; these are the higher ones. SSA's table
+    # excludes the $1,500 burial funds exclusion, which is a separate
+    # parameter.
+    - title: 42 U.S.C. § 1395w-114(a)(3)(E)(i) - Alternative resource standard
+      href: https://www.law.cornell.edu/uscode/text/42/1395w-114#a_3_E_i
+    - title: 42 CFR § 423.773(b)(2)(iii) and (d)(2) - Resource thresholds
+      href: https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-423/subpart-P/section-423.773#p-423.773(d)(2)
+    - title: SSA POMS HI 03030.025 - Resource Limits for Subsidy Eligibility
+      href: https://secure.ssa.gov/poms.nsf/lnx/0603030025

policyengine_us/parameters/gov/hhs/medicare/part_d/low_income_subsidy/eligibility/resources/sources.yaml

@@ -0,0 +1,20 @@
+description: Medicare counts these assets as resources under the Part D low-income subsidy.
+values:
+  2006-01-01:
+    - bank_account_assets
+    - stock_assets
+    - bond_assets
+
+metadata:
+  unit: list
+  period: year
+  label: Medicare Part D low-income subsidy countable resource sources
+  reference:
+    # SSA counts liquid resources (cash, financial accounts, stocks, bonds,
+    # mutual funds, retirement accounts and similar) and equity in real
+    # property other than the home. The model has no retirement account or
+    # non-home real property inputs.
+    - title: 20 CFR § 418.3405 - What types of resources do we count?
+      href: https://www.ecfr.gov/current/title-20/chapter-III/part-418/subpart-D/section-418.3405
+    - title: 42 CFR § 423.772 - Definitions (resources)
+      href: https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-423/subpart-P/section-423.772

policyengine_us/parameters/gov/hhs/medicare/part_d/low_income_subsidy/income/excluded_sources.yaml

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+description: Medicare excludes these Supplemental Security Income unearned income sources from countable income under the Part D low-income subsidy.
+values:
+  2006-01-01:
+    - dividend_income
+    - interest_income
+
+metadata:
+  unit: list
+  period: year
+  label: Medicare Part D low-income subsidy excluded income sources
+  reference:
+    - title: 20 CFR § 418.3350(d) - What types of unearned income do we not count?
+      href: https://www.ecfr.gov/current/title-20/chapter-III/part-418/subpart-D/section-418.3350#p-418.3350(d)
+    - title: SSA POMS HI 03020.050 - Unearned Income Exclusions
+      href: https://secure.ssa.gov/poms.nsf/lnx/0603020050

policyengine_us/parameters/gov/household/cbo_means_tested_transfers.yaml

@@ -11,6 +11,7 @@ values:
     - reduced_price_school_meals
     - spm_unit_energy_subsidy
     - general_assistance
+    - part_d_lis
 
 metadata:
   unit: list
@@ -19,3 +20,7 @@ metadata:
   reference:
     - title: Congressional Budget Office, Reconciling the Official Poverty Measure and CBO’s Distributional Analysis of Household Income, Including In-Kind Transfers
       href: https://www.cbo.gov/publication/61157
+    # CBO counts the Medicare Part D low-income subsidy as a means-tested
+    # transfer, not as Medicare (see cbo_medicare_benefit).
+    - title: Congressional Budget Office, Sensitivity of the Distribution of Household Income to the Treatment of Health Insurance From 1979 to 2021 (January 2026)
+      href: https://www.cbo.gov/publication/61910

policyengine_us/programs.yaml

@@ -1117,6 +1117,23 @@ programs:
       adjustments; gross Part B premium calibration should use the
       enrollment-gated gross_medicare_part_b_premium_if_enrolled variable.
 
+  - id: medicare_part_d_lis
+    name: Medicare Part D Extra Help
+    full_name: Medicare Part D Low-Income Subsidy (Extra Help)
+    category: Healthcare
+    agency: HHS
+    status: partial
+    coverage: US
+    variable: part_d_lis
+    parameter_prefix: gov.hhs.medicare.part_d.low_income_subsidy
+    verified_start_year: 2015
+    notes: >-
+      Models eligibility (countable income below 150% of the poverty guideline,
+      resource limits, and deemed eligibility for Medicaid and SSI recipients
+      and Medicare Savings Program enrollees) and values the subsidy at the
+      Medicare Trustees' average payment per subsidy enrollee, as CBO does;
+      the premium and cost-sharing subsidies are not computed per person.
+
   # --- HUD programs ---
   - id: section_8
     name: Section 8