Implement Louisiana State Supplementary Payment (SSP)

[hua7450]

Summary

Implements Louisiana's Optional State Supplement (OSS) — a state-administered SSI supplement paid to aged, blind, and disabled persons (including children) residing in non-psychiatric Medicaid long-term care facilities.

Closes #8171

Regulatory Authority

• LDH J-300 / J-0000 (current OSS rules and amount)
• LDH H-800 / H-831.6 (personal care needs allowance / Medicaid LTC eligibility)
• LDH Z-700 (rate chart with historical OSS table)
• SSA 2011 State Assistance Programs Report — Louisiana
• SPA 25-0013 (July 2025 increase)

Program Overview

• Administration: State-administered (Louisiana Department of Health, Bureau of Health Services Financing)
• Funding: State funds
• Effective date: March 1, 1982 (Senate Concurrent Resolution No. 133, 1980)
• Current caseload: 4,539 recipients (1,115 aged, 33 blind, 3,391 disabled) per January 2011 SSA report — most recent verified count

Eligibility

Requirement	Source	How Modeled
Aged, blind, or disabled + SSI resource and nonfinancial gates	LDH H-831.2; SSA 2011 report; SSA POMS	is_ssi_eligible (categorical + resource + immigration/residency, excludes income test so non-SSI LTC residents in the $30–$38 countable-income band are still reachable)
Resides in a federal Code D living arrangement (Medicaid-paid medical treatment facility)	LDH J-300 #page=2; SSA POMS SI 00520.011	ssi_federal_living_arrangement == MEDICAL_TREATMENT_FACILITY (same enum that triggers the $30 institutional FBR)
Louisiana resident	LDH J-300	defined_for = StateCode.LA
Not Medicare SNF beneficiary	LDH J-300 #page=2	Not modeled (Medicare SNF coverage not tracked at the moment)
Not MAGI-based LTC beneficiary	LDH J-300 #page=2	Not modeled (Medicaid eligibility track not modeled at the moment)
Not subject to transfer-of-resource penalty	LDH J-300 pp.2-3	Not modeled (Medicaid penalty rules not modeled at the moment)
Not temporary (≤3-month) institutional stay	LDH J-300 #page=3	Not modeled (institutional stay duration not tracked at the moment)
Not HCBS beneficiary	LDH J-300 #page=3	Not modeled (HCBS waiver enrollment not tracked at the moment)

Note on facility scope: LA law (J-300, H-831.6) limits OSS to non-psychiatric Medicaid LTC residents (NF or ICF/IID), but PolicyEngine doesn't distinguish facility type below the federal MEDICAL_TREATMENT_FACILITY enum. We treat the federal enum as equivalent to the LA scope.

Benefit Amounts (LDH Z-700 / SPA 25-0013)

Category	Effective Date	Maximum OSS	Personal Care Needs Allowance
All eligible	2011-01-01	$8.00	$38.00
All eligible	2025-07-01	$15.00	$45.00

Couple treatment: Per-person rate (couple = 2 × individual; SSA 2011 Table 1 shows $16/$76 couple = 2 × $8/$38)
COLA: None — flat amount, last increase July 2025 via SPA 25-0013

Benefit Calculation

Formula (per LDH J-300, SSA 2011 LA report):

OSS = min(max(personal_care_needs_allowance − ssi − ssi_countable_income, 0), maximum_payment)

• Uses the actual federal SSI payment (ssi), not the institutional FBR constant — this correctly handles partial-SSI recipients whose federal payment is reduced by countable income, and reaches non-SSI LTC residents whose countable income sits between the FBR ($30) and the PNA ($38 / $45).
• Pre-July 2025: $38 − ssi − countable, capped at $8
• Post-July 2025: $45 − ssi − countable, capped at $15

Requirements Coverage

12 of 12 in-scope requirements implemented; 7 NOT-MODELED exclusions documented.

Covered (11 + registry):

• REQ-001 LA residency — defined_for = StateCode.LA
• REQ-002 Aged/blind/disabled categorical — via is_ssi_eligible
• REQ-003 Medicaid LTC facility — ssi_federal_living_arrangement == MEDICAL_TREATMENT_FACILITY
• REQ-009 Federal SSI resource limits — via is_ssi_eligible
• REQ-010 Federal SSI income exclusions — ssi_countable_income
• REQ-011 Top-up formula (PNA − ssi − countable, capped)
• REQ-012 Maximum OSS ($8 → $15 on 2025-07-01)
• REQ-013 Personal care needs allowance ($38 → $45 on 2025-07-01)
• REQ-014 Couple treatment (per-person Person variable)
• REQ-017 Children eligible (no age gate)
• REQ-018 No COLA / not auto-indexed
• REQ-020 Registry (spm_unit_benefits.py + household_state_benefits.yaml + programs.yaml)

NOT-MODELED (documented): REQ-004, 005, 006, 007, 008 (narrow Medicaid-track exclusions); REQ-015, 016 (cents-level rounding rule).

Not Modeled (by design)

What	Source	Why Excluded
Medicare SNF / MAGI LTC / transfer-of-resource / temp stays / HCBS exclusions	LDH J-300	These narrow exclusion conditions require Medicaid eligibility tracking we don't have at the moment
$1.00 floor when raw amount is $0.50–$1.00, $0 when ≤$0.49	LDH J-300 #page=2	Cents-level administrative rule with no material impact on whole-dollar formulas
Pre-2011 backdating	—	Earliest verified value is January 2011 SSA report; pre-2011 amounts not directly verified

Files

policyengine_us/parameters/gov/states/la/hhs/oss/
  ├── maximum_payment.yaml ($8 → $15 on 2025-07-01)
  └── personal_care_needs_allowance.yaml ($38 → $45 on 2025-07-01)

policyengine_us/variables/gov/states/la/hhs/oss/
  ├── la_oss_eligible.py
  └── la_oss.py

policyengine_us/tests/policy/baseline/gov/states/la/hhs/oss/
  ├── la_oss_eligible.yaml (8 cases)
  ├── la_oss.yaml (13 cases)
  └── integration.yaml (12 cases)

# Registry
policyengine_us/variables/household/income/spm_unit/spm_unit_benefits.py (add la_oss)
policyengine_us/parameters/gov/household/household_state_benefits.yaml (add la_oss to both date entries)
policyengine_us/programs.yaml (add LA SSP state implementation entry)

Historical Notes

• Maximum OSS was static at $8/month for 15+ years (at least 2010 through June 30, 2025), then increased to $15/month effective July 1, 2025 via SPA 25-0013 (approved Nov 3, 2025).
• Personal care needs allowance moved $38 → $45 on the same date.
• Program inception: March 1, 1982 per SCR 133/1980 — but no verified historical values for early years.

Verification TODO

• Verify payment amounts against LDH J-300 / Z-700 (current)
• Verify eligibility logic against LDH H-831.2 / J-300
• Verify amounts current as of 2011-2025
• CI passes

Test plan

• 33 tests pass locally (la_oss_eligible: 8, la_oss: 13, integration: 12)
• CI passes

[codecov]

Codecov Report

✅ All modified and coverable lines are covered by tests.
✅ Project coverage is 86.04%. Comparing base (1b0db4c) to head (d888043).
⚠️ Report is 12 commits behind head on main.

Additional details and impacted files

@@            Coverage Diff             @@
##             main    #8172      +/-   ##
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+ Coverage   85.71%   86.04%   +0.33%     
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  Files           3        3              
  Lines          42       43       +1     
  Branches        2        2              
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+ Hits           36       37       +1     
  Misses          6        6              

Flag	Coverage Δ
unittests	86.04% <100.00%> (+0.33%)	⬆️

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