Apply 416.1163(e)(2) to deemed SSI and identify SSI couples by marriage, not tax roles

changelog.d/ssi-couples-and-deeming-cap.fixed.md

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+SSI under spousal income deeming is now the lesser of the couple computation and the individual Federal benefit rate less the person's own countable income (20 CFR 416.1163(e)(2)), not the couple computation capped at the individual rate; uncapped_ssi applies the same rule, so state supplements that read it see the federal shortfall. SSI couples are now identified by the co-resident spouse test that resource deeming uses rather than by tax-unit head and spouse roles, for joint claims, combined couple income and resources, and income deeming from an ineligible spouse (416.1801(c), 416.1806, 416.1160(d)). State supplement couple rates, income, resources, care categories and spouse allowances now use only the actual spouses when a situation omits marital units and includes a third adult. Colorado OAP retains declared spouses living apart; Missouri retains their combined resources for medical separation, Virginia and South Dakota retain joint care-entry budgets, and Oregon retains the community-care spouse payment across facilities. Iowa pools only the identified spouses across its state supplement paths, retains its prior-SSI residential-care entry budget across facilities, and requires an explicit shared-room input for the same-month entry rule without prior SSI.
+Retained state spouse budgets now reject explicit parent links and tax-dependent pairs across households. Non-MAGI Medicaid income, premium, resource and spenddown budgets and California CAPI use only the identified spouses when marital units are omitted. Regressions pin claimant-wage deeming continuity and the 2026 wage/self-employment cases.

policyengine_us/tests/policy/baseline/gov/hhs/medicaid/medicaid_ssi_couple_three_adult.yaml

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+# Omitted marital units form one default group. Only the identified spouses
+# may enter these non-MAGI Medicaid budgets; the third adult is unrelated.
+- name: California excludes an unrelated adult's premiums from a couple budget.
+  period: 2026
+  absolute_error_margin: 0.01
+  input:
+    people:
+      head:
+        age: 67
+        is_tax_unit_head: true
+        pension_income: 36_000
+        medicare_enrolled: false
+      spouse:
+        age: 67
+        is_tax_unit_spouse: true
+        pension_income: 24_000
+        medicare_enrolled: false
+      third:
+        age: 67
+        pension_income: 12_000
+        health_insurance_premiums: 12_000
+        medicare_enrolled: false
+        ssi_federal_living_arrangement:
+          2026-01: MEDICAL_TREATMENT_FACILITY
+    tax_units:
+      couple:
+        members: [head, spouse]
+      third:
+        members: [third]
+    families:
+      couple:
+        members: [head, spouse]
+      third:
+        members: [third]
+    spm_units:
+      couple:
+        members: [head, spouse]
+      third:
+        members: [third]
+    households:
+      household:
+        members: [head, spouse, third]
+        state_code: CA
+  output:
+    ssi_couple_computation_applies:
+      2026-01: [true, true, false]
+    # (36,000 + 24,000 - 240) / 2; the third adult's 12,000 is not deducted.
+    medicaid_optional_senior_or_disabled_countable_income: [29_880, 29_880, 0]
+
+- name: Optional ABD income and assets exclude an unrelated adult and retain the couple limits.
+  period: 2026
+  input:
+    people:
+      head:
+        age: 70
+        is_tax_unit_head: true
+        medicaid_optional_senior_or_disabled_countable_income: 8_946
+        ssi_countable_resources: 1_200
+      spouse:
+        age: 68
+        is_tax_unit_spouse: true
+        medicaid_optional_senior_or_disabled_countable_income: 8_946
+        ssi_countable_resources: 1_200
+      third:
+        age: 70
+        medicaid_optional_senior_or_disabled_countable_income: 50_000
+        ssi_countable_resources: 50_000
+    tax_units:
+      couple:
+        members: [head, spouse]
+      third:
+        members: [third]
+    families:
+      couple:
+        members: [head, spouse]
+      third:
+        members: [third]
+    spm_units:
+      couple:
+        members: [head, spouse]
+      third:
+        members: [third]
+    households:
+      household:
+        members: [head, spouse, third]
+        state_code: WV
+  output:
+    # West Virginia's 2026 annual SSI rates: couple 17,892; individual 11,928.
+    medicaid_optional_senior_or_disabled_income_limit: [17_892, 17_892, 11_928]
+    is_optional_senior_or_disabled_income_eligible: [true, true, false]
+    # Couple assets 2,400 are below 3,000; the third adult's 50,000 is excluded.
+    is_optional_senior_or_disabled_asset_eligible: [true, true, false]
+
+- name: Section 209b spenddown excludes an unrelated adult's medical expenses.
+  period: 2026
+  input:
+    people:
+      head:
+        age: 70
+        is_tax_unit_head: true
+        is_optional_senior_or_disabled_income_eligible: false
+        medicaid_optional_senior_or_disabled_countable_income: 20_000
+        medicaid_medically_needy_medical_expenses: 5_000
+        medicaid_optional_senior_or_disabled_income_limit: 25_000
+      spouse:
+        age: 68
+        is_tax_unit_spouse: true
+        is_optional_senior_or_disabled_income_eligible: false
+        medicaid_optional_senior_or_disabled_countable_income: 20_000
+        medicaid_medically_needy_medical_expenses: 5_000
+        medicaid_optional_senior_or_disabled_income_limit: 25_000
+      third:
+        age: 70
+        is_optional_senior_or_disabled_income_eligible: false
+        medicaid_optional_senior_or_disabled_countable_income: 0
+        medicaid_medically_needy_medical_expenses: 12_000
+        medicaid_optional_senior_or_disabled_income_limit: 25_000
+    tax_units:
+      couple:
+        members: [head, spouse]
+      third:
+        members: [third]
+    families:
+      couple:
+        members: [head, spouse]
+      third:
+        members: [third]
+    spm_units:
+      couple:
+        members: [head, spouse]
+      third:
+        members: [third]
+    households:
+      household:
+        members: [head, spouse, third]
+        state_code: IL
+  output:
+    # 2 x (20,000 - 5,000) = 30,000, above 25,000; subtracting the third
+    # adult's expenses would incorrectly bring the couple down to 18,000.
+    is_209b_ssi_recipient_income_eligible_for_medicaid: [false, false, true]
+
+- name: Medically needy income and assets exclude an unrelated adult.
+  period: 2026
+  input:
+    people:
+      head:
+        age: 70
+        is_tax_unit_head: true
+        is_adult_for_medicaid: false
+        is_optional_senior_or_disabled_for_medicaid: false
+        is_ssi_recipient_for_medicaid: false
+        ssi_countable_income: 10_000
+        medicaid_medically_needy_medical_expenses: 6_500
+        ssi_countable_resources: 1_000
+      spouse:
+        age: 68
+        is_tax_unit_spouse: true
+        is_adult_for_medicaid: false
+        is_optional_senior_or_disabled_for_medicaid: false
+        is_ssi_recipient_for_medicaid: false
+        ssi_countable_income: 10_000
+        medicaid_medically_needy_medical_expenses: 6_500
+        ssi_countable_resources: 1_000
+      third:
+        age: 70
+        is_adult_for_medicaid: false
+        is_optional_senior_or_disabled_for_medicaid: false
+        is_ssi_recipient_for_medicaid: false
+        ssi_countable_income: 50_000
+        ssi_countable_resources: 50_000
+    tax_units:
+      couple:
+        members: [head, spouse]
+      third:
+        members: [third]
+    families:
+      couple:
+        members: [head, spouse]
+      third:
+        members: [third]
+    spm_units:
+      couple:
+        members: [head, spouse]
+      third:
+        members: [third]
+    households:
+      household:
+        members: [head, spouse, third]
+        state_code: MA
+  output:
+    # 7,000 income <= 7,800 couple limit; 2,000 assets <= 3,000. The
+    # unrelated adult's income and assets do not enter either comparison.
+    is_medically_needy_for_medicaid: [true, true, false]
+
+- name: Missouri spouse deeming excludes an unrelated third adult's income.
+  period: 2026
+  absolute_error_margin: 0.01
+  input:
+    people:
+      head:
+        age: 70
+        is_tax_unit_head: true
+        ssi_unearned_income: 17_400
+      spouse:
+        age: 60
+        is_tax_unit_spouse: true
+        ssi_earned_income: 4_800
+      third:
+        age: 60
+        ssi_earned_income: 120_000
+        ssi_unearned_income: 120_000
+    tax_units:
+      couple:
+        members: [head, spouse]
+      third:
+        members: [third]
+    families:
+      couple:
+        members: [head, spouse]
+      third:
+        members: [third]
+    spm_units:
+      couple:
+        members: [head, spouse]
+      third:
+        members: [third]
+    households:
+      household:
+        members: [head, spouse, third]
+        state_code: MO
+  output:
+    # The SSI spouse-status mask already excludes an unrelated singleton.
+    is_ssi_ineligible_spouse: [false, true, false]
+    medicaid_optional_senior_or_disabled_income_deemed_from_ineligible_spouse: [2_004, 0, 0]
+
+- name: Missouri spouse deeming excludes another couple's ineligible spouse.
+  period: 2026
+  absolute_error_margin: 0.01
+  input:
+    people:
+      head:
+        age: 70
+        is_tax_unit_head: true
+        ssi_unearned_income: 17_400
+      spouse:
+        age: 60
+        is_tax_unit_spouse: true
+        ssi_earned_income: 4_800
+      other_head:
+        age: 70
+        is_tax_unit_head: true
+      other_spouse:
+        age: 60
+        is_tax_unit_spouse: true
+        ssi_earned_income: 12_000
+        ssi_unearned_income: 12_000
+    tax_units:
+      couple:
+        members: [head, spouse]
+      other_couple:
+        members: [other_head, other_spouse]
+    families:
+      couple:
+        members: [head, spouse]
+      other_couple:
+        members: [other_head, other_spouse]
+    spm_units:
+      couple:
+        members: [head, spouse]
+      other_couple:
+        members: [other_head, other_spouse]
+    households:
+      household:
+        members: [head, spouse, other_head, other_spouse]
+        state_code: MO
+  output:
+    is_ssi_ineligible_spouse: [false, true, false, true]
+    # First couple: floor((400 - 65) / 2 + 1,450 - 20) - 1,430 = 167
+    # monthly. Second: floor((1,000 - 65) / 2 + 1,000 - 20) = 1,447.
+    medicaid_optional_senior_or_disabled_income_deemed_from_ineligible_spouse: [2_004, 0, 17_364, 0]

policyengine_us/tests/policy/baseline/gov/ssa/ssi/eligibility/income/deemed/ssi_income_deemed_from_ineligible_spouse.yaml

@@ -154,3 +154,43 @@
         members: [person1, person2]
   output:
     ssi_income_deemed_from_ineligible_spouse: [0, 0]
+
+# 416.1160(d): 'Ineligible spouse means someone who lives with you as your
+# husband or wife and is not eligible for SSI benefits.' Tax-unit roles do
+# not decide it: here the model makes the elder head and the claimant the
+# tax-unit spouse, and the claimant's husband a dependent.
+# 2026 rates: $994 individual, $1,491 couple.
+- name: Income of an ineligible spouse who is a tax-unit dependent is deemed
+  period: 2026-01
+  absolute_error_margin: 0.01
+  input:
+    people:
+      elder:
+        age: 90
+        social_security_retirement: 900 * 12
+      claimant:
+        age: 70
+        social_security_retirement: 600 * 12
+      husband:
+        age: 60
+        employment_income: 2_000 * 12
+    tax_units:
+      tax_unit:
+        members: [elder, claimant, husband]
+    marital_units:
+      elder_unit:
+        members: [elder]
+      couple:
+        members: [claimant, husband]
+    households:
+      household:
+        members: [elder, claimant, husband]
+        state_code: FL
+  output:
+    is_ssi_ineligible_spouse: [false, false, true]
+    # $2,000 > $497, so income is deemed (416.1163(d)(2)). Couple countable
+    # income: ($600 - $20) + ($2,000 - $65) / 2 = $1,547.50; alone $580;
+    # deemed $967.50. $1,547.50 exceeds the $1,491 couple rate, so the
+    # claimant is ineligible on income.
+    ssi_income_deemed_from_ineligible_spouse: [0, 967.50, 0]
+    ssi: [114, 0, 0]