Fix CA Medi-Cal immigration eligibility for DACA/TPS in 2026

changelog_entry.yaml

@@ -0,0 +1,4 @@
+- bump: patch
+  changes:
+    fixed:
+      - Fix CA Medi-Cal immigration eligibility for DACA/TPS holders in 2026. Previously, DACA/TPS holders incorrectly lost eligibility after the January 2026 enrollment freeze. Per WCLP guidance, DACA/TPS holders are not affected by the freeze and can still newly enroll.

policyengine_us/parameters/gov/states/ca/chhs/ca_state_funded_immigration_statuses.yaml

@@ -0,0 +1,25 @@
+description: Immigration statuses eligible for CA state-funded Medi-Cal (without satisfactory federal immigration status).
+values:
+  2016-01-01:
+    - UNDOCUMENTED
+    - DACA
+    - TPS
+    - DACA_TPS
+  # TODO: After Oct 2026, federal OBBBA removes refugees, asylees, parolees,
+  # PRUCOL, and others from federal Medicaid funding. Whether CA will cover
+  # these groups with state funds is uncertain as of Jan 2026:
+  # - Current state law: keep full-scope Medi-Cal with dental
+  # - DHCS interpretation: move to Medi-Cal with no dental + premiums
+  # - Governor's proposed budget (Jan 9, 2026): restricted-scope only
+  # Update this parameter when legislation clarifies the outcome.
+metadata:
+  label: CA state-funded Medi-Cal eligible immigration statuses
+  period: year
+  unit: list
+  reference:
+    - title: California Welfare and Institutions Code Section 14007.8
+      href: https://california.public.law/codes/welfare_and_institutions_code_section_14007.8
+    - title: WCLP - Medi-Cal Immigration Changes Practice Tip (Nov 2025)
+      href: https://wclp.org/wp-content/uploads/2025/11/251113-Medi-Cal-immigration-changes-practice-tip-FINAL.pdf#page=1
+    - title: Health Provisions in the 2025 Federal Budget Reconciliation Bill | KFF
+      href: https://www.kff.org/tracking-the-medicaid-provisions-in-the-2025-budget-bill/

policyengine_us/parameters/gov/states/ca/chhs/medi_cal_enrollment_freeze/affected_statuses.yaml

@@ -0,0 +1,13 @@
+description: Immigration statuses subject to the CA Medi-Cal enrollment freeze starting January 1, 2026.
+values:
+  2026-01-01:
+    - UNDOCUMENTED
+metadata:
+  label: CA Medi-Cal enrollment freeze affected statuses
+  period: year
+  unit: list
+  reference:
+    - title: WCLP - Medi-Cal Immigration Changes Practice Tip (Nov 2025)
+      href: https://wclp.org/wp-content/uploads/2025/11/251113-Medi-Cal-immigration-changes-practice-tip-FINAL.pdf#page=1
+    - title: California Welfare and Institutions Code Section 14007.8(b)(1)
+      href: https://california.public.law/codes/welfare_and_institutions_code_section_14007.8

policyengine_us/tests/policy/baseline/gov/states/ca/chhs/is_ca_medicaid_immigration_status_eligible.yaml

@@ -3,52 +3,57 @@
 
 # Age-based eligibility tests (standard pathway)
 
-- name: Case 1, child under 19 is eligible in 2020.
+- name: Case 1, undocumented child under 19 is eligible in 2020.
   period: 2020
   input:
     age: 18
     is_pregnant: false
+    immigration_status: UNDOCUMENTED
     state_code: CA
   output:
     is_ca_medicaid_immigration_status_eligible: true
 
-- name: Case 2, adult 50+ is ineligible in 2020 (before expansion).
+- name: Case 2, undocumented adult 50+ is ineligible in 2020 (before expansion).
   period: 2020
   input:
     age: 50
     is_pregnant: false
+    immigration_status: UNDOCUMENTED
     state_code: CA
   output:
     is_ca_medicaid_immigration_status_eligible: false
 
-- name: Case 3, adult 26+ is ineligible in 2020 (before expansion).
+- name: Case 3, undocumented adult 26+ is ineligible in 2020 (before expansion).
   period: 2020
   input:
     age: 26
     is_pregnant: false
+    immigration_status: UNDOCUMENTED
     state_code: CA
   output:
     is_ca_medicaid_immigration_status_eligible: false
 
-- name: Case 4, pregnant adult is eligible regardless of age.
+- name: Case 4, pregnant undocumented adult is eligible regardless of age.
   period: 2020
   input:
     age: 26
     is_pregnant: true
+    immigration_status: UNDOCUMENTED
     state_code: CA
   output:
     is_ca_medicaid_immigration_status_eligible: true
 
-- name: Case 5, adult 26+ is eligible in 2024 (after expansion).
+- name: Case 5, undocumented adult 26+ is eligible in 2024 (after expansion).
   period: 2024
   input:
     age: 26
     is_pregnant: false
+    immigration_status: UNDOCUMENTED
     state_code: CA
   output:
     is_ca_medicaid_immigration_status_eligible: true
 
-# Continuous coverage tests for 2026 enrollment freeze
+# Continuous coverage tests for 2026 enrollment freeze (UNDOCUMENTED only)
 
 - name: Case 6, undocumented adult not on Medicaid is ineligible in 2026.
   period: 2026
@@ -73,26 +78,97 @@
     # Existing enrollees without SIS retain coverage per Section 14007.8
     is_ca_medicaid_immigration_status_eligible: true
 
-- name: Case 8, child under 19 is still eligible in 2026 (not affected by freeze).
+- name: Case 8, undocumented child under 19 is still eligible in 2026 (not affected by freeze).
   period: 2026
   input:
     age: 10
     is_pregnant: false
+    immigration_status: UNDOCUMENTED
     receives_medicaid: false
     state_code: CA
   output:
     # Children under 19 remain eligible for new enrollment
     is_ca_medicaid_immigration_status_eligible: true
 
-- name: Case 9, refugee on Medicaid does not get CA state-funded eligibility.
+# DACA/TPS are NOT affected by the enrollment freeze (per WCLP Practice Tip Nov 2025)
+
+- name: Case 9, DACA adult is eligible in 2024.
+  period: 2024
+  input:
+    age: 35
+    is_pregnant: false
+    immigration_status: DACA
+    state_code: CA
+  output:
+    is_ca_medicaid_immigration_status_eligible: true
+
+- name: Case 10, DACA adult remains eligible in 2026 (not affected by freeze).
+  period: 2026
+  input:
+    age: 35
+    is_pregnant: false
+    immigration_status: DACA
+    receives_medicaid: false
+    state_code: CA
+  output:
+    # Per WCLP: "People with DACA are not impacted by this full-scope Medi-Cal ban"
+    is_ca_medicaid_immigration_status_eligible: true
+
+- name: Case 11, TPS adult remains eligible in 2026 (not affected by freeze).
+  period: 2026
+  input:
+    age: 50
+    is_pregnant: false
+    immigration_status: TPS
+    receives_medicaid: false
+    state_code: CA
+  output:
+    # TPS holders are not affected by the enrollment freeze
+    is_ca_medicaid_immigration_status_eligible: true
+
+- name: Case 12, DACA_TPS adult remains eligible in 2026 (not affected by freeze).
   period: 2026
+  input:
+    age: 40
+    is_pregnant: false
+    immigration_status: DACA_TPS
+    receives_medicaid: false
+    state_code: CA
+  output:
+    is_ca_medicaid_immigration_status_eligible: true
+
+# Immigration statuses NOT covered by CA state-funded program
+
+- name: Case 13, citizen is not eligible for CA state-funded program.
+  period: 2024
+  input:
+    age: 35
+    is_pregnant: false
+    immigration_status: CITIZEN
+    state_code: CA
+  output:
+    # Citizens use federal Medicaid, not CA state-funded
+    is_ca_medicaid_immigration_status_eligible: false
+
+- name: Case 14, LPR is not eligible for CA state-funded program in 2024.
+  period: 2024
+  input:
+    age: 35
+    is_pregnant: false
+    immigration_status: LEGAL_PERMANENT_RESIDENT
+    state_code: CA
+  output:
+    # LPRs use federal Medicaid, not CA state-funded
+    is_ca_medicaid_immigration_status_eligible: false
+
+- name: Case 15, refugee is not eligible for CA state-funded program in 2024.
+  period: 2024
   input:
     age: 35
     is_pregnant: false
     immigration_status: REFUGEE
-    receives_medicaid: true
     state_code: CA
   output:
-    # Refugees have satisfactory immigration status - they use federal rules
-    # CA state-funded program is only for those without SIS
+    # Before Oct 2026, refugees have federal eligibility
     is_ca_medicaid_immigration_status_eligible: false
+

policyengine_us/variables/gov/states/ca/chhs/is_ca_medicaid_immigration_status_eligible.py

@@ -13,27 +13,48 @@ class is_ca_medicaid_immigration_status_eligible(Variable):
     California Welfare and Institutions Code Section 14007.8 provides
     state-funded Medi-Cal to individuals without satisfactory immigration
     status based on age brackets. Starting January 1, 2026, new enrollments
-    for adults 19+ are frozen, but existing enrollees retain coverage.
+    for adults 19+ are frozen for certain statuses (undocumented), but:
+    - Existing enrollees retain coverage (continuous coverage)
+    - DACA/TPS holders are NOT affected by the freeze
+    - After October 2026, refugees/asylees losing federal coverage are
+      picked up by CA state-funded coverage
     """
     defined_for = StateCode.CA
 
     def formula(person, period, parameters):
         p = parameters(period).gov.states.ca.chhs
+        immigration_status = person("immigration_status", period)
+        immigration_status_str = immigration_status.decode_to_str()
+
+        # Check if person has a CA state-funded eligible immigration status
+        is_ca_state_funded_status = np.isin(
+            immigration_status_str, p.ca_state_funded_immigration_statuses
+        )
+
         age = person("age", period)
         pregnant = person("is_pregnant", period)
         # Standard eligibility based on age or pregnancy
         standard_eligible = (
             p.eligible_regardless_of_immigration_status.calc(age) | pregnant
         )
-        # Continuous coverage only applies after enrollment freeze
+
+        # Enrollment freeze logic (effective January 1, 2026)
         if p.medi_cal_enrollment_freeze.in_effect:
+            # Check if person's status is affected by the freeze
+            is_freeze_affected = np.isin(
+                immigration_status_str,
+                p.medi_cal_enrollment_freeze.affected_statuses,
+            )
             receives_medicaid = person("receives_medicaid", period)
-            # Section 14007.8 is specifically for undocumented immigrants
-            immigration_status = person("immigration_status", period)
-            undocumented = (
-                immigration_status
-                == immigration_status.possible_values.UNDOCUMENTED
+
+            # Freeze-affected (UNDOCUMENTED): standard age eligibility OR
+            #   continuous coverage (already enrolled)
+            # Not freeze-affected (DACA/TPS/others): always eligible
+            #   (Health4All covered all ages by 2024, freeze doesn't apply)
+            return is_ca_state_funded_status & where(
+                is_freeze_affected,
+                standard_eligible | receives_medicaid,
+                True,
             )
-            continuous_coverage = receives_medicaid & undocumented
-            return standard_eligible | continuous_coverage
-        return standard_eligible
+
+        return is_ca_state_funded_status & standard_eligible