policyengine-healthcare

Name: policyengine-healthcare
Author: PolicyEngine

31stars5forks

How to install policyengine-healthcare?

policyengine/policyengine-claude/policyengine-healthcare

$npx -y skills add PolicyEngine/policyengine-claude --skill policyengine-healthcare

Installs into the current project.

Summary

US healthcare domain knowledge (Medicaid, ACA premium tax credit, CHIP, Medicare) for analysts using the policyengine package. Load for: why ACA PTC and Medicaid changes show $0 in household_net_income (the include_health_benefits_in_net_income gotcha) and how to measure health i

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SKILL.md

1	# PolicyEngine US healthcare domain knowledge
2
3	Medicaid, the ACA marketplace (premium tax credit), CHIP, and Medicare are the hardest US programs
4	to analyze correctly, because they are modeled as in-kind health benefits rather than cash.
5	This skill is the domain layer for analysts using the `policyengine` package; for non-health US
6	programs use policyengine-us, for the shared calculation/reform mechanics use the
7	policyengine skill, and for building new health variables use policyengine-model-development.
8
9	Verified against policyengine 4.21.0 / policyengine-us 1.764.6 (2026-07). Re-verify variable names
10	and parameter values before reporting.
11
12	## The one gotcha that dominates everything: health benefits are excluded from net income
13
14	`gov.simulation.include_health_benefits_in_net_income` defaults to False. ACA PTC, Medicaid,
15	CHIP, and Medicare cost flow through `household_health_benefits`, which the default
16	`household_net_income` does not include. So a reform that changes `aca_ptc` or `medicaid`
17	produces a $0 change in `household_net_income` — the single biggest time-sink in health
18	analysis. If you score a PTC or Medicaid reform by net-income change and get zero, this is why.
19
20	Measure health impact one of these ways instead:
21
22	- `household_net_income_including_health_benefits` — the same net income with health benefits
23	folded in. Its difference from `household_net_income` is exactly the household's health-benefit
24	value.
25	- The program variable directly — `aca_ptc` (tax_unit), `medicaid` (person), summed or
26	differenced across baseline and reform.
27	- Population cost: `pe.us.calculate_budgetary_impact`. Its `total` already adds the
28	shared-funding health-program cost (Medicaid / CHIP / Medicare Savings Programs) on top of
29	Δtax − Δbenefits, so it captures the health split automatically — do not hand-roll it from
30	`household_net_income`. See the policyengine skill for the population flow.
31
32	Verified end to end (single adult, $35k, Texas — ACA-eligible, not Medicaid-eligible):
33
34	<!-- verify -->
35	```python
36	import policyengine as pe
37
38	r = pe.us.calculate_household(
39	people=[{"age": 45, "employment_income": 35_000}],
40	tax_unit={"filing_status": "SINGLE"},
41	household={"state_code": "TX"},
42	year=2026,
43	extra_variables=["aca_ptc", "household_net_income_including_health_benefits"],
44	)
45	assert round(r.tax_unit.aca_ptc, 2) == 6_250.38 # a real PTC...
46	# ...but it is NOT in default net income; the gap is exactly the PTC:
47	gap = (r.household.household_net_income_including_health_benefits
48	- r.household.household_net_income)
49	assert round(gap, 2) == round(r.tax_unit.aca_ptc, 2)
50	```
51
52	And the toggle itself:
53
54	<!-- verify -->
55	```python
56	from policyengine_us import CountryTaxBenefitSystem
57	p = CountryTaxBenefitSystem().parameters
58	assert p.gov.simulation.include_health_benefits_in_net_income("2026-01-01") == False
59	```
60
61	## Healthcare variables
62
63	Entity and period are load-bearing (verified). Note `aca_ptc` and `slcsp` are tax-unit;
64	Medicaid/CHIP eligibility is person; `slcsp` is monthly.
65
66	\| Variable \| Entity \| Period \| Meaning \|
67	\|---\|---\|---\|---\|
68	\| `aca_ptc` \| tax_unit \| year \| ACA premium tax credit (annual) \|
69	\| `is_aca_ptc_eligible` \| person \| year \| PTC eligibility (income band, no disqualifying coverage) \|
70	\| `aca_magi` \| tax_unit \| year \| MAGI for ACA — `adds` `medicaid_magi` \|
71	\| `aca_required_contribution_percentage` \| tax_unit \| year \| required premium contribution rate \|
72	\| `slcsp` \| tax_unit \| month \| second-lowest silver plan (benchmark) premium \|
73	\| `medicaid` \| person \| year \| modeled Medicaid benefit value (per-capita cost when enrolled) \|
74	\| `is_medicaid_eligible` \| person \| year \| overall Medicaid eligibility \|
75	\| `medicaid_enrolled` \| person \| year \| eligibility × take-up \|
76	\| `medicaid_category` \| person \| year \| enum (see precedence below) \|

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policyengine-healthcare

31stars5forks

View on GitHub

How to install policyengine-healthcare?

policyengine/policyengine-claude/policyengine-healthcare

$npx -y skills add PolicyEngine/policyengine-claude --skill policyengine-healthcare

Installs into the current project.

Summary

Files · 1

View on GitHub

SKILL.md

1	# PolicyEngine US healthcare domain knowledge
2
3	Medicaid, the ACA marketplace (premium tax credit), CHIP, and Medicare are the hardest US programs
4	to analyze correctly, because they are modeled as in-kind health benefits rather than cash.
5	This skill is the domain layer for analysts using the `policyengine` package; for non-health US
6	programs use policyengine-us, for the shared calculation/reform mechanics use the
7	policyengine skill, and for building new health variables use policyengine-model-development.
8
9	Verified against policyengine 4.21.0 / policyengine-us 1.764.6 (2026-07). Re-verify variable names
10	and parameter values before reporting.
11
12	## The one gotcha that dominates everything: health benefits are excluded from net income
13
14	`gov.simulation.include_health_benefits_in_net_income` defaults to False. ACA PTC, Medicaid,
15	CHIP, and Medicare cost flow through `household_health_benefits`, which the default
16	`household_net_income` does not include. So a reform that changes `aca_ptc` or `medicaid`
17	produces a $0 change in `household_net_income` — the single biggest time-sink in health
18	analysis. If you score a PTC or Medicaid reform by net-income change and get zero, this is why.
19
20	Measure health impact one of these ways instead:
21
22	- `household_net_income_including_health_benefits` — the same net income with health benefits
23	folded in. Its difference from `household_net_income` is exactly the household's health-benefit
24	value.
25	- The program variable directly — `aca_ptc` (tax_unit), `medicaid` (person), summed or
26	differenced across baseline and reform.
27	- Population cost: `pe.us.calculate_budgetary_impact`. Its `total` already adds the
28	shared-funding health-program cost (Medicaid / CHIP / Medicare Savings Programs) on top of
29	Δtax − Δbenefits, so it captures the health split automatically — do not hand-roll it from
30	`household_net_income`. See the policyengine skill for the population flow.
31
32	Verified end to end (single adult, $35k, Texas — ACA-eligible, not Medicaid-eligible):
33
34	<!-- verify -->
35	```python
36	import policyengine as pe
37
38	r = pe.us.calculate_household(
39	people=[{"age": 45, "employment_income": 35_000}],
40	tax_unit={"filing_status": "SINGLE"},
41	household={"state_code": "TX"},
42	year=2026,
43	extra_variables=["aca_ptc", "household_net_income_including_health_benefits"],
44	)
45	assert round(r.tax_unit.aca_ptc, 2) == 6_250.38 # a real PTC...
46	# ...but it is NOT in default net income; the gap is exactly the PTC:
47	gap = (r.household.household_net_income_including_health_benefits
48	- r.household.household_net_income)
49	assert round(gap, 2) == round(r.tax_unit.aca_ptc, 2)
50	```
51
52	And the toggle itself:
53
54	<!-- verify -->
55	```python
56	from policyengine_us import CountryTaxBenefitSystem
57	p = CountryTaxBenefitSystem().parameters
58	assert p.gov.simulation.include_health_benefits_in_net_income("2026-01-01") == False
59	```
60
61	## Healthcare variables
62
63	Entity and period are load-bearing (verified). Note `aca_ptc` and `slcsp` are tax-unit;
64	Medicaid/CHIP eligibility is person; `slcsp` is monthly.
65
66	\| Variable \| Entity \| Period \| Meaning \|
67	\|---\|---\|---\|---\|
68	\| `aca_ptc` \| tax_unit \| year \| ACA premium tax credit (annual) \|
69	\| `is_aca_ptc_eligible` \| person \| year \| PTC eligibility (income band, no disqualifying coverage) \|
70	\| `aca_magi` \| tax_unit \| year \| MAGI for ACA — `adds` `medicaid_magi` \|
71	\| `aca_required_contribution_percentage` \| tax_unit \| year \| required premium contribution rate \|
72	\| `slcsp` \| tax_unit \| month \| second-lowest silver plan (benchmark) premium \|
73	\| `medicaid` \| person \| year \| modeled Medicaid benefit value (per-capita cost when enrolled) \|
74	\| `is_medicaid_eligible` \| person \| year \| overall Medicaid eligibility \|
75	\| `medicaid_enrolled` \| person \| year \| eligibility × take-up \|
76	\| `medicaid_category` \| person \| year \| enum (see precedence below) \|

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