California CCHIP eligibility varies by county

[daphnehanse11]

California has a county-specific CHIP eligibility pathway that is not representable with the current state-level CHIP child income limit.

Policy detail:

• California County Children Health Initiative Program (CCHIP) is only available in Santa Clara, San Francisco, and San Mateo counties.
• It provides full-scope coverage to children ages 0-19 whose families have incomes between 266% and 322% FPL.
• DHCS describes this as above 266% to 322% FPL in its 2026 FPL program table.

Why this matters:

• gov.hhs.chip.child.income_limit is state-level, so it cannot distinguish the three CCHIP counties from the rest of California.
• Modeling this as statewide would overstate CHIP eligibility outside those counties; leaving California as no separate CHIP misses CCHIP eligibility in those counties.

Potential implementation direction:

• Add a county-aware California CCHIP eligibility condition, likely using county_str.
• Consider whether this belongs as a California-specific CHIP variable or as a more general geographic override pattern for CHIP income limits.

Sources:

• DHCS MEDIL I 26-12, Apr. 20, 2026: https://www.dhcs.ca.gov/services/medi-cal/eligibility/letters/Documents/I-26-12.pdf
• DHCS Program Descriptions by FPL, 2026: https://www.dhcs.ca.gov/services/medi-cal-resources/medi-cal-eligibility-division/all-county-welfare-directors-medi-cal-eligibility-division-information-letters/program-descriptions-by-fpl-enclosure-3/
• CMS eligibility levels note on California separate CHIP: https://www.medicaid.gov/medicaid/national-medicaid-chip-program-information/medicaid-childrens-health-insurance-program-basic-health-program-eligibility-levels

[daphnehanse11]

Local model check: this does not appear to be modeled yet.

• gov.hhs.chip.child.income_limit is broken down only by state_code, and California is set to -.inf.
• is_chip_eligible_child reads household state_code only; it does not read county or county_str.
• I did not find CCHIP, C-CHIP, or County Children's Health Initiative references in policyengine_us.
• A direct check with identical child facts in SAN_MATEO_COUNTY_CA and LOS_ANGELES_COUNTY_CA returns False for is_chip_eligible_child in both cases, so target-county CCHIP eligibility is not currently represented.

The relevant county enums already exist for SAN_FRANCISCO_COUNTY_CA, SAN_MATEO_COUNTY_CA, and SANTA_CLARA_COUNTY_CA, so implementation can use existing geographic inputs.