Alabama FCEP CHIP eligibility is county-limited

[daphnehanse11]

Alabama has a county-limited From-Conception-to-End-of-Pregnancy (FCEP) CHIP pathway that is currently represented only as a state-level income limit.

Policy detail:

• Alabama FCEP coverage applies in Montgomery, Macon, and Russell counties.
• CMS state plan materials list the FCEP income standard as applying by county rather than statewide.
• KFF reports Alabama FCEP at 317% FPL for January 2026, but the state plan source indicates the geographic limitation.

Why this matters:

• gov.hhs.chip.fcep.income_limit[AL] is state-level and currently treats Alabama FCEP as available statewide from 2024.
• That likely overstates FCEP CHIP eligibility outside Montgomery, Macon, and Russell counties.

Potential implementation direction:

• Add an Alabama-specific county condition for is_chip_fcep_eligible_person, probably keyed on county_str.
• Alternatively introduce a geographic availability parameter for CHIP FCEP pathways if we expect more state-specific geography later.

Sources:

• CMS Alabama CHIP state plan, AL-19-0018-RIM: https://www.medicaid.gov/sites/default/files/2023-04/al-19-0018-rim.pdf
• KFF Medicaid and CHIP Income Eligibility Limits for Pregnant Women, January 2026: https://www.kff.org/affordable-care-act/state-indicator/medicaid-and-chip-income-eligibility-limits-for-pregnant-women-as-a-percent-of-the-federal-poverty-level/
• Medicaid.gov CHIP eligibility overview explaining FCEP and possible geographic criteria: https://www.medicaid.gov/chip/chip-eligibility-enrollment

[daphnehanse11]

Local model check: this is partially modeled, but the county limitation is not.

• gov.hhs.chip.fcep.income_limit is broken down only by state_code; Alabama is set to 3.17 starting in 2024.
• is_chip_fcep_eligible_person reads household state_code only; it does not read county or county_str.
• I did not find county-specific FCEP logic for MONTGOMERY_COUNTY_AL, MACON_COUNTY_AL, or RUSSELL_COUNTY_AL in CHIP code.
• A direct check with identical pregnant-person facts in MONTGOMERY_COUNTY_AL and MOBILE_COUNTY_AL returns True for is_chip_fcep_eligible_person in both cases, so the current model treats Alabama FCEP as statewide.

The relevant county enums already exist for MONTGOMERY_COUNTY_AL, MACON_COUNTY_AL, and RUSSELL_COUNTY_AL, so implementation can use existing geographic inputs.