DPSS ePolicy

I-864, Affidavit of Support (New)

Refers to the United States Citizenship and Immigration Services (USCIS) Form I-864, "Affidavit of Support", Under Section 213A of the Immigration and Nationality Act (INA), which is completed and signed by the sponsor.

Under Section 213A of the INA, the new affidavit is a legally enforceable contract between the sponsor and the federal government, for the benefit of the sponsored immigrant and of any federal, state, or local government agency or entity that provides the sponsored immigrant with any means-tested public benefit.

Note: The new affidavit is required for all applications for immigrant visas or for adjustment of status filed on or after December 19,1997.

I-134, Affidavit of Support (Obsolete)

Refers to USCIS Form I-134, "Affidavit of Support", that was signed before the formulation and implementation of the new version of the affidavit, Form I-864.

Basic CAPI

Refers to the original eligibility component of CAPI, for which the earliest possible payment date was December 1, 1998. A non-citizen is potentially eligible for basic CAPI if they:

1. Entered the U.S. prior to August 22, 1996; or
   
   
2. Entered the U.S. on or after August 22, 1996; and
   
   
   • Have a sponsor who is deceased or disabled; or
     
     
   • A victim of abuse by the sponsor or the sponsor’s spouse.

Conditional CAPI

A continuation of CAPI benefits, pending SSA determination of SSI/SSP eligibility, for CAPI participants who become naturalized U.S. citizens.

Eligible Couple

An eligible individual and their eligible spouse.

Note: Each individual in a couple case must complete and sign their own application. (Refer to 49-055.4 Couple Cases)

Eligible Individual

An aged, blind, or disabled individual who meets all the requirements for CAPI eligibility.

Eligible Spouse

An aged, blind, or disabled individual who meets all CAPI eligibility requirements (including filing an application) and the spouse of another aged, blind, or disabled individual and who is living with that individual. For purposes of calculating the CAPI benefit, a spouse who is receiving SSI/SSP will also be considered an eligible spouse.

Extended CAPI

Refers to the more recent eligibility component of CAPI, for which the earliest possible payment date was October 1, 1999. A non-citizen is potentially eligible for extended CAPI if they entered the U.S. on or after August 22, 1996, and meets one of the following criteria:

1. Does not have a sponsor;
   
   
2. Has a sponsor who is NOT deceased or disabled; or
   
   
3. Has a sponsor and is NOT a victim of abuse by the sponsor or the sponsor’s spouse.

Note: The sponsor-deeming rule is applicable for ten years from the date the sponsor signed the Affidavit of Support. 

Fleeing Felon

A person who flees to avoid persecution, or custody or confinement after conviction for a crime under the laws of the place from which the person flees.

Household

A personal place of residence in which the individual(s) share common living quarters and functions as a single economic unit.

Note: The members of a household do not need to be related by blood or marriage, but must live together in a single dwelling and function as an economic unit. A person who is temporarily absent from a household is still a member of the household.

Household Operating Expenses

The household’s total monthly expenditures for food, rent, mortgage, property insurance required by the mortgage holder, property taxes, heating fuel, gas, electricity, water, sewer, and garbage collection service. Household expenses must be added on the SOC 453, "Cash Assistance Program for Immigrants (CAPI) Statement of Household Expenses and Contributions".

Note: Expenditures paid for by someone outside the household are not included.

Immigrant/Non-Citizen

An individual who is not a U.S. citizen.

Ineligible Parent

A natural or adoptive parent or the parent’s spouse who is not eligible for CAPI or SSI/SSP and lives with a minor child who is the CAPI applicant/participant.

Ineligible Spouse

Someone living with the applicant/participant as a spouse who is not eligible for CAPI or SSI/SSP.  An otherwise eligible spouse who does not apply for CAPI or SSI/SSP is considered an ineligible spouse.

Medical Treatment Facility

An institution or part of an institution that is licensed or approved by a federal, state, or local government to provide inpatient medical care services.

Naturalized Citizen

A person, born a foreign citizen or national, who has lawfully become a citizen of the U.S. under the U.S. Constitution and laws.

Parole Violator

A person who violates a condition of probation or parole imposed under federal or state law.

Participant

An individual who has an approved CAPI case.

Presumed Maximum Value (PMV)

The maximum value that can be attributed to In-Kind Support and Maintenance (ISM) received by the applicant/participant for purposes of determining the countable income. The value of the PMV is equal to one-third of the federal SSI benefit plus $20.

Pro Rata Share

The average monthly household operating expenses (based on reasonable estimate if exact figures are not available) divided by the number of people in the household, regardless of age.

PRUCOL

Non-citizens residing in the U.S. whom USCIS knows are in the U.S. and is not taking steps to deport or remove them from the U.S.

(Refer to 49-020.1 Immigration Status - PRUCOL)

Public Institution

An institution that is operated or controlled by the federal government, a State, or a political subdivision of a State, such as a city or county.

Note: This excludes a publicly operated community residence which serves 16 or fewer residents.

The most common examples of public institutions are jails, prisons, and Veterans Affairs (VA) hospitals.

Qualified Alien

An immigrant who is:

1.  A Lawful Permanent Resident;
   
   
2. Granted Cuban/Haitian entrant status;
   
   
3. A refugee;
   
   
4. An asylee;
   
   
5. Deportation/removal is being withheld;
   
   
6. Paroled into the U.S. for a period of at least one year;
   
   
7. A conditional entrant admitted to the U.S.; or
   
   
8. A battered person, child of a battered spouse, or parent of a battered child with a petition pending

(Refer to 49-020 Immigration Status - Qualified Alien) 

Sponsor

A person who has executed an Affidavit of Support agreeing to support an immigrant as a condition of the immigrant’s admission for permanent residence in the U.S..

Sponsor-Deeming Rule

Considering the income and resources of the sponsor in determining the immigrant’s eligibility for a government benefit program, such as CAPI.

Sponsored Immigrant

A person on whose behalf a sponsor has executed an Affidavit of Support.

Spouse

The definition of a married couple follows California Law which includes same-sex marriages. A spouse is defined under any of the following conditions:

1. Legally married under the laws of California, or the state where the applicant/participant had their permanent residence while living together;
   
   
2. Either member of the couple is entitled to the other member’s Social Security benefits as the spouse of the other; or
   
   
3. The applicant/participant resides with an unrelated person of the opposite or same sex in the same household and both lead people to believe they are spouses. 
   

SSI/SSP

Refers to the federal (SSI) and state (SSP) funded programs that provides cash assistance to aged, blind, and disabled residents of California. The SSA office administers SSI/SSP.

Substantial Gainful Activity (SGA)

Work activity that involves doing significant physical or mental activities, or a combination of both, for pay or profit. Average earnings of more than $1,470 per month ordinarily indicate an applicant/participant is engaged in SGA.

Suspension

A stoppage of CAPI benefits that is always effective the first day of a month when an individual no longer meets all eligibility requirements.

Termination

Occurs when benefits have been suspended for 12 consecutive months and cannot be reinstated without filing a new application.

1. The applicant/participant leaves California and decides to stop living in California, then the applicant is not eligible to receive CAPI and no longer considered a California resident. 
   
   
2. The applicant does not live in California for more than 90 calendar days, then the applicant is not eligible to receive CAPI and is considered to have stopped living in California, unless contrary evidence is provided.
   
   
3. The applicant leaves the U.S. for an entire calendar month, then the applicant does not regain CAPI eligibility until the applicant has been back in the U.S. for at least 30 consecutive days. 
   
   
4. The applicant resides in a public institution for an entire calendar month, then the applicant is not eligible to receive CAPI only if the public institution is operated by a county, city, state, or federal government.

Residency in a private hospital or nursing facility generally does not disqualify an applicant/participant for CAPI. When an applicant/participant resides in a medical treatment facility, then:

1. The applicant/participant may be eligible to receive a full CAPI benefit during the first three months of institutionalization, if all the following conditions are met:
   
   
   • A resident through the entire month who stayed in a public or private medical treatment facility; and
     
     
   • Medi-Cal pays or is expected to pay over 50% of the cost of care for that month; or
     
     
   • For children under age 18, Medi-Cal and/or any health insurance policies issued by a private provider pays or are expected to pay 50% of the cost of care for that month.
     
     
2. The applicant/participant may be eligible to receive a CAPI benefit amount that is limited to the Title XIX Medical Facility rate, if: 
   
   
   • The applicant/participant must have been eligible for a CAPI benefit in the month prior to entering a facility;
     
     
   • The facility must be a public institution. The primary purpose must be the provision of medical or psychiatric care, or a public or private Medi-Cal certified medical treatment facility;
     
     
   • The applicant/participant must continuously reside through the entire affected month;
     
     
   • A physician must certify that the applicant expects the applicant/participant to be medically confined for 90 full consecutive days or less; and
     
     
   • The applicant/participant (or someone on his/her behalf) must demonstrate the participant needs to pay some or all expenses for maintaining the home or living arrangement that the applicant/participant may return to upon release the medical treatment facility.

Identity Documents

Driver’s license or other government issued photo identification e.g., State Identification (ID) card, passport, matricula card, or U.S. Citizenship Immigration Services documents.

Note: Expired Lawful Permanent Resident (LPR) cards can be accepted if the eligibility staff can verify the applicant/participant has current lawful permanent resident status via a SAVE query. (Reference Medi-Cal Program (MCP) 18-15 Errata, Desk Guide – Systematic Alien Verification for Entitlement (SAVE))

Immigration Documents

Resident Alien Card or other residency/immigration documents with evidence of applicant’s/participant’s current legal immigration status.

(Refer to 49-020 Immigration Status – Qualified Alien)

Proof of Age

Applicant’s/participant’s passport, birth certificate, U.S. Citizenship and Immigration Services documents, SSI or Title II Social Security forms, Medi-Cal, or other records (including baptismal or other religious certificate) indicating the applicant is at least 65 years of age. 

Proof of California Residency

Driver’s license, State ID card, or current letter mailed to applicant’s/participant’s address. 

Proof of Expenses

Rental Agreement, housing and utility costs such as rent receipts or utility bills showing the applicant’s/participant’s name and amount due, and all other relevant documentations. 

Proof of Income and Resources

Current pay stubs showing gross monthly income and dates received, copy of last year federal income tax return, copies of award letters, all current bank statements, unemployment insurance, Social Security, worker’s compensation, VA income checks, disability insurance, copy of loan papers (with the name of CAPI applicant/participant receiving the loan, the amount and current balance), child support and/or spousal support award letter, property statements, vehicle registrations, life and/or burial issuance policies, life estate agreement, and all other relevant documentations.

Proof of SSI Ineligibility

Denial letter from SSA issued within the last six months.

Note: Not needed for non-qualified aliens.  

Sponsor Verifications

Pay stubs, bank statements, tax records, rent receipts, proof of property ownership, and all relevant documentations from all sponsors.