DPSS ePolicy

Terms and Descriptions

Benefits Categories 

CAPI payment standard categories that determine the amount of benefits an individual or couple is granted. The payment standard categories are:

• Aged or Disabled
  
  
• Blind
  
  
• Non-Medical Out-of-Home Care (NMOHC)
  
  
• Aged or Disabled without cooking facilities
  
  
• Disabled Minor
  
  
• Disabled Minor (Household of Another)
  
  
• Aged or Disabled (Reduced Needs)
  
  
• Blind (Household of Another)
  
  
• NMOHC (Reduced Needs)
  
  
• Title XIX Medical Facility Standard

Disabled Child Living with Parent 

The disabled child payment standard applies to all disabled children under age 18 who are living with a parent, guardian, or relative by blood or marriage.

• The reduced needs payment standard for children may apply to children living with a parent(s) if the parent meets the conditions listed under the “Reduced Needs with In-Kind Room and Board” section.
  
  
• One of the nonmedical out-of-home care payment standards may apply to children living with a non-parent relative or guardian if the conditions under the “Non-Medical Out-of-Home Care” section are met. 
  
  
• Benefits for blind children are determined using the payment standards for blind adults. 

Note: This living arrangement does not apply to Qualified Aliens that are disabled minors. These children are not eligible for CAPI because they are potentially eligible to SSI/SSP.

Household

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

Household of Another (HOA)

An applicant/participant who lives with someone else (other than a spouse, parent, or a non-Qualified Alien minor child) and the participant receives both food and shelter from that person and does not contribute toward the household expenses or pays less than the pro rata share for food and shelter.  Also, they do not have ownership interest or rental liability. 

Note: The In-kind support is not counted as income but is applied in this situation by using the reduced needs CAPI payment standards for living in the HOA. 

In-Kind Income

Income in the form of cash or negotiable instrumentals. Examples of In-kind income include real property, food, and occasionally wages (e.g., room and board or clothing as compensation for employment).  In-kind income that is unearned and directly satisfies the need for food or shelter is called “In-kind Support and Maintenance” (ISM).

Note: Resources converted to cash are counted as resources. 

ISM

Unearned income received in the form of food, clothing or shelter that is given to a CAPI applicant/participant for free or the applicant/participant receives for free because someone else pays for it.  ISM can be received from someone living in the same household or from outside the household. 

Note: Shelter expenses include room, rent, mortgage payments, property taxes, heating fuel, gas, electricity, water, sewer, and garbage services.  Mobile home space rental is not a shelter expense.

Independent Living 

A CAPI applicant/participant is determined to be in an “Independent Living” situation when one of the following conditions applies to the person (or spouse or parent whose income is deemed to the applicant/participant living in the same home):

• Has full or joint ownership of the home in which they live;
  
  
• Their name is on the rental agreement;
  
  
• Lives alone;
  
  
• Lives with others and pays an amount equal to their pro rata share of the household expenses;
  
  
• Lives with others and all the members of the household receive public assistance;
  
  
• Rents a room under a business-like arrangement; or
  
  
• Homeless. 

Note: An applicant receiving ISM for an amount less than the Presumed Maximum Value (PMV) may only be charged with the actual amount of the ISM received, not the full PMV (e.g., in January 2021, the PMV is $330.57 for an individual and $541.38 for a couple). Refer to 49-035: Income for more details on ISM Value under PMV Rule.

Independent Living Without Cooking Facilities
A CAPI applicant/participant who is aged or disabled and meets one of the criteria listed under the “Independent Living" section does not have a stove and refrigerator available for their use and does not have meals provided as part of the living arrangement. 

Ineligible Participants 

This living arrangement does not apply to blind individuals or couples with at least one blind member.

Restaurant Meal Allowance (RMA)

This living arrangement has an extra benefit built into the CAPI standard amount.  The extra benefit is known as the RMA. 

Refer to Manual of Policy and Procedures (MPP) Section 46-160.

Living Arrangement

Where you live, if you live alone or with someone else, or if you live in an institution, such as a nursing home. Your living arrangement also depends on who pays for your food and shelter.

PMV

The maximum amount charged when a CAPI applicant/participant is receiving ISM, which helps in determining countable income. The value of the PMV is equal to one-third of the federal SSI benefit plus $20. 

Pro Rata Share

The portion of a household’s total expenses that is attributable to the applicant/participant. It is calculated on the SOC 453, CAPI Statement of Household Expenses and Contributions form, by dividing the average monthly household expenses by the total number of people in the household including adults and children, regardless of age. 

Note: Pro rata share does not apply to those who are fully supported (e.g., those who pay nothing toward their support) and does not apply to applicant/participant who resides alone or with a spouse and/or minor children only.

Reduced Needs with In-Kind Room and Board

None of the conditions listed under the “Independent Living” section apply and the applicant (or parent, if the applicant is a minor child) is living in the household of another (relative or non-relative) for a full calendar month and receiving both food and shelter as described in 49-035: Income.

Note: This living arrangement does not apply if the person supplying the support and maintenance is the spouse of the applicant/participant, or parent if the applicant/participant is a minor child.

Title XIX Medical Facility

The Title XIX medical facility payment standard applies to persons who reside throughout a month in a medical facility and Medi-Cal (title XIX of the Social Security Act) pays more than 50% of the cost of the person’s care.

An exception to the Title XIX medical facility rule applies, and one of the other payment standards would be used when a participant is temporarily confined for medical care and all of the following apply:

• The individual must have been eligible for a CAPI benefit under one of the higher payment standards in the month prior to entering a facility where the Title XIX facility rate would apply.
  
  
• A physician must certify that the participant is expected to be medically confined for 90 consecutive days or less.
  
  
• The participant must demonstrate that they need to pay some or all of the expenses of maintaining the home or living arrangement to which they may return.