49-050 Living Arrangements and Benefits Categories

CAPI

49-050 Living Arrangements and Benefits Categories

Release Date

04/20/2023

Section Heading

Purpose

To convert existing policy to new writing style only - No concept changes

Policy

A Cash Assistance Program for Immigrants (CAPI) individual’s living arrangement affects which CAPI payment standard is selected to determine their CAPI benefit amount. The first day of the month is the basis for determining the living arrangements and in turn the payment standards used for that entire month. If a participant moves, living arrangements resulting from a move are effective the first of the month following the date of move.

Note: If a change of living arrangements has been reported, benefit changes made will either be a positive or negative change. If a positive change occurs, the change will take effect starting the day of the change and additional benefits will be issued. If a negative change occurs, the change will take effect after the Notice of Action (NOA) of reduced benefits has been sent out.

Background

The household composition is an important eligibility factor in the determination of CAPI eligibility and payment standards. CAPI payment standards are equivalent to Supplemental Security Income/State Supplemental Payments (SSI/SSP) payment standards.

Definitions

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.

Requirements

The following forms must be completed, as applicable:

The SOC 453 must be completed with all applications. This form is also used to determine if they are paying for their pro rata share.

Note: If the landlord refuses to indicate the amount of rent being paid, it is assumed that the applicant/participant is NOT paying his pro rata share and ISM will be applied as appropriate.
The SOC 887, CAPI NMOHC Payment Standard Eligibility Determination must be completed to determine if the CAPI participant is eligible for the NMOHC payment standard.
The SOC 887A, Retroactive Certification of NMOHC Payment Standard Eligibility must be completed when the CAPI participant cannot provide evidence of an earlier NMOHC start date. The participant’s attestation is required to determine the start date of NMOHC services.

Verification Docs

N/A

Procedures

Administrative Release

Number: 5963 Date: April 20, 2023

A CAPI applicant/participant is considered to be part of an NMOHC when they live in a protective living arrangement outside of the SSI/SSP recipient’s own home, where they receive room, board, and non-medical care and supervision. A CAPI individual will be considered for NMOHC when living:

In a nursing home, a licensed foster care, community care or residential care facility.

Note: The Eligibility Worker (EW) must verify the facility’s licensure by contacting the local Community Care Licensing field office. EWs can use the following website to access more information regarding licensed facilities: Social Services - Community Care Facility Search

The EW shall contact the Adult Services Division listed below to determine whether a residence can be certified:

Bureau of Special Operations
Adult Services Division
IHSS Metro West Region
2707 S. Grand Ave.
Los Angeles, CA 90007
(213) 744 – 3716
In a County approved non-licensed private residence of an applicant’s relative, legal guardian, or conservator, where the need for and the appropriateness of the care has been certified by the County.

Note: A relative is related by blood (e.g., parent, son, brother, half-brother, half-sister, uncle, aunt, niece, nephew, first cousin or any such person denoted by the prefix “grand” or “great”).

Detailed provisions regarding NMHOC can be found in MPP Section 46-140.

The reduced needs NMOHC payment standard applies to persons who meet the conditions under the “Reduced Needs with In-Kind Room and Board” section and are receiving care and supervision while living in the home of a relative.

The EW should complete the SOC 887 each time an applicant/participant answers “Yes” to Questions 3, 4, or 5 on the SOC 453. A new SOC 887 must also be completed to determine if the applicant/participant is still eligible for the NMOHC payment standard if they report a change in living arrangements.

Note: If the applicant/participant is unable to provide evidence of an earlier NMOHC start date, the EW must have the applicant/participant self-attest to determine the start date of NMOHC services by using the SOC 887A.

A CAPI applicant/participant cannot receive both the NMOHC CAPI rate and In-Home Supportive Services (IHSS). The CAPI applicant/participant must choose one or the other.

Note: Higher CAPI payment standards apply for blind individuals, or couples where at least one member is blind, if the individual or couple is in either the independent living or reduced needs household of another living arrangement.

HOA and PMV vs. Independent Living Situation

The following chart must be used when determining whether the applicant’s/ participant’s living situation is an HOA, PMV or Independent Living Situation:

If the CAPI Indivdiual Receives Both Food and Shelter and Does Not Pay Their Pro Rata Share, Then...

HOA situation applies.

If the CAPI Individual Receives Both Food and Shelter and Pays Their Pro Rata Share, Then...

Independent Living situation applies.

If the CAPI Individual Receives Either Food or Shelter (Not Both) and Does Not Pay Their Pro Rata Share, Then...

PMV applies.

If the CAPI Individual Recevies Either Food or Shelter (Not Both) and Pays Their Pro Rata Share, Then...

Independent Living situation applies.

Determining Whether a Marital Relationship Exists

Two individuals are considered married if they are:

Legally married under the laws of the state where they make their permanent home;

Note: All states must permit and recognize same-sex marriages. The definition of a married couple follows California Law which includes same-sex marriages occurring in California between June 16, 2008 and November 4, 2008, as well as, marriages of same-sex individuals performed in California on or after June 13, 2013.

Entitled to Title II Social Security benefits, one as the spouse of the other; or
Living together in the same household and holding themselves out as a married couple to the community in which they live.

Note: For registered domestic partners, they are not considered married under California law; thus, they do not fall within the definition of “eligible couple.” They may apply for CAPI benefits; however, individually and if they meet all CAPI requirements, each may be qualified to receive CAPI under Individual Payment Standard.

Married couples, whether the couple is same-sex or opposite-sex, may be qualified for CAPI as a couple if they meet all CAPI requirements (aged, blind, or disabled, legal immigrants, resources, income, California residency and living arrangements).

Note: A married couple’s benefits will be under the Couple Payment Standard.

When Two Individuals are No Longer Considered Married

If Two Individuals Stated They Are No Longer Married, Then...

The following must have occurred:

Either individual dies.
They receive an issuance of a final decree of annulment or divorce.
Either individual begins living with a different person whom the agency would also recognize as a spouse.
They change their permanent home to a state whose laws do not recognize their marriage.
They no longer hold themselves out as married.
They are no longer married for Title II Social Security purposes.

If a Marital Relationship Ends by Death, Divorce, or Annulment in the Same Month It Began, Then...

Treat the marriage as if it had never existed. Otherwise, the termination of marriage is effective the month after the month of death, divorce, or annulment.

If the Couple Alleges That They Are Divorced, Then...

Obtain a copy of the divorce decree.

Note: Two individuals are no longer married as of the date they receive issuance of a final decree of divorce.

If the couple provides the proof of a divorce, the EW should evaluate each CAPI participant based upon each participant’s own income (such as pensions and other income). Although the living arrangement details were not provided, the county must determine if any applicable In-kind and support exists.

If the Couple States They Are Divorced and Are Still Living Together, Then...

Obtain signed statements from both individuals explaining why they are living together (e.g., illness, economic reasons).

If the couple is truly separated or divorced (but reside in the same place), then the county should treat them as individual CAPI cases. If they are living with others and receiving some type of ISM, then that must be developed.

Processing a Couple that Has Resumed Living Together

A marital relationship exists when two individuals resume living together after having lived together previously as a married couple. In such a case, the individuals are considered in a marital relationship unless evidence is provided that they are not.

Evidence that proves the couple is not in a marital relationship includes evidence of a divorce or the termination of a holding out relationship.

If the Couple Is Still Legally Married Under the Laws of the State Where They Make Their Permanent Home and They Resume Living Together After Having Lived Apart, Then...

They are a married couple regardless of the reason they resumed living together.

Note: All states must permit and recognize same-sex marriages.

If the Couple Alleges That They Are Legally Separated, Then...

Consider the couple to be married since a legal marriage still exists.

Note: Legal separation does not imply that the couple is not living together.

If the Couple Alleges That They Are Divorced, Then...

Obtain a copy of the divorce decree. Obtain signed statements from both individuals explaining why they are living together (e.g., illness, economic reasons) and determine if they are holding themselves out to the community as married.

If the Couple Alleges That They Are No Longer Holding Themselves Out as Married, Then...

Accept their allegation unless there is contrary evidence provided.

Forms

SOC 887 CAPI Non-Medical Out-of-Home Care (NMOHC) Payment Standard Eligibility Determination

SOC 887A Retroactive Certification of NMOHC Payment Standard Eligibility

SOC 453, CAPI Statement of Household Expenses and Contributions

Examples

Example 1 – Pro Rata Share

Mr. Estrada resides with two other people. The total household expenses, including food, shelter and clothing, are $900. The total expenses of $900 divided by 3 is $300. The pro rata share is $300 and the applicant/participant must pay at least $300 towards expenses.

If the applicant/participant pays less than $300, then ISM applies. The next step is to determine if the applicant’s/participant’s situation falls under the category of a HOA or PMV.

Example 2 – HOA

Mrs. Jones lives with her daughter. The total number of members in the household is five. The total expenses of the household are $2,500. To determine the pro rata share, divide $2,500 by 5, which equals $500. Mrs. Jones only pays $250 for her share of the expenses. Since Mrs. Jones received both food and shelter from her daughter and pays less than her pro rata share, she would be considered to be living in the “Household of Another.”

Example 3 – PMV

Mrs. Jones lives with her daughter. The total number of members in the household is five. The total expenses of the household are $2,500 divided by 5, which equals $500. Mrs. Jones pays only $250 for her share of the expenses. Mrs. Jones has a special diet and eats separately from her daughter. Since Mrs. Jones does not receive both food and shelter and does not pay her pro rata share, PMV applies.

Note: In this instance, Mrs. Jones would be able to apply for CalFresh separately from her daughter.

System Screens

N/A

References

Administrative Directive (AD) No. 5644 California Domestic Partner and Same-Sex Spouse, dated June 25, 2020

Social Security Administration (SSA) – Program Operations Manual System (POMS): SI 00501.150 Determining Whether a Marital Relationship Exists

SSA – POMS: SI 00835.120 Rental Liability as LA Basis

Obsolete Docs

N/A

Contact

Administrative staff may contact the GR Special Projects & SSI Advocacy Section at (562) 908-6732.

Revision Date

N/A

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