49-025 AGE AND DISABILITY

.1 To be eligible for CAPI as an aged individual, a person must be 65 years of age or older. .11 An applicant must submit evidence of his or her date of birth in accordance with federal regulations. .111 An applicant whose age is a condition of eligibility must submit a public record of birth, or a religious record of birth or baptism recorded before age 5, if available. If such records are not available, other evidence may be submitted to establish the applicant’s date of birth. If the applicant alleges to be at least age 68, any document submitted that is at least 3 years old will be sufficient. .2 To be eligible for CAPI as a blind individual, a person must meet the requirements specified in 20 CFR 416.981 et seq. for the SSI/SSP program. Effective 7/1/08 HANDBOOK BEGINS HERE .21 A person who is determined to be statutorily blind is considered blind for purposes of SSI/SSP eligibility as stated in 20 CFR 416.981: "Statutory blindness is central visual acuity of 20/200 or less in the better eye with the use of a correcting lens. An eye which has a limitation in the field of vision so that the widest diameter of the visual field subtends an angle no greater than 20 degrees is considered to have a central visual acuity of 20/200 or less." HANDBOOK ENDS HERE .22 The Department’s Disability and Adult Programs Division is responsible for making all blindness and disability determinations for CAPI. .221 A current determination of blindness established for Title II Social Security, SSI/SSP, or Medi-Cal can be used to establish blindness for CAPI. A current determination is one that has not lapsed due to benefit termination. HANDBOOK BEGINS HERE .222 Medical History and related forms must be completed and transmitted to the State Programs Branch of the Disability and Adult Programs Division along with any other medical documentation. The required forms are the MC 220, MC 221, and MC 223 and must be annotated with the identifier "CAPI CASE". HANDBOOK ENDS HERE .3 To be eligible for CAPI as a disabled individual, a person must meet the requirements specified in 20 CFR 416.901 et seq. for the SSI/SSP program. Effective 10/16/03 HANDBOOK BEGINS HERE .31 20 CFR 416.905(a) defines disability for adults as follows: "(a) The law defines disability as the inability to do any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months." To meet this definition, applicants must have a severe impairment, which makes them unable to do their previous work or any other substantial gainful activity which exists in the national economy. To determine whether a person is able to do any other work, SSA considers a person’s residual functional capacity, age, education, and work experience." .32 20 CFR 416.906 defines disability for children under age 18 as follows: "If you are under age 18, we will consider you disabled if you have a medically determinable physical or mental impairment or combination of impairments that causes marked and severe functional limitations, and that can be expected to cause death or that has lasted or can be expected to last for a continuous period of not less than 12 months...." HANDBOOK ENDS HERE .33 Any child or adult who is engaging in substantial gainful activity at the time of filing a new CAPI application will not be considered disabled. .34 The Department’s Disability and Adult Programs Division is responsible for making all blindness and disability determinations for CAPI. .341 A current determination of disability established for Title II Social Security, SSI/SSP or Medi-Cal can be used to establish disability for CAPI. A current determination is one that has not lapsed due to benefit termination. HANDBOOK BEGINS HERE .342 Medical History and related forms must be completed and transmitted to the State Programs Branch of the Disability and Adult Programs Division along with any other medical documentation. The required forms are the MC 220, MC 221, and MC 223 and must be annotated with the identifier "CAPI CASE". HANDBOOK ENDS HERE Effective 10/16/03 .4 Counties may make a Presumptive Disability determination while awaiting the formal disability or blindness determinations from the State Programs Branch. HANDBOOK BEGINS HERE .41 The Presumptive Disability decision may only be made when the applicant meets specific diagnoses listed below: (a) Amputation of two limbs. (b) Amputation of a leg at the hip. (c) Allegation of total deafness. (d) Allegation of total blindness. (e) Allegation of bed confinement or immobility without a wheel chair, walker or crutches, due to a long-standing condition (excluding recent accident or recent surgery). (f) Allegation of stroke (cerebral vascular accident) more than 3 months in the past and continued marked difficulty in walking or using a hand or arm. (g) Allegation of cerebral palsy, muscular dystrophy, or muscle atrophy and marked difficulty in walking (e.g., use of braces), speaking, or coordination of hands or arms. (h) Allegation of diabetes with amputation of foot. (i) Allegation of Down's Syndrome. (j) Allegation of severe mental deficiency made by another individual filing on behalf of the claimant who is at least 7 years old. (For example: A mother filing for benefits for her child states that the child attends (or attended) a special school, or special classes in school, because of mental deficiency or, is unable (or was unable) to attend any type of school, and requires care and supervision of routine daily activities.) Note: "mental deficiency" means mental retardation. This category pertains to individuals who depend upon others for meeting personal care needs such as hygiene and for doing other routine activities which grossly exceeds age- appropriate dependence as a result of mental retardation. HANDBOOK CONTINUES Effective 10/16/03 HANDBOOK CONTINUE (k) A child is age 6 months or younger and the birth certificate or other evidence (e.g., hospital admission summary) shows a weight at birth below 2 pounds, 10 ounces (1,200 grams). (l) Human immunodeficiency virus (HIV) infection (accompanied by a medical-source statement regarding manifestations of illness.) (m) A child is 6 months or younger and available evidence (e.g., hospital admission summary) shows a gestational age at birth as follows: Gestational Age (in weeks) Birth Weight 37-40 Less than 2,000 grams (4 lbs. 6 oz.) 36 1,875 grams or less (4lbs. 2 oz.) 35 1,700 grams or less (3 lbs. 12 oz.) 34 1,500 grams or less (3 lbs. 5 oz.) 33 1,325 grams or less (n) A physician or knowledgeable hospice official confirms an individual is receiving hospice services due to terminal cancer. HANDBOOK ENDS HERE .42 To be eligible for CAPI benefits based on a finding of presumptive disability, a person must meet all other eligibility criteria. .43 CAPI payments based on presumptive disability cannot be made for longer than 6 months. .44 Payments based on a presumptive disability are not considered overpayments if the applicant is ultimately determined to be not blind or disabled. NOTE: Authority cited: Sections 10553, 10554, and 18943, Welfare and Institutions Code. Reference: 20 CFR 404.1505; 20 CFR 404.1581; 20 CFR 416.202; 20 CFR 416.906; 20 CFR 416.920; 20 CFR 416.931 through .944; 42 CFR 435.530; 42 CFR 435.540, and Sections 18937 and 18940, Welfare and Institutions Code. Effective 10/16/03