49-050 LIVING ARRANGEMENTS AND BENEFIT CATEGORIES

.1 CAPI payment standards are equivalent to SSI/SSP payment standards, except that: .11 The payment standards for individuals are $10 less than the SSI/SSP payment standards for individuals. .12 The payment standards for eligible couples are $20 less than the SSI/SSP payment standards for eligible couples. .13 The payment standards for couples when one member is receiving or applying for CAPI and the other is receiving SSI/SSP is $10 less than the SSI/SSP payment standards for eligible couples. .2 A person’s living arrangement affects which CAPI payment standard is selected to determine the individual’s benefit amount. Living arrangements are always determined as of the first moment of the month and that determination is the basis for the payment standard used for that month, subject to the throughout-a- month rule for institutions or reduced needs living arrangements. The living arrangements for CAPI described below are determined in the same manner as they are for SSI/SSP. .21 Independent living means that one of the following conditions applies to the person (or spouse or parent whose income is deemed to the applicant or recipient living in the same home): .211 Has ownership interest in the home. .212 Has rental liability. .213 Lives alone. .214 Lives with others and pays a pro rata share of the shelter and/or food expenses. .215 Lives with others and all members of the household receive public income maintenance payments. .22 Independent living without cooking facilities means that the aged or disabled individual meets one of the criteria in Section 49-050.21, does not have a stove and refrigerator available for his or her use, and does not have meals provided as part of the living arrangement. .221 Detailed provisions are found in MPP Section 46-160. Effective 10/16/03 .23 Reduced needs with in-kind room and board means that none of the conditions listed in MPP Section 49-050.21 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 MPP Section 49-035.521. .231 This living arrangement does not apply if the person supplying the support and maintenance is the spouse of the recipient or applicant, or parent if the recipient or applicant is a minor child. .24 Nonmedical out-of-home care means receiving room, board and care and supervision related to the person’s individual needs in a licensed nonmedical facility, or the home of a relative. .241 Detailed provisions are found in MPP Section 46-140. .242 The reduced needs nonmedical out of home care payment standard applies to persons who meet the conditions in MPP Section 49-050.23 above and are receiving care and supervision while living in the home of a relative. .243 The higher nonmedical out-of-home care payment standard applies to all other persons who receive care and supervision in a licensed facility, or who live in the home of a relative and meet one of the conditions listed in MPP Section 49-050.214 or .215 above. .25 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. .251 The reduced needs payment standard for children may apply to children living with a parent(s) if the parent meets the conditions in MPP Section 49-050.23 above. .252 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 described in MPP Section 49-050.24 above are met. .253 Benefits for blind children are determined using the payment standards for blind adults. .26 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 percent of the cost of the person’s care. Effective 10/16/03 .261 An exception to the Title XIX medical facility rule applies, and one of the other payment standards would be used when a recipient is temporarily confined for medical care and all of the following apply: (a) The individual must have been eligible for 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. (b) A physician must certify that the recipient is expected to be medically confined for 90 consecutive days or less. (c) The recipient must demonstrate that he or she needs to pay some or all of the expenses of maintaining the home or living arrangement to which he or she may return. .27 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. NOTE: Authority cited: Sections 10553, 10554, and 18943, Welfare and Institutions Code. Reference: 20 CFR 416.414; 20 CFR 416.1131 - 416.1132; 20 CFR 416.1148; Section 1611(e)(1)(G) of Title XVI of the Social Security Act, and Sections 12200, 12201.5, 18940, and 18941, Welfare and Institutions Code.