Blindness/Disability

Blindness

To qualify as blind, a person must be found “statutorily blind” or meet presumptive disability standards. Statutory blindness is central visual acuity of 20/200 or less in the better eye with the use of a corrective lens.

Note: Work or the ability to perform SGA is not a factor in determining blindness.

Disability

To qualify as disabled, a person must be found to have the inability to do any SGA due to a 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.

The DDSD will make a determination of eligibility based on medical documentation provided. The DDSD process for CAPI is the same as for Medi-Cal determinations.

[Refer to Medi-Cal Handbook, [“DDSD — EW Procedures,” page 22-46]. for more information]

Note: A new DDSD referral is NOT needed if client’s disability-based Medi-Cal benefit is active, unless it is a sponsor-deeming disability evaluation. The EW must ensure that the reexamination date of the current DDSD determination has not expired and there is no indication that the medical condition has improved.

Types of CAPI DDSD Evaluation

There are two types of disability evaluations for CAPI:

  1. Regular Disability
    1. This applies to CAPI applicants who are under 65 years old. Disability must be established before CAPI benefits can be approved. A determination established for one of the following programs is acceptable verification of blindness or disability for CAPI:
      1. Title II Social Security,
      2. SSI/SSP, or Medi-Cal.
    2. If there is no existing verification of a physical or mental disability from Title II Social Security, SSI/SSP, or Medi-Cal, a DDSD referral must be completed to be eligible for disability-based CAPI.

      1. Note: If the disabled individual is age 65 or over, CAPI benefits may be paid on the basis of age while the disability determination is pending, if all eligibility is met.

  2. Sponsor-Deeming Disability
    1. This only applies to sponsored noncitizens whose sponsor signed the “Affidavit of Support” (I-134). If DDSD determines that the sponsored noncitizen becomes blind or disabled AFTER admission to the United States, deeming of sponsor’s income and property will be inapplicable or will cease.
    2. A new DDSD referral is still needed for sponsor-deeming disability evaluations even if there is a current DDSD determination and client’s disability-based Medi-Cal is active.

Refer to Disability Determination Service Division (DDSD) Referral.

Presumptive Disability

EWs may make a Presumptive Disability determination while awaiting the formal disability decision from DDSD. A Presumptive Disability determination may only be made when the applicant/recipient meets a specific diagnosis as listed below:

  • Amputation of two limbs.
  • Amputation of a leg at the hip.
  • Allegation of total deafness.
  • Allegation of total blindness.
  • 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).
  • Allegation of a stroke (cerebral vascular accident) more than 3 months in the past and continued marked difficulty in using a hand or arm.
  • 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.
  • Allegation of Down’s Syndrome.
  • Allegation of a severe mental deficiency made by another individual filing on behalf of the claimant who is at least seven years old.

    • Note: “Mental Deficiency” means mental retardation. This category pertains to individuals who depend on 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.

  • A child is age six months or younger and the birth certificate or other evidence (e.g. hospital admission summary) shows a weight at birth below two pounds, ten ounces (1,200 grams).
  • HIV infection (accompanied by a medical-source statement regarding manifestations of illness).
  • A child is age six months or younger and available evidence (e.g. hospital admission summary) shows a gestational age at birth.
  • A physician or knowledgeable hospice official confirms an individual is receiving hospice services due to terminal cancer.
  • EWs may approve CAPI benefits based on Presumptive Disability as long as the client meets all other eligibility criteria.
  • CAPI payments based on Presumptive Eligibility must NOT be made for longer than six (6) months.

    • Note: CAPI benefits based on a presumptive disability are not considered overpayments if the CAPI client is ultimately determined to not be blind or disabled by DDSD.

Related Topics

Deeming Exception Due to the Sponsored Noncitizen’s Disability (for I-134 only)