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 Social Services Benefits Specialist (SSBS) 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.

Important: The SSBS must indicate any reasonable accomodations and/or auxiliary aids and services the client needs in section 10 of the MC 221. Refer to "Reasonable Accommodation" in the General Information topic.

Types of CAPI DDSD Evaluation

There are two types of disability evaluations for CAPI:

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.
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

SSBSs 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 who has not attained their first birthday, and the birth certificate or other medical evidence (e.g. hospital admission summary) shows a weight at birth below two pounds, ten ounces (1,200 grams) at birth.
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.
Allegation of a spinal cord injury producing an inability to move without the use of a walker or bilateral hand-held assistive device for more than two weeks (with confirmation of such status from an acceptable medical source).
Allegation of intellectual disability or another neurodevelopmental impairment (e.g., autism spectrum disorder), with a complete inability to independently perform basic self-care activities (such as toileting, eating, dressing, or bathing), made by another person who files on behalf of an applicant who is at least 4 years old.
Allegation of End Stage Renal Disease (ESRD) requiring chronic dialysis.
Allegation of Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease.
A physician confirms by telephone or in a signed statement that an individual has a terminal illness with a life expectancy of six months or less, or a physician (or hospice official, e.g., hospice coordinator, staff nurse, social worker, or medical records custodian) confirms that an individual is receiving hospice services because of a terminal illness.
Symptomatic HIV infection or Acquired Immunodeficiency Syndrome (AIDS).

SSBSs 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. However, an overpayment may occur if presumptive disability payments are issued incorrectly due to a non-disability factor (e.g., excess income, resources, living arrangements, etc.).

Applicant 65 or Older and Alleging Blindness

When an applicant is age 65 or older, and alleges blindness, the SSBS should authorize the higher blind payment standard for the six-month presumptive period. If six payments have been issued and the DDSD has not yet rendered a final determination, the appropriate benefit amount for an aged individual should be used while the county continues to await DDSD’s response. In this scenario, once DDSD provides a formal determination confirming that the applicant is blind, a retroactive underpayment must be issued to account for the difference in benefits for the months in which the applicant received the aged-individual payment amount.

Discontinuance of Presumptive Disability Payments

Presumptive disability payments end when:

The DDSD makes a formal determination on whether the applicant is blind or disabled;
The sixth month of presumptive payment is issued to the applicant; or
The applicant no longer meets one of the CAPI eligibility requirements.

Note: In cases where all presumptive disability payments have been issued and the county is awaiting DDSD’s determination, the SSBS must not deny, terminate, or suspend the applicant’s CAPI application unless the applicant is no longer eligible for CAPI. These cases must be kept in a pending status until confirmation is received that DDSD has made a determination as to whether the applicant is blind or disabled.

Reapplying for CAPI After a Determination from DDSD

When an individual’s prior application was denied due to a determination from DDSD that they are not blind or disabled, the individual may reapply for CAPI, and another presumptive disability finding may be made only when one of the following applies:

The individual presents sufficient evidence;
There is documentation of a worsening physical or mental condition;
There is documentation of the existence of a new impairment; or
There is a strong likelihood that the claim will be medically approved.

Otherwise, when a previously denied individual reapplies for CAPI and does not meet one of the requirements listed above, presumptive disability payments must not be authorized.

Notice of Actions

Clients must be informed in writing when presumptive disability payments are approved, denied, and when the six months of presumptive disability payments have been exhausted.

Sending the Notice of Approval

When presumptive disability payments are initially authorized, the SSBS must send the client a Notice of Approval Cash Assistance Program for immigrants (CAPI) (NA 693) with the following information included:
“The county has temporarily authorized Presumptive Disability payments (MPP 49-025.4) while your disability determination is reviewed with the Disability Determination Services Division. You can receive no more than 6 months of Presumptive Disability payments. You must meet all other CAPI eligibility requirements while you are receiving Presumptive Disability payments. If a final determination of your disability is still pending after 6 months, pursuant to MPP 49-025.43, CAPI payments will automatically be paused/stopped while awaiting the final determination. Payments based on Presumptive Disability are not considered overpayments if you are determined to be not blind or not disabled so long as you continue to meet all CAPI eligibility requirements while receiving these payments.”

Providing the Notice of Change

When six months of presumptive disability payments have been exhausted and DDSD has not yet rendered a decision on whether the applicant is blind or disabled, the SSBS must send the Notice of Change-Cash Assistance Program for Immigrants (CAPI) (NA 692). The notice must include the following language informing the client that their Presumptive Disability payments will end, but that the county continues to hold the case open while awaiting a determination:
“You have received the maximum number of Presumptive Disability payments allowed under MPP 49-025.4. The county will continue to keep your case open while we wait to receive the notification from the Disability Determination Services Division that you are or are not blind or disabled. Neither the county nor your Social Services Benefits Specialist has the authority to decide disability or blindness. Once the county is notified if you are blind or disabled, we will send you another notice.”

Providing the Notice of Denial

The SSBS must send the Notice of Denial Cash Assistance Program for Immigrants (CAPI) (NA 691) when DDSD determines the applicant is not blind or disabled, or when DDSD indicates no decision could be made (i.e., “not determined”). In cases where DDSD is unable to determine whether the applicant is blind or disabled due to the applicant’s lack of participation or compliance with DDSD’s request(s), the SSBS may deny the application and must state the reason why DDSD was unable to render a decision.
In these circumstances, on the NA 691, the SSBS should select: “You have failed to cooperate with the county application process (see comments). (MPP 49-015.1).” The SSBS must also include a comment identifying the reason why DDSD was unable to determine whether the applicant is blind or disabled.