Disability Determination

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 substantial gainful activity 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 DDSD determinations.

Note: Any child or adult who is engaging in SGA at the time of filing a new CAPI application will not be considered disabled.

Current Determination

A current determination of disability is one that has not lapsed due to benefit termination. A determination established for one of the following programs is acceptable verification of blindness or disability for CAPI:

Title II Social Security,
SSI/SSP, or
Medi-Cal.

Disability Evaluation

There are two types of disability evaluations for CAPI:

Regular Disability

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:

Title II Social Security,
SSI/SSP, or
Medi-Cal.

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.

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

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.

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.

Required DDSD Forms

MC 220 – Authorization for Release of Information
MC 221 – Disability Determination and Transmittal (CAPI case to be flagged)
MC 223 – Applicant’s Supplemental Statement of Facts for Medi-Cal

Annotate the MC 221 with the identifier “CAPI CASE” in Item 8, next to the box that is checked to indicate Initial Referral.

Under Item 10, “County Worker Comment(s),” write if the evaluation is a Regular Disability CAPI or a Sponsor-Deeming Disability CAPI.

Presumptive Disability

If an individual’s blindness / disability meets one of the specified presumptive disability conditions and the individual meets all other CAPI eligibility criteria, CAPI benefits may be paid presumptively pending the final disability determination from DDSD. A presumptive disability determination MUST be documented in a Journal Entry. Refer to Presumptive Disability for a list of conditions.