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Non-Medical Out-of-Home Care (NMOHC)
CAPI individuals (adults or minors), and couples who receive non-medical care and supervision (personal and domestic services) from a relative, legal guardian, conservator, or licensed facility staff, may qualify for the NMOHC payment standard if they reside in a qualifying living arrangement.
Definitions
The following general definitions apply to terms used when discussing NMOHC.
Non-medical Care or Supervision
NMOHC services are defined as non-medical care or supervision and may include, but are not limited to, services such as assistance in dressing, grooming, bathing, and other personal hygiene; assistance with storing, distributing, or taking medication; arrangement of and assistance with medical and dental care, including transportation; supervision of individual’s schedule and activities; and monitoring food intake or special diets.
Able and Available Spouse
When a CAPI individual is living with their ineligible spouse, regardless of the household/living arrangement, the ineligible spouse is presumed able and available to provide care and supervision as if the couple lived in their own household. An individual living with an ineligible spouse is not eligible to receive the NMOHC payment standard.
Ineligible Spouse
An ineligible spouse is someone living with the claimant as husband or wife and is either ineligible for CAPI or SSI/SSP or is otherwise eligible but does not apply for either benefit.
Relative
A relative is defined as a parent, son, daughter, brother, sister, half-brother, half-sister, uncle, aunt, niece, nephew, first cousin, or any person of the preceding generation denoted by the prefix “grand” or “great.” .
State Licensed NMOHC Facility
A “state licensed NMOHC facility” includes:
- A licensed residential care or licensed community care facility; or
- A licensed foster care facility, including but not limited to a foster family or group home (including youth over the age of 18 in extended foster care up to age 21 (up to age 22 with special health needs).
Definitions of living arrangements specifically for children include, but are not limited to:
Certified Family Home
A certified family home is a family residence that is certified by a licensed FFA, is issued a certificate of approval by that agency as meeting licensing standards, and is used only by that foster family agency for placements. Residents may be children under 18 or those in extended foster care after the age of 18.
Foster Family Home
A foster family home is a state or county home licensed by the CCLD. Residents may be children under 18 or those in extended foster care after the age of 18.
Group Home
A group home is a licensed facility that provides 24-hour care and supervision to children, provides specified services to a specific client group, maintains a structured environment and provides such services, at least in part, by staff employed by the licensee. Residents may be children under 18 and those in extended foster care after the age of 18.
Definition of a living arrangement specifically for adults includes, but is not limited to:
Family Home for Developmentally Disabled Adults
FH are a type of facility for developmentally disabled adults established through CDDS. CAPI recipients residing in Family Homes are eligible for NMOHC assuming: (1) the provider is not the spouse of the recipient and (2) the residence is not the recipient’s own home. Similar to other NMOHC facilities, the Family Home provides room, board, personalized care and supervision to its residents.
Qualifying Living Arrangements
Qualifying Living Arrangements for Adults (age 18 or older)
Any of the following is a NMOHC qualifying living arrangement for adults:
- An aged, blind, or disabled individual/couple who resides in a state licensed NMOHC facility;
- An aged, blind, or disabled individual who resides in a Family Home approved by a Family Home Agency acting on behalf of a California Regional Center;
- An aged, blind, or disabled individual/couple who resides in the household of a relative, legal conservator or guardian and receives non-medical care and supervision from a relative who lives either inside or outside the household.
Qualifying Living Arrangements for Minors (under 18 years old)
Any of the following is a NMOHC qualifying living arrangement for adults:
- A blind or disabled child who resides in a state licensed NMOHC facility;
- A disabled child residing in the home of a relative who is not a parent;
- A disabled child residing in the home of a legal guardian/conservator who is not a relative;
- A blind child who resides in the household of a relative who is not a parent and not a legal guardian/conservator;
- A blind or disabled child who resides in a "certified family home" approved by a licensed foster family agency;
- A youth who receives extended foster care after the age of 18 (non-minor dependent) and who resides in a licensed/certified foster care home.
Living arrangements NOT eligible for the NMOHC payment standard:
- An adult who owns his or her residence or has rental liability for the residence;
- An adult whose ineligible spouse (as defined on page 3 of this ACL) is able and available, and resides in the same household, regardless of the household/living arrangement;
- An adult who resides with a non-relative who is not the claimant’s conservator or legal guardian;
- An adult who resides in a facility that is not a state licensed or approved Family Home facility;
- A disabled child living with his or her parent(s);
- A blind child (under age 18, or age 18 to 21 and attending school or training full-time) who resides in the household of his or her parent or legal guardian;
- A blind or disabled child who resides in a certified family home, foster family home, or group home that is not currently licensed by the CCLD or the CDDS (as applicable).
Note: CAPI individuals who are ineligible for the NMOHC payment standard but might have a need for non-medical care and supervision must be informed of IHSS and must be provided with the contact telephone number (408) 792-1600.
CAPI claimants residing with relatives may nonetheless be deemed to be living in their “own home” for the purpose of IHSS and may therefore qualify for IHSS services.
CAPI individuals may only be eligible for either NMOHC or IHSS, but not both. The EW must inform the CAPI individual of the two options: reduced needs payment standard or the independent living payment standard will apply to individuals who choose IHSS.
Important: Refer to NMOHC Payment Standard - Flow Charts below in this chapter.
NMOHC Payment Standard
The maximum monthly amount of CAPI available under the NMOHC payment standard will depend on the individual’s living arrangement. The Eligibility Worker must develop the facts surrounding a individual’s living arrangement to determine which of the following NMOHC payment standard levels apply:
Household of Another in NMOHC Payment Standards (With In-Kind Room and Board)
The HOA non-medical out-of-home care payment standard applies to persons who:
- Meet the living arrangements conditions of the HOA (living with a relative, legal guardian, or conservator), AND
- Are receiving care and supervision in addition to BOTH food and shelter from within the household.
- (Care and supervision includes: assistance with activities of daily living such as taking medication, dressing, bathing, toileting, grooming and personal hygiene, monitoring food intake or special diets, maintenance and/or supervision of their cash resources, protective supervision, and other specified personal and domestic services).
Higher Standard (Licensed Facility or Without In-Kind Room and Board)
The higher NMOHC payment standard applies to persons who live in a:
Licensed Facility/RCH
The CAPI individual receives care and supervision in a LICENSED RCH and pays for both room and board.
Relative’s Home
The CAPI individual lives in the home of a relative where he/she receives care and supervision, and either:
- Pays a prorated share of household living expenses, or
- All members of the household receive public assistance.
Effective Date and Partial Month Proration
The effective date of a claimant’s NMOHC certification is the month in which he or she moved into the licensed facility. Although CAPI eligibility requirements must be satisfied, residency at the licensed facility throughout the month is not required. The NMOHC benefit amount must be prorated for any claimant residing in a licensed facility for a partial month.
Forms Used in the Determination of NMOHC Payment Standard
The forms below must be used in the determination of NMOHC payment standards:
- SOC 887 - CAPI Non-Medical Out Of Home Care Payment Standard Eligibility Determination.
- This must be completed each time a claimant answers “Yes” to Questions 4 or 5 on SOC 453- CAPI Statement of Household Expenses and Contributions.
- SOC 887A: Retroactive Certification of NMOHC Payment Standard Eligibility.
- Is to be used when the CAPI individual cannot provide evidence of an earlier NMOHC start date, which is required to determine the start date of NMOHC services.
Verification of NMOHC
To be eligible for the NMOHC payment standard, a CAPI individual must either reside in a licensed facility or reside in the home of a relative or legal guardian/conservator and receive care and supervision from a relative or legal guardian/conservator living inside the home or a relative outside the household.
Licensed Facilities
The CDSS CCLD oversees the licensure of facilities and residences that provide care and supervision to low-income aged, blind, and/or disabled individuals who might otherwise become homeless. Such facilities include group homes, foster family homes, ARF, and RCFE (also known as “assisted living” or “board and care” facilities).
To determine whether a facility has an active license, the EW must either confirm this information on the CCLD website or speak to a CCLD representative at the CCBI at 844-538-8766. Do not verify licensure by contacting the facility.
Important: NMOHC payment standards can be authorized only for facilities that are shown as “Licensed.” Facilities with a “Pending” licensure status are to be treated as unlicensed facilities. NMOHC must not be authorized for residents of such facilities.
Family Homes, by contrast, are exempt from state licensing requirements and are not under the jurisdiction of the CCLD. Rather, they are regulated through the CDDS. EWs can verify that a facility has been approved as a Family Home by contacting the Family Home’s local regional center. A list of regional centers and jurisdictions is available online at DDS.
The EW must document the confirmation of the facility’s license or approval in the CAPI case in a Journal Entry.
Relative’s Home
To verify that the CAPI individual is living in the home of a relative, a rental/lease agreement; utility bills; or California State ID/driver license; can be an acceptable form of verification.
To verify that the CAPI individual is being provided care and supervision from a relative or legal guardian/conservator living inside the home, an affidavit/Sworn Statement (SCD 101) from such person stating that he or she is providing the CAPI individual with care and supervision, is sufficient.
The affidavit/sworn statement must be used in addition to the claimant completing SOC 887A (the claimant's self-attestation as to when NMOHC services started). A cross-reference should be done on the individual’s attested NMOHC living arrangement with information listed on SOC 814 or SOC 804 to verify consistency in information reported.
NMOHC Payment Standard - Flow Charts
The table below can serve as a guide in the determination of qualified and non-qualified living arrangements:
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