Form Soc 369a - Kinship Guardianship Assistance Payment (Kin-Gap) Program Agreement Amendment Page 2
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39. For a youth eligible for a Kin-GAP benefit who is a teen parent and has a child living in the same home, the rate may
include a two hundred dollar ($200) monthly payment made to the relative caregiver in a whole family foster home.
10. If a child is living with a teen parent who is eligible for Kin-GAP benefits, the rate paid to the relative guardian on behalf
of the teen parent shall include the “infant supplement” which is an additional benefit for the care and supervision of the
child.
11. Payments on behalf of a child who is a recipient of Kin-GAP benefits and who is also a consumer of a California regional
center services shall be based on the dual agency rates established by the State Department of Social Services.
12. Continuation of the Kin-GAP benefit depends upon my/our responsibility for the support of the child and on the child’s
continued receipt of my/our support.
13. I/We agree to inform the agency immediately if any of the following occurs:
•
Our address changes.
•
The youth is no longer residing in the family home.
•
I/We are no longer providing any type of support to the youth.
•
I/We are no longer responsible for the support of the youth.
•
Guardianship is terminated and/or dependency is reinstated.
•
The child begins to receive earned or unearned income (i.e., Social Security, SSI/SSP, other).
Failure to report these changes may result in an overpayment which may be recovered by a one-time charge or a
reduction in current and future Kin-GAP benefits.
14. I/We understand that ______________________ will remain eligible to receive a Kin-GAP benefit from the State of
(NAME OF CHILD)
California regardless of where I/we reside.
15. I/We understand that under the terms of this agreement the child is eligible for medical services under Medi-Cal,
California’s Medicaid program. It is understood that if we move to another state we will need to apply for Medicaid in
that state. I/We are aware that medical coverage and social services may vary in other states.
16. I/We understand that the child will not be eligible to receive a Kin-GAP payment after reaching the age of 18 years
unless he or she is in school and is expected to graduate by the age of 19 years.
17. Effective January 1, 2012, a former dependent child or ward of the juvenile court who is eligible for the Kin-GAP program
and who attained 16 years of age before originally entering the Kin-GAP program shall continue to receive aid up to 19
years of age; effective January 1, 2013, up to 20 years of age; and, effective January 1, 2014, up to 21 years of age [the
extension of benefits for those between 20 and 21 years of age shall be contingent upon appropriation by the California
Legislature], as long as one or more of the following conditions exist:
(1) The individual is completing secondary education or a program leading to an equivalent credential.
(2) The individual is enrolled in an institution which provides postsecondary or vocational education.
(3) The individual is participating in a program or activity designed to promote or remove barriers to employment.
(4) The individual is employed for at least 80 hours per month.
(5) The individual is incapable of doing any of the activities described in (1) to (4), inclusive, due to a medical condition,
and that incapability is supported by regularly updated information in the case plan of the individual.
18. Kin-GAP benefits shall continue to age 21 if the youth has a physical or mental disability that warrants the continuation
of assistance.
Pursuant to Welfare and Institutions Code Section 1403(c), relative guardians who receive Kin-GAP payments are
responsible for reporting to the responsible public agency when the nonminor former dependent no longer satisfies at
least one of the five conditions described above.
SOC 369A (7/15) REQUIRED FORM - NO SUBSTITUTES PERMITTED
PAGE 2 of 3
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