File 05-10026.TXT Uploaded from F.L.I.C.net on 16-NOV-93 1-(607)-272-1549 (7 days-24 hours, 8-N-1) F.L.I.C.net operated by the: Finger Lakes Independence Center 607 W. Clinton Street Suite 112 Ithaca NY, 14850 Voice/TTY 1-(607) 272-2433 SYSOP: Jon W. Merritt Virus Scanned, McAfee Associates 9.12 V100 Booklet title: "Social Security And SSI Benefits For Children With Disabilities." U.S. Department of Health And Human Services Social Security Administration SSA Publication No. 05-10026 January 1992 ICN 455260 About This Booklet This booklet is written primarily for the parents and caregivers of children with disabilities and adults disabled since childhood. It illustrates the kinds of Social Security and Supplemental Security Income (SSI) benefits a child with a disability might be eligible for and explains how we evaluate disability claims for children. About 3.6 million children already get benefits from Social Security including approximately 450,000 disabled children under the age of 18 who get SSI benefits. This booklet will help you decide if your child, or a child you know, is eligible for Social Security or SSI. What's Inside The Three Ways A Child Can Get Benefits From Social Security Or SSI SSI Benefits For Children With Disabilities Non-Medical Rules How We Decide If A Child Is Disabled For SSI A Special Message To Parents Of Children With Severe Disabilities Children With HIV Infection Social Security Benefits For Older Children With Disabilities And For Adults Disabled Since Childhood Non-Medical Rules How We Decide If An Adult Child Is Disabled Applying For Social Security Or SSI Benefits ... And How To Expedite The Process Medicaid And Medicare To Learn More About Social Security And SSI The Three Ways A Child Can Get Benefits From Social Security Or SSI There are three ways a child might be eligible for benefits from Social Security or SSI. The three kinds of benefits are: 1) Social Security Dependents Benefits--These are benefits payable to children under the age of 18 on the record of a parent who is collecting retirement or disability benefits from Social Security, or survivors benefits payable to children under the age of 18 on the record of a parent who has died. Although children eligible for these benefits might be disabled, we do not need to consider their disability to qualify them for benefits. In other words, a child under age 18 is eligible for Social Security merely because he or she is the dependent child of someone getting retirement or disability benefits, or of a parent who has died. Note: A child can continue receiving dependents or survivors benefits until age 19 if he or she is a full-time student in elementary or high school. About 2.6 million children receive dependents or survivors benefits from Social Security. 2) Social Security Benefits For Adults Disabled Since Childhood--The benefits explained in the previous section normally stop when a child reaches age 18 (or 19 if the child is a full-time student). However, those benefits can continue to be paid into adulthood if the child is disabled. To qualify for these benefits, an individual must be the son or daughter of someone who is getting Social Security retirement or disability benefits, or of someone who has died, and that child must have a disability that began prior to age 22. Although most of the people getting these benefits are in their 20's and 30's (and some even older), the benefit is considered a "child's" benefit because of the eligibility rules. About 600,000 people receive "disabled adult child's" benefits. 3) SSI Benefits For Children--These are benefits payable to disabled children under age 18 who have limited income and resources, or who come from homes with limited income and resources. About 450,000 children with disabilities currently receive SSI payments. SSI Benefits For Children With Disabilities Non-Medical Rules SSI is a program that pays monthly benefits to people with low incomes and limited assets who are 65 or older, blind, or disabled. Children can qualify if they meet Social Security's definition of disability (see pages 7 and 8) and if their income and assets fall within the eligibility limits. As its name implies, Supplemental Security Income supplements a person's income up to a certain level. The level varies from one state to another and can go up every year based on cost-of-living increases. Check with your local Social Security office to find out more about the SSI benefit levels in your State. Rules For Children Under 18 Most children do not have their own income and do not have many as sets. However, when children under age 18 live at home (or are away at school but return home occasionally and are subject to parental control), we consider the parent's income and assets when we decide if the child qualifies. We refer to this process as "deeming" of income and assets. Check with your Social Security office for information about your child's specific situation and for a full explanation of the "deeming" process. Rules For Children 18 And Older When a child turns 18, we no longer consider a parent's income and assets when we decide if he or she can get SSI. A child who was not eligible for SSI before his or her 18th birthday because a parent's income or assets were too high may become eligible at 18. On the other hand, if a child with a disability who is getting SSI turns 18, continues to live with his or her parent(s), but does not pay for food or shelter, a lower payment rate may apply. How We Decide If A Child Is Disabled For SSI While your local Social Security office decides if your child's income and assets are within the SSI limits, all documents and evidence pertaining to the disability are sent to a State office, usually called the Disability Determination Service (DDS). There, a team, comprised of a disability evaluation specialist and a doctor, reviews your child's case to decide if he or she meets our definition of disability. If the existing records available are not thorough enough for the DDS team to make a decision, you may be asked to take your child to a special examination that Social Security will pay for. It is very important that you do this. Defining "Disability" To understand how Social Security evaluates disabilities in children, you must first understand how Social Security defines disability in general. To qualify for a Social Security or SSI disability benefit, a person must have a physical or mental impairment that is expected to keep him or her from doing any "substantial" work for at least a year. (Generally, a job that pays $500 or more a month is considered "substantial" work.) Or a person must have a condition that is expected to result in his or her death. Deciding SSI Disability For Children Under 18 Of course, a child's disability cannot be evaluated using these work related adult criteria. The law states that a child will be considered disabled if he or she is not working and has an impairment that is as severe as one that would disable an adult. This means the condition must limit the child's ability to function like other children of the same age so much that the impairment is comparable to one which would make an adult disabled. To make this decision, the disability evaluation specialist first checks to see if the child's disability can be found in a specific listing of impairments that is contained in Social Security's regulations, or if the condition is equal to an impairment that is on the list. These listings are descriptions of symptoms, signs, or laboratory findings of physical and mental problems, such as cerebral palsy, mental retardation, or muscular dystrophy, that are severe enough to disable a child. If the symptoms, signs, or laboratory findings of the child's condition are the same as, or equal to, the listing, he or she is considered disabled for SSI purposes. If a disability cannot be established using the "listing" criteria, then the disability evaluation team will assess the child's ability to function in everyday life. Children are considered "disabled" for SSI purposes if their impairment substantially reduces their ability to do the things and behave in the ways that children of a similar age normally do. A Special Message To Parents Of Children With Severe Disabilities The disability evaluation process generally takes several months. But the law includes special provisions for people (including children) signing up for SSI disability whose condition is so severe that they are presumed to be disabled. In these cases, SSI benefits are paid for up to 6 months while the formal disability decision is being made. (Of course, these payments can only be made if the child meets the other eligibility factors explained on pages 5 and 6). Following are some of the disability categories in which we can presume the child is disabled and make immediate SSI payments: * Deafness+ * Blindness * Cerebral Palsy * Down Syndrome * Muscular Dystrophy+ * Significant mental deficiency * Diabetes (with amputation of one foot) * Amputation of two limbs * Amputation of leg at the hip +In some cases If we make these special payments, and if we later decide that the child's disability is not severe enough to qualify for SSI, the benefits do not have to be paid back. Children With HIV Infection Young children with HIV infection differ from adults, or even from older children (age 13 or older), in the way the infection is acquired and in the course of the disease. DDS disability examiners and doctors have been provided with extensive guidelines to use when evaluating claims for children involving HIV infection. Some children may not have the conditions specified in our current guidelines for evaluating HIV infection, but may have other signs and symptoms that indicate an impairment that affects their ability to engage in activities expected of children of the same age. As indicated earlier, this kind of evidence may help show that your child is disabled for SSI purposes. Social Security Benefits For Older Children With Disabilities And For Adults Disabled Since Childhood Non-Medical Rules As indicated earlier, a child under the age of 18, including a child with a disability, qualifies for Social Security benefits simply because he or she is a minor child of a retired, disabled, or deceased worker. In other words, we don't consider a child's disability when deciding if he or she can get Social Security dependent's or survivor's benefits. However, when a child who is getting a dependent's or survivor's benefit from Social Security reaches 18, those benefits generally stop unless one of the following conditions is met: * The child is a full-time student in an elementary or high school. In this case, benefits continue until age 19; or * The child is disabled. In this case benefits can continue as long as the child remains disabled, even into his or her adult years. Many times, an individual dosen't become eligible for a disabled child's benefit from Social Security until later in life. Here's an example: John Jones starts collecting Social Security retirement benefits at the age of 62. He has a 38-year-old son, Ben, who has been mentally retarded since birth. Ben will start collecting a disabled "child's" benefit on his fathers Social Security record. How We Decide If An "Adult Child" is Disabled We will evaluate the disability of an adult child (age 18 or older who is applying for Social Security for the first time, or who is being converted from a Social Securtiy dependent child's benefit, by using adult disability criteria. Briefly, to qualify for disability, an adult must have a physical or mental impairment, or combination of impairments, that is expected to keep him or her from doing any "substantial" work for at least a year or is expected to result in death. (Generally, a job that pays $500 or more per month is considered substantial.) The individual's condition is compared to a listing of impairments that are considered to be severe enough to prevent an individual from working for a year or more. If the individual is not working and has an impairment that meets or is equal to a condition on the list, then he or she is considered disabled for Social Security purposes. If we cannot match the person's impairment with one of the listings, then we assess his or her ability to perform the same type of work he or she did in the past (if any). If the person cannot do that work, or does not have any past work histoy, then we consider his or her ability to do any kind of work he or she is suited for (based on age, education, and experience). If, considering all these factors, a person is found to be unable to do any substantial work, then he or she would qualify for disability benefits from Social Security. Applying For Social Security Or SSI Benefits ... And How To Expedite The Process You can apply for Social Security or SSI benefits for your child by calling or visiting your local Social Security offlce. You can help expedite the claims process if you have the child's Social Security number and birth certificate available when you apply. If you're signing up your child for SSI, you also will need to provide records that show your income and your assets, as well as those of the child. The medical evaluation specialists at the DDS need thorough and detailed medical records to help them decide if your child is disabled. When you file, you will be asked to provide names, addresses, and telephone numbers of all doctors, hospitals, clinics, and other specialists your child has visited. In addition, if your child is under age 18 and applying for SSI, you will be asked to describe how your child's disability affects his or her ability to function as a child of similar age normally would. Therefore, we will ask you to provide the names of teachers, day care providers, and family members who can give us information about how your child functions in his or her day-to-day activities. Please be as specific and thorough as possible when you answer these questions. This means that you should give us the dates of visits to doctors or hospitals, the account numbers, and any other information that will help us to get your child's medical records as soon as possible. If you do not have this information, tell the interviewer as much as you know. If you have any school records, bring them with you to the interview. In many communities, special arrangements have been made with medical providers, social service agencies, and schools to help us get the evidence we need to process your child's claim. Most DDS's have Professional Relations Officers who work directly with these organizations to facilitate this process. However, your additional cooperation in obtaining records and evidence would be helpful. Medicaid And Medicare Medicaid is a health insurance program for people with low incomes and limited assets. In most States, children who get SSI benefits qualify for Medicaid coverage. In many States, this coverage comes automatically with SSI eligibility. In other States, you must sign up for it. And some children can get Medicaid coverage even if they don't qualify for SSI. Check with your local Social Security office or your State or county social services office for more information. Medicare is a Federal health insurance program for people 65 or older, and for people who have been getting Social Security disability benefits for 2 years. Because children, even those with disabilities, do not get Social Security disability benefits until they turn 18, no child can get Medicare coverage until he or she is 20 years old. The only exception to this rule is for children with chronic renal disease who need a kidney transplant or maintenance dialysis. Children in such a situation can get Medicare if a parent is getting Social Security or has worked enough to be covered by Social Security. Other Health Care Services If we decide a child is disabled and eligible for SSI, we refer him or her for health care services under the Children with Special Health Care Needs (CSHCN) provisions of the Social Security Act. These programs are generally administered through State health agencies. Although there are differences, most CSHCN programs help provide specialized services through arrangements with clinics, private offices, hospital-based out- and in- patient treatment centers, or community agencies. CSHCN programs are known in the States by a variety of names, including Children's Special Health Services, Children's Medical Services, and Handicapped Children's Program. Even if your child is not eligible for SSI, a CSHCN program may be able to help you. Local health departments, social services offices, or hospitals should be able to help you contact your CSHCN program. To Learn More About Social Security And SSI Social Security produces a variety of publications that explain the various Social Security programs, including benefits available to children. For general information, we suggest you ask for a free copy of one of these: * Understanding Social Security (Publication No. 05-10024) * Retirement (Publication No. 05-10035) * Disability (Publication No. 05-10029) * Medicare (Publication No. 05-10043) * SSI For Groups And Organizations (Publication No. 05-11015) (All of these publications are available in Spanish.) U.S. Government Printing Office: 1992-312-172/40030