Non-Medical Rules

SSI is a program that pays monthly benefits to people with low incomes and limited assets who are 65 or older, or blind, or disabled. Children can qualify if they meet Social Security's definition of disability for SSI children 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. Your local Social Security office can tell you more about the SSI benefit levels in your state.

Rules For Children Under 18

We consider the parent's income and assets when deciding if a child under 18 qualifies for SSI. This applies to children who live at home, or who are away at school but return home occasionally and are subject to parental control. 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 age 18, we no longer consider the 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 the parent's income or assets were too high may become eligible at age 18.

If a disabled child getting SSI turns 18 and continues to live with his or her parents, but does not pay for food or shelter, a lower SSI 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, consisting of a disability evaluation specialist and a medical or psychological consultant, reviews your child's case to decide if he or she meets our definition of disability.

If the available records 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, and that your child puts forth his or her best effort during the examination. The results of the examination will not be considered valid unless your child puts forth his or her best effort. Failure to attend the examination, or invalid results due to poor effort, could result in an unfavorable decision.

Deciding SSI Disability For Children Under 18

The law states that a child will be considered disabled if he or she has a physical or mental condition (or a combination of conditions) that results in "marked and severe functional limitations." The condition must last or be expected to last at least 12 months or be expected to result in the child's death. And, the child must not be working at a job that we consider to be substantial work.

To make this decision, the disability evaluation specialist first checks to see if the child's disability can be found in a special listing of impairments that is contained in Social Security's regulations. These listings are descriptions of symptoms, signs or laboratory findings of more than 100 physical and mental problems, such as cerebral palsy, mental retardation or muscular dystrophy, that are severe enough to disable a child. The child's condition does not have to be one of the conditions on the list. But, if the symptoms, signs or laboratory findings of the child's condition are the same as, or medically equal in severity to the listing, your child is considered disabled for SSI purposes. If your child's impairment(s) does not meet or medically equal a listing, the DDS then decides whether it "functionally equals" the listings. They assess the effects of the condition or combination of conditions on your child's ability to perform daily activities by comparing your child's functioning to that of children the same age who do not have impairments. To do this, they consider questions such as:

• What activities is your child able or not able to perform?
• Which activities are limited in comparison with those of same-age peers?
• What type and amount of help does your child need to complete age-appropriate activities?

To determine whether your child's impairment causes "marked and severe functional limitations," the disability evaluation team obtains evidence from a wide variety of sources who have knowledge of your child's condition and how it affects his or her ability to function on a day-to-day basis and over time. These sources include, but are not limited to, the doctors and other health professionals who treat your child, teachers counselors, therapists and social workers. A finding of disability will not be based solely on your statements or in the fact that your child is, or is not, enrolled in special education classes.

A Special Message To Parents Of Children With Severe Disabilities

The disability evaluation process generally takes several months. However, 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 six months while the formal disability decision is being made. (These payments can be made only if the child meets the other eligibility factors.)

Following are some of the disability categories in which we can presume your child is disabled and make immediate SSI payments:

• HIV infection
• Total Blindness
• Total Deafness (in some cases)
• Cerebral palsy ( in some cases)
• Down syndrome
• Muscular dystrophy (in some cases)
• Mental retardation
• Diabetes (with amputation of one foot)
• Amputation of two limbs
• Amputation of leg at the hip

If we make these special payments, and 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

Children with HIV infection may differ from adults 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 results in marked and severe functional limitations. As indicated earlier, this kind of evidence may help show that your child is disabled for SSI purposes.

Continuing Disability Reviews

After a child starts receiving SSI, the law requires that we review the child's disability to verify that he or she is still disabled. The continuing disability review (CDR) must be done:

• At least every three years for children under 18 whose conditions are expected to improve; and

• Not later than 12 months after birth for babies whose disability is based on their low birth weight; unless we determine the condition is not expected to improve by your child's first birthday, and we schedule
  the CDR for a later date.

At the time we do a CDR, the representative must present evidence that the child is and has been receiving treatment that is considered medically necessary and available for the child's disabling condition. This requirement applies to all cases unless we decide that such evidence would be inappropriate or unnecessary.

Disability Redeterminations At Age 18

Under the law, children who are eligible for SSI benefits in the month before they turn age 18 must have their eligibility redetermined.

The redetermination will be done during the one-year period beginning on your child's 18th birthday, or in place of a CDR whenever we determine the individual's case is subject to a redetermination. We will use the rules for adults filing new claims when making the redetermination.

Children In Certain Medical Care Facilities

The monthly SSI payment will be limited to $30 for children under age 18 who live, throughout a calendar month, in certain institutions where private health insurance pays for their care.

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This information is from SSA Publication No. 05-10026