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Children’s Disability Benefits

The individual who collects benefits on the child’s behalf is called the representative payee, where a child is generally considered to be an individual under the age of 18. In most cases, a child’s parents serve as the representative payee.

Note that there is a difference between the representative payee and the authorized representative. The latter is a person designated (in writing) by the claimant/recipient to pursue on the claimant/recipient’s behalf rights granted by the Social Security Act.

Benefit Eligibility

A child may qualify for SSDI or SSI benefits in one of three ways.

1. SSDI Auxiliary Benefits for Children Under 18

Auxiliary benefits are available to children under the age of 18 based on a parent’s disability and/or earnings records and not on a child’s disability.

If a child is the dependent of someone who is currently receiving disability benefits or of someone who died while receiving benefits, he or she is eligible for dependents’ or survivors’ benefits. The child does not have to be disabled to receive these benefits, but in order to receive dependents’ benefits, must be unmarried.

Dependents’ and survivors’ benefits are available to children under age 18 based on the record (workforce earnings record) of a parent who is or was a recipient, where parent means biological parent, adoptive parent, or stepparent.

Once a child qualifies for auxiliary benefits, he is eligible until he turns 18, or, if he is a full-time elementary or high school student, 19. The SSA sends child recipients a form at the beginning and the end of each school year asking whether they are still in school. Failure to return a completed form may result in termination of benefits. If the child turns 19 during the school year, the SSA can choose to continue the benefits for as long as two months in order to allow the student to finish the term. Up until the age of 19, a child may collect benefits for a vacation period of up to four months provided he intends to return to school full-time by the end of the four-month period.

The SSA requires immediate notification if a child recipient leaves school, changes school, or changes his status from full-time to part-time. Furthermore, notification is required if a student receives payment from an employer for attending school. In most cases, if a student over 18 leaves school but returns full-time before age 19, he can receive benefits, but must reapply for them.

If you have a stepchild who receives benefits based on your earnings but you and the child’s parent divorce, the child’s benefits will end the month after the divorce is finalized. You are required to notify the SSA when the divorce is final.

2. SSDI Benefits for Adults Who Have Been Disabled Since Childhood

If a young adult, who would ordinarily stop receiving benefits at age 18 or 19, is disabled, he or she can continue to receive benefits provided that:

*the disability began before the age of 22, and

*the recipient is the child of a living or deceased SS retirement or disability benefits recipient

If an individual meets both conditions, he or she is considered by the SSA to be an “adult child” or “adult disabled since childhood” and the benefits he or she receives are considered a “child’s benefit.”

3. Children’s SSI Benefits

Low-income elderly and disabled people may qualify for SSI benefits. Children under 18 may also qualify for these benefits if the SSA considers them disabled and if their income and assets (or their parents’ income and assets) render them eligible. Your local Social Security office will have information about the qualifying income and asset limits, as these limits vary by state.

Once an individual turns 18, he is an adult according the SSA. Consequently, only his own income and assets (and not those of his parents), as well as any medical conditions he has, are what determine his eligibility for SSI. If the young adult still receives food and shelter from his parents, he might receive a lower disability benefit payment because the government considers the food and shelter he is receiving to be benefits. This is true even if the SSA considers him a medically disabled adult.

B. The SSDI or SSI Benefit Application Process

You can apply for SSDI or SSI benefits on behalf of your child by visiting your local SSA office. Be sure to bring your child’s Social Security number and birth certificate, as well as any documentation you have of your income, assets, and those of your child. You will receive a SSA-3820-BK form to fill out.

If the meets initial eligibility requirements, the file is sent to the state Disability Determination Services (DDS) office where it will be reviewed by a medical consultant and a non-medical examiner in order to determine whether or not your child qualifies for disability benefits.

In order to speed up the review process, provide as much information about, and documentation of your child’s condition, or help the SSA get these records by providing thorough contact information for the healthcare providers who have treated your child and any relevant insurance information. The more information you provide, the better.

If your child is under 18 and applying for SSI, provide the names and contact information for teachers, daycare providers, and family members who can help the DDS understand how your child functions relative to other children his age. Bring your child’s school records with you if you are able.

Be an active participant in helping the DDS get this information; the more helpful you are, the faster the review process will be.

C. Disability Evaluation

Disability evaluation is relevant only to those children applying for SSI. Under SSI rules, anyone under 18 can qualify for disability based on his own medical issues. However, all SSI claimants, regardless of age, must undergo what is called a sequential evaluation.

1. Disability in Children for SSI

If a child satisfies all nonmedical eligibility requirements and his medical condition is both marked and severe, where marked means more than moderate and less than extreme, and severe means more than mild or slight, he may qualify for disability. The SSA will require your child’s medical records to make this determination and then will forward them to the DDS. If the DDS decides the medical records supplied are insufficient, your child may be required to undergo a government-funded consultative examination (CE).

a. Marked and Severe

Marked and severe is a legal designation in the Social Security Act. It is a designation that can attach to medical conditions that fulfill a specific medical requirement listing in the SSA’s Listing of Impairments or produce the equivalent in functional limitations.

b. Child Listing of Impairments 

In order to determine whether or not a child can be considered disabled for SSI purposes, a DDS medical consultant will check your child’s condition against the Listing of Impairments by reviewing information received from healthcare providers, teachers, counselors, therapists, and social workers who have worked with your child. If the child’s condition is listed in, or equivalent in medical severity to one of the listings, he will qualify as disabled in SSI terms.

c. Special Rules for Severely Disabled Children 

In cases of presumed severely disabled children who satisfy all nonmedical eligibility requirements, SSI benefits will begin immediately and continue for up to six months while a formal disability decision is underway. If the child is ultimately found not to be disabled, the payments received do not need to be paid back.

d. Special Rules for HIV-Infected Children

Special rules apply to children with HIV infection because sometimes the contraction and course of the disease affects children differently than it does adults. DDS evaluators have extensive guidelines they use for evaluating child HIV cases.

2. SSDI and Disabled Adult Children 

All SSDI applicants, whether new or being converted from a child’s benefit, over the age of 18 are evaluated as adults. Their nonmedical eligibility is predicated on having a parent worker who has paid enough Social Security taxes to be eligible for SSDI benefits. In order to qualify for disability, a claimant must have a physical or mental condition that is medically severe enough to prevent him from doing any substantial work for at least one year, or is considered fatal.

A claimant’s condition is checked against the Listing of Impairments. If his condition is on the list, or is equivalent in medical severity to one of the listings, he is considered disabled in Social Security terms.

If the claimant’s condition is not on, or equivalent to one of the conditions on the list, the DDS will consider his ability to do the kind of work he did in the past, or, if he is young and lacks work history, to do any kind of work appropriate to his vocational factors (i.e. age, education, experience, training). If found unable to do any substantial work, he is eligible for SSDI benefits.

D. Continuing Disability Reviews for SSI Children 

A child receiving benefits is subject to periodic continuing disability reviews (CDR). Such reviews allow the SSA to determine whether or not the child is still disabled. The CDRs are conducted as follows (however, in spite of legal requirements, budget shortfalls often delay the CDR schedule):

*a minimum of every three years for children whose conditions are likely to improve

*within 12 months after birth for babies whose disability is related to low birth weight

*at some point during the 18th year if the individual has received benefits for at least one month before his 18th birthday

In cases of benefit recipients under 18 whose conditions are unlikely to improve, the SSA decides when and how often to conduct CDRs.

During a CDR, you must show evidence that your child has been undergoing available treatment that the SSA has deemed medically necessary for his condition. If you refuse to provide evidence requested, the SSA will suspend payments and elect a new representative payee it believes will act in the best interest of the child. The SSA usually will not pay children directly unless they are over age 18. However, in some cases, the SSA will pay a child under age 18 directly if any of the following circumstances apply:

*The child beneficiary is a parent and files on her own behalf and/or that of her child and is experienced in handling her personal finances.

*The child is capable (a decision made by the SSA) to use the payments to tend to his own medical needs and no other qualified payee is available.

*The child is within seven months of his 18th birthday and is filing an initial claim for benefits.

E. Additional Healthcare Concerns 

Federal law grants disabled children, especially those receiving SSI benefits, multiple types of healthcare assistance. They include:

1. Medicaid 

Medicaid is a healthcare assistance program designed for those with low incomes and limited assets. In many states, child SSI recipients are also eligible for Medicaid, and in some states, the eligibility requirements for both programs are linked. However, in other states, claimants must sign up for Medicaid separately. Moreover, some children who don’t qualify for SSI may still qualify for Medicaid. More information about this is available at your local Social Security office.

2. Children with Special Healthcare Needs 

In some cases, the SSA will refer a child SSI recipient for additional healthcare services under the Children with Special Health Care Needs (CSHCN) section of the Social Security Act. Such services are the domain of state-run health agencies and are administered through state cooperation with multiple agencies such as clinics, private offices, and hospital treatment centers.

Different states have different names for the CSHCN program. They include: Children’s Special Health Services, Children’s Medical Services, Handicapped Children’s Program, or something else entirely. Even if your child fails to qualify for SSI, he may still qualify for services through a CSHCN program. You can seek information about your state’s CSHCN program at your local health department office, social services office, or hospital.

3. Children in Certain Medical Care Facilities

An SSI claimant or recipient’s living situation may affect his eligibility and/or payment amount. More specifically, residence in a public institution (operated or controlled by a federal, state, or local government agency, and housing 17 or more individuals) generally renders a claimant ineligible for SSI benefits.

Exceptions to the rule may apply if a child has spent at least one month in an institution – public or private – and at least 50% of the costs have been covered by private insurance, Medicaid, or some combination thereof. In such cases, a child may be eligible for a $30 SSI payment each month. The same exception applies to a child who has spent part of a month in a public institution and part in a private institution with at least 50% of the costs covered by private insurance, Medicaid, or some combination thereof. If the child is in a private institution and his costs are not at least 50% covered by private insurance or Medicaid, he may be eligible for a monthly SSI payment not subject to the $30 limit exception.

Call your local Social Security Field Office for more information about laws concerning an institutionalized child, and note that you are required to report to the SSA your child’s admittance to, or discharge from a medical facility or institution.

4. Medicare

Medicare is a government-run health insurance program designed for those 65 and older, or those who have been SSDI benefit recipients for at least two years. No one under the age of 20 is eligible for Medicare coverage, with the exception of children who suffer from chronic renal disease and require a kidney transplant or regular dialysis. Such children may qualify for Medicare if a parent is an SSDI recipient or has worked enough to qualify for Social Security insurance.