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Summary

There is a safety net for children living with a disability through Social Security Disability Insurance (SSDI), Social Security Retirement Income (SSR), Supplemental Security Income (SSI) and a variety of other state or local programs.

There are also benefits for older children (18 and over) with a disability and for adults who have been disabled since childhood.

Social Security uses different criteria about disability depending on whether the child is under or over age 18.

When determining whether a child with HIV is disabled, Social Security uses different criteria than it uses for adults.

Children with a disability may also be entitled to Medicaid, Medicare or other health care services.

Apply for SSDI, SSR and/or SSI benefits through your local Social Security office. You can start the process by calling a toll free number.

For information, see:

Social Security Disability Insurance (SSDI) and Social Security Retirement Income (SSR) Benefits For Children With A Disability

Children can receive benefits under these programs as either:

  • Dependents benefits payable to children under the age of 18 based on the record of a parent who is collecting retirement or disability benefits from Social Security.
  • Survivors benefits payable to children under the age of 18 on the record of a parent who has died.

Although children under age 18 who are eligible for these benefits might be disabled, Social Security does not need to consider their disability to qualify them for benefits.

Note: An unmarried 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.

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 both:

  • Eligible as the child of someone who is getting Social Security retirement or disability benefits, or of someone who has died.
  • The 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.

Supplemental Security Income (SSI) Benefits For Children With A Disability

Supplemental Security Income (SSI) is a program that pays monthly benefits to people with low incomes and limited assets who are age 65 or older, blind, or disabled. Children can qualify if they meet Social Security's definition of disability 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 increase every year based on cost-of-living increases.

Special Income Waiver for Disabled Students

Because disabled children who are attending school have special expenses and because they are working toward becoming self-sufficient through their studies, an exemption is provided for income earned by the students. In 2013 up to $1,730 per month to a maximum of $6,960 per year will not be counted as income for SSI eligibility purposes.

Rules For Children Under Age 18

Most children do not have their own income and do not have many assets. However, when children under age 18 live at home (or are away at school but return home occasionally and are subject to parental control), Social Security considers the parent's income and assets when deciding if the child qualifies. The Social Security Administration refers to this process as "deeming" income and assets to the child.

Rules For Children Age 18 And Older

When a child turns 18, the Social Security Administration no longer considers a parent's income and assets in deciding 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 age 18.

On the other hand, a lower benefit may be given if a child with a disability who is receiving SSI benefits turns 18 and continues to live with his or her parent(s) but does not pay for food or shelter.

Presumptive Disability

The disability evaluation process generally takes several months. However, the law includes special provisions for people (including children) signing up for Supplemental Security Income (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. Of course, these payments can only be made if the child meets the other eligibility factors explained above.

Following are some of the disability categories in which Social Security will presume the child is disabled and make immediate SSI payments:

  • HIV infection*
  • Blindness
  • Deafness (in some cases)
  • Cerebral Palsy (in some cases)
  • Down Syndrome
  • Muscular Dystrophy (in some cases)
  • Significant mental deficiency
  • Diabetes (with amputation of one foot)
  • Amputation of two limbs
  • Amputation of leg at the hip

*Social Security uses a special form for children with HIV applying for Presumptive SSI Benefits. It is SSA-4815-F6, which you can obtain by calling Social Security at 800.772.1213. (If you request a copy of this form, please photocopy a copy for us so we can share it with other people in a similar situation.)

If Social Security makes presumptive disability payments, the benefits do not have to be paid back if Social Security later decides that the child's disability is not severe enough to qualify for SSI. 

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How Social Security Decides If A Child Is Disabled For Purposes Of Supplemental Security Income (SSI)

Children age 18 or over

All documents and evidence relating to the child's disability are sent to a state office, usually called the Disability Determination Service (DDS). At DDS, a team comprised of a disability evaluation specialist and a doctor reviews the child's situation to decide if he or she meets the Social Security definition of disability. To learn more, see: Supplemental Security Income (SSI).

If the available records are not sufficient for the DDS team to make a decision, you may be asked to take your child to a special examination for which Social Security will pay. It is important that the child undergo this examination if requested, and that the child puts forth his or her best effort during the examination. The results of the examination will not be considered valid unless a 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.

Children Under Age 18

A under the age of 18 will be considered to be disabled if each of the following are present:

  • He or she has a physical or mental condition (or a combination of conditions) that results in "marked and severe functional limitations."
  • The condition lasts or is expected to last at least 12 months or be expected to result in the child's death.
  • The child must not be working at a job that Social Security could consider to be substantial work. For practical purposes, the child should not be working when applying for SSI.

To decide if a child is disabled, the disability evaluation specialist first checks to see if the child's disability can be found in a special listing of conditions that is contained in Social Security's regulations. If not in the listing, the question becomes whether the condition is medically or functionally equal to an impairment that is on the list.

The listings are descriptions of symptoms, signs or laboratory findings of more than 100 physical and mental problems that are severe enough to disable a child. For example, the list includes cerebral palsy, mental retardation, and muscular dystrophy.

A child's condition does not have to be one of the conditions on the list. If the symptoms, signs or laboratory findings of the child's condition are the same as, or medically equal in severity to, the listing, the child is considered disabled for SSI purposes.

A child will also be considered disabled if the functional limitations from his or her condition or combination of conditions are the same as the disabling functional limitations of any listed impairment.

To determine whether a 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 the 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 the child, teachers, counselors, therapists and social workers.

A finding of disability will not be based solely on a parent's statements or on the fact that a child is, or is not, enrolled in special education classes.

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 the current guidelines for evaluating HIV infection, but may have other signs and symptoms that indicate an impairment that results in marked severe functional limitations. As indicated earlier, this kind of evidence may help show that your child is disabled for Social Security purposes.

Benefits For Older Children Living With A Disability And For Adults Disabled Since Childhood

Although children under 18 who are disabled may be eligible for benefits, Social Security doesn't need to consider a child's disability when deciding if they qualify for 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.
  • 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 doesn't become eligible for a disabled child's benefit from Social Security until later in life. For example: John Jones starts collecting Social Security retirement benefits at the age of 62. He has a 38-year-old son, Ben, who has had cerebral palsy since birth. Ben can start collecting a disabled "child's" benefit on his father's Social Security record.

How Social Security Decides If An "Adult Child" Is Disabled

Social Security 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 Security 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, in 2008, a job that pays $940 or more per month is considered substantial.) For more information, see Supplemental Security Income (SSI).

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 Social Security cannot match the person's impairment with one of the listings, then an assessment will be made of 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 history, then Social Security will 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.

Children And Medicaid

Medicaid is a health care program for people with low incomes and limited assets. In most states, children who get SSI benefits qualify for Medicaid.

In many states, Medicaid comes automatically with SSI eligibility. In other states, you must sign up for it.

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.

To Learn More

More Information

Medicaid

Children And Medicare

Medicare is a federal health insurance program for people 65 or older, and for people who have been getting Social Security disability benefits for two 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 receiving Social Security benefits or has worked enough to be covered by Social Security.

To Learn More

More Information

Medicare

Children And Other Health Care Services

If Social Security decides a child is disabled and eligible for Supplemental Security Income (SSI) benefits, the child will be referred 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. Local health departments, social services offices, or hospitals should be able to help you contact your CSHCN program.

To Learn More About Social Security Disability Insurance (SSDI), Social Security Retirement Income (SSR) and Supplemental Security Income (SSI) For Disabled Children

Social Security produces a variety of publications that explain the various Social Security programs, including benefits available to children.

The following publications are free sources of additional information:

You may also order or see the publications at your local Social Security office or you can call the toll-free number 800.772.1213. You can speak to a representative between 7 a.m. and 7 p.m. each business day. The lines are busiest early in the week and early in the month. If your business can wait, it's best to call at other times. When you call, have your Social Security number handy.

Recorded information and services are available 24 hours a day, including weekends and holidays.

You can also access Social Security at http://www.ssa.gov

People who are deaf or hard of hearing may call the toll-free TTY number, 800.325.0778, between 7 a.m. and 7 p.m. on business days.

The Social Security Administration treats all calls confidentially. Social Security also wants to ensure that you receive accurate and courteous service. That's why your call may be monitored by a second Social Security representative.

Applying For Social Security Disability Insurance (SSDI), Social Security Retirement Income (SSR) or Supplemental Security Income (SSI) Benefits

You can apply for Social Security or SSI benefits for your child by calling or visiting your local Social Security office. It is advisable to have the child's Social Security number and original or certified copy of the child's birth certificate when you apply. If you're enrolling 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 decide if your child is disabled. You can speed up the claims process by providing full medical records or by helping obtain them.

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 on a day-to-day basis. You may be asked to provide the names of teachers, day care providers, and family members who can give information about how your child functions. If you have any school records, you should bring them with you to the interview.

Be as specific and thorough as possible when you answer Social Security's questions. This means that you should give them the dates of visits to doctors or hospitals, the account numbers and any other information that will help get your child's medical records as soon as possible. If you do not have all of this information, tell the interviewer as much as you know.

For advice concerning how to conduct yourself in the interview, see How To Make A Friend At Social Security.

In many communities, special arrangements have been made with medical providers, social service agencies, and schools to help Social Security get the evidence needed 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 will help obtain a faster decision about your claim.