Childhood Disability Benefits (SSI):
Ensuring Support for Children in Poverty
Objectives:
At the end of this training, you should . . .
 Know what Child SSI is,
 Understand SSA standards for
determining eligibility for Child
SSI, and
 Know how to help patients
navigate the SSI application and
appeal process.
Poverty and Health
 Poverty causes poor health
 People with a higher socioeconomic
status have better health outcomes.
 “Psychological, social and economic
adversity in childhood can have longterm consequences for health.”
 Benedict, Meredith et. al., Social
Determinants of Health Disparities
and the Role of Law, Poverty Health
and Law, 2011.
Poor health causes poverty
 Medical conditions, disabilities,
and overall poor health affect
ability to maintain employment and
manage expenses.
 Illness and medical bill contributed
to 62% of US bankruptcies in 2007
 Ohio access basics, Health Policy
Institute of Ohio, October 2012
Poverty in our Community
Kids Count Data Center (datacenter.kidscount.org)
 Ohio
 23.1% of Ohio Children are living in poverty
 44.9% of Ohio Children qualify for Public
Health Insurance
 Lucas County
 29% of Lucas County are living in poverty
 53% of Lucas County children are enrolled in
Public Health Insurance
Wide Range of Factors Influence Child Health
Housing
&
Utilities
Stability
&
Safety
School
Discipline
& Special
Education
Food
Employment
& Income
Child and
Family
Health
Health
Care
Access
Immigrant
Status
Challenges for Families in Poverty
with Children with Disabilities
 Trouble holding a job
 Making ends meet
 Meeting child’s disability-related
needs
 Access to supports
 Stress on the family
What is SSI?
 Supplemental Security Income
(a.k.a. Title XVI, Childhood
Disability Benefits)
 A federally financed and
administered needs-based
program for adults and children
with disabilities in poverty.
 Children’s SSI program
created in 1972
Purpose of Child SSI: Where does SSI fit in?
 To assure a minimum level of income for children who are
blind or disabled and who do not have sufficient income and
resources to maintain a standard of living.
 Financial support to children in poverty when their disability
may require that they receive additional supports, supervision,
care. (i.e. Parent may not be able to maintain work due to child’s
needs.)
Who is eligible for Child SSI?
 A child with a disability
 A child under age 18 will be considered disabled if he or she has a
medically determinable physical or mental impairment or combination
of impairments that causes marked and severe functional limitations,
and that can be expected to cause death or that has lasted or can be
expected to last for a continuous period of not less than 12 months.
 Not engaged in substantial gainful activity (working)
 Low income
Process for Applying for SSI
 Applicants can apply in person at the local SSA field office, by phone,
mail, or online.
 The application and related forms ask for a description of the claimant's
impairment(s); names, addresses, and telephone numbers of treatment
sources; and other information that relates to the alleged disability.
 The field office is responsible for verifying nonmedical eligibility
requirements, which may include age, employment, marital status,
citizenship/residency and Social Security coverage information, and
additionally, for SSI eligibility, income, resources, and living
arrangement information.
Application Process Continued
 Initial Application sent to Disability Determination Services (DDS).
 If denial of Initial application, claiming can file a request for
reconsideration within 60 days.
 If reconsideration denied, claimant can request an Administrative
Hearing in 60 days. Hearing are before an administrative law judge in
SSA's Office of Disability Adjudication and Review. (This process can
take years!)
Determining Child Eligibility for SSI
 Social Security will look at whether
the child meets, “medically equals,”
or “functionally equals” the Child
Listings of Impairments
 For older children, Social Security will
look to whether the child is working.
 The child’s functional ability is
compared to other children of similar
ages
The Childhood Listings
 Listing of Impairments - Childhood Listings (Part B)
 The following sections provide medical criteria for the
evaluation of impairments of children under age 18 (where
criteria in Part A - Adult listings do not give appropriate
consideration to the particular disease process in childhood).
http://www.socialsecurity.gov/disability/professionals/blueboo
k/ChildhoodListings.htm
 If a child meets a listing, the child qualifies for SSI (Assuming
the child also meets the income and work requirements)
Case Study: Asthma
 Johnny is 8 years old and was diagnosed with asthma at age 5. He and his
mother live in a run-down inner city home with a leaky roof. Johnny’s Mom
would love to move them to a place that is less damp and moldy, but she
has been unable to save up first month’s rent and a security deposit.
 Johnny’s asthma is not well-controlled. He uses an albuterol nebulizer on a
twice daily basis, but his Mom has confided to you that she has caught him
sometimes pulling off the mask because he finds it uncomfortable and
doesn’t like the “hopped up” way that the medicine sometimes makes him
feel after a breathing treatment. She has begun watching him for the entire
treatment to make sure that he keeps the mask on.
Case Study: Asthma (cont’d.)
 During the last year, he has been treated for asthma attacks at the
emergency room 5 times. The first three times all occurred during one
month last winter. After the third time, Johnny’s doctor prescribed a 7-day
course of corticosteroids to try to stop his persistent low-grade wheezing.
After each of the other two attacks (one in May and one in September),
Johnny’s doctor has prescribed 5-day courses of corticosteroids.
 Johnny’s Mom has applied for SSI on the basis of his asthma. She is
hopeful that he will be approved so that they will have enough money to
move to a nicer apartment, which might improve Johnny’s asthma.
 Can Johnny meet the listing for asthma 103.03?
 How can you help?
Case Study: Asthma (cont’d.)
 Check the listing: 103.03 Asthma
 Help Mom gather relevant medical records
 Encourage Mom to appeal if denied
 Be willing to complete questionnaires
and/or submit a detailed letter to SSA
indicating how child’s symptoms in light
of the listing. (In other words, SSA may
need you to lay out the symptoms which
meet the listing.)
Childhood functional domains
 For children, the medical evidence should address the child’s
physical health and well-being functional limitations in
learning, motor functioning, performing self-care activities,
communicating, socializing, and completing tasks (and, if a
child is a newborn or young infant from birth to age 1,
responsiveness to stimuli)
Child’s disability benefits
 In Functional Limitations, Social
Security looks for Marked and Extreme
differences:
 “Extreme” = impairment interferes very
seriously with ability to independently
initiate, sustain or complete activities, or
more than marked.
 “Marked” = more than moderate but less
than extreme; serious interference with
ability in independently initiate, sustain, or
complete activities.
Case Study: ADHD
 Diagnosis: ADHD, ODD, Mood disorder, and speech delays;
 Identified as a student with an Emotional Disturbance eligible for special
education services; While attending kindergarten: removed and placed in an
inpatient program at Kobacker Center for three days for endangering others
at the school;
 Attended five different elementary schools and just completed her second
year of second grade – regularly sent to office and suspended;
 Receiving mental health service at Zepf Center; Patient at University
Pediatrics at UT, prescribed Adderall;
 Denied SSI at initial application and reconsideration phase.
Case Study ADHD
Physician Involvement
 Pediatrician referred case to the MLPC
 Pediatrician took the time to complete a Functional Capacity
Assessment for the child
 MLPC prepared case for Administrative Law Judge Hearing:
 Gathering medical, mental health and educational records
 Preparing pre-hearing brief
 Representing child at hearing
Case Study ADHD
Taking case through the functional domains
 Acquiring and Using Information
 Attending and Completing Tasks
 Interacting and Relating with Others
 Caring for herself
 Moving about and manipulation objects
 Physical health and well-being
Case Study ADHDH
Impact of physician involvement
 ALJ stated in favorable decision:
 The claimant’s primary care physician, submitted a functional capacity
assessment. She noted that she has treated the claimant for her ADHD
and ODD for 3 years and that the claimant has exhibited hyperactivity
and impulsivity during office visits. Based on her clinical observations,
Dr. opined that the claimant had slight to serious limitations in her
ability to acquire and use information, obvious to very serious
limitations in attending and completing tasks, and obvious to very
serious limitations in interacting and relating to others. The
undersigned affords great weight to the Dr. opinions because they are
consistent with the medical records as a whole.
Periodic Review of Eligibility and Cessation
 Continuing Disability Reviews for
Children's SSI Cases
 Any child who receives SSI disability
benefits will have their eligibility
reviewed at least once every three years.
 At age 18 – the child’s eligibility is
reviewed using adult SSI standards.
 The CDR process for children occurs
as follows…
Periodic Review of Eligibility and Cessation
 STEP ONE:
 Has there has been medical improvement in the child's impairments?
SSA defines medical improvement as any decrease in the medical
severity of [the] impairment(s) which was present at the time of the most
recent favorable decision . . .20 CFR 416.994a(c).
 If there has been NO medical improvement, the child is still disabled and
entitled to benefits.
 If there has been medical improvement, go to STEP TWO.
Periodic Review of Eligibility and Cessation
 STEP TWO:
 If there has been medical improvement, SSA determines whether the
impairment(s) the child had at the time of SSA's most recent favorable
decision NOW meets or medically or functionally equals the severity of
the listing it met at that time.
 If the current impairment(s) still meets or equals the original listing, the
child remains disabled and benefits will continue.
 If there has been medical improvement and the child's impairment(s) no
longer meets the listing that it met at the time of the last favorable
decision, go on to STEP THREE
Periodic Review of Eligibility and Cessation
 STEP THREE:
 SSA must consider whether the child's impairment(s) is
disabling under the new childhood disability standard, as it
appears at 20 CFR 416.924.
If the child's impairment(s) falls within the new childhood
disability standard, disability benefits will continue.
 If it does not, disability will cease.
 In determining whether a child is currently disabled at STEP
THREE, SSA conducts the following review:
Periodic Review of Eligibility and Cessation
 Does the child have a severe impairment?
If yes, go on to next step. If no, the child is not disabled.
 Does the child's impairment(s) meet or equal any of the current listed
impairments?
If yes, the child remains disabled. If no, go on to next step.
 Does the child's impairment functionally equal the severity of any listed
impairment?
If yes, the child is remains disabled. If no, the child is not disabled.
NOTE: There are a few exceptions in which disability may end, even if there has
been no medical improvement. Advocates should review the regulations at 20
CFR 416.944a(e) and (f).
Rights upon Cessation
 Notice
 Reconsideration
 Hearing
Physician’s Role in Child SSI cases:
 What can you do to help?
 Discuss case and process with patient. Encourage patient to cooperate




with attending SSA physician appointments, providing relevant
documents and signing and returning forms from SSA.
Review Child SSI Listings
Help gather medical records and identify relevant tests, assessments,
etc.
Write a letter to SSA regarding condition, symptoms, severity, etc.
keeping in mind the listings.
Be willing to complete an Functional Capacity Questionnaire
Opportunity for Systemic Advocacy
 Review and comment on listings
 Work with advocacy coalitions
(asthma, autism, others?)
Resources
 Disability Rights Ohio www.disabilityrights.ohio
 The Ability Center of Greater Toledo: (419) 885-5733
 Social Security Administration:
http://www.socialsecurity.gov/disability/professionals/bluebook/
ChildhoodListings.htm
 edResourcesOhio.org
 Medical Legal Partnership for Children: mlpc.ablelaw.org