Benefits For Children With Disabilities _______________________________________ Social Security Administration SSA Publication No. 05-10026 April 1996 (Destroy prior editions) 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. Millions of children already get benefits from Social Security. This booklet will help you decide if your child, or a child you know, is eligible for Social Security or SSI. __________________________________ Social Security's Toll-Free Number 1-800-772-1213 Call between 7 a.m. and 7 p.m. any business day. __________________________________ 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) 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. 2) 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. 3) 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. 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 "Deciding SSI Disability for Children Under 18") 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 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), 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 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. 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 descrip- tions 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. To determine the child's ability to function, the disability evaluation team obtains evidence from a wide variety of sources who have knowledge of how your child functions on a day-to-day basis, and how your child has functioned 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 on 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. 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 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). Following are some of the disability categories in which we can 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 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 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 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 doesn'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 cerebral palsy since birth. Ben will start collecting a disabled "child's" benefit on his father's 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 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, 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 history, 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 office. You should 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. You can speed up the claims process by providing the medical records or helping us get 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 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. If you have any school records, you should bring them with you to the interview. 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 all of this information, tell the interviewer as much as you know. 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 will help us decide your claim faster. Medicaid And Medicare 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. 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 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 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) * Survivors (Publication No. 05-10084) * Disability (Publication No. 05-10029) * SSI (Publication No. 05-11000) * Medicare (Publication No. 05-10043) * SSI For Groups And Organizations (Publication No. 05-11015) (Many of these publications are available in Spanish.) To get copies of these and other publications or to learn more about benefits for children with disabilities, call or visit your local Social Security office. Social Security publications are also available to users of the Internet. Type: http://www.ssa.gov to access the Internet and these publications. Or you can call our toll-free number 1-800-772-1213. You can speak to a representative between 7 a.m. and 7 p.m. each business day. Our lines are busiest early in the week and early in the month so, if your business can wait, it's best to call at other times. When you call, have your Social Security number handy. If you have a touch-tone phone, recorded information and services are available 24 hours a day, including weekends and holidays. People who are deaf or hard of hearing may call our toll-free "TTY" number, 1-800-325-0778, between 7 a.m. and 7 p.m. on business days. The Social Security Administration treats all calls confidentially--whether they're made to our toll-free numbers or to one of our local offices. But we also want to ensure that you receive accurate and courteous service. That's why we have a second Social Security representative monitor some incoming and outgoing telephone calls. ---------- A New Definition Of Disability For Children On August 22, 1996, the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 changed the definition of disability for children under the Supplemental Security Income (SSI) program. The new definition of disability for children: ----------------------------------------------------------------- * requires a child to have a physical or mental condition or conditions that can be medically proven and which result in marked and severe functional limitations; ----------------------------------------------------------------- * requires that the medically proven physical or mental condition or conditions must last or be expected to last at least 12 months or be expected to result in death; ----------------------------------------------------------------- * says that a child may not be considered disabled if he or she is working at a job that we consider to be substantial work. The new law also changes the way we consider certain behavior problems caused by a child's condition or conditions. Some Children Who Are Now Eligible May Be Affected Because of these changes, we may no longer consider some children disabled. The law requires us to review the cases of certain children who are now eligible for SSI to see if they are disabled under the new definition of disability for children. What We Will Do ----------------------------------------------------------------- * We will send letters to the representative payees for these children before January 1, 1997, telling them that we expect to review their cases. ----------------------------------------------------------------- * Before the review starts, we will contact each child's representative payee for information about the child's condition. ----------------------------------------------------------------- * After we review the case, we may decide that the child is still disabled, or we may decide that he or she is not disabled because of the new law. If we find the child is not disabled because of the new law, we will stop the child's SSI. SSI will not stop before July 1, 1997, as long as the child meets all other eligibility rules. ----------------------------------------------------------------- * When we make our decision, we will send another notice to explain it. That letter will also explain the right to appeal the decision and will discuss continuation of benefits during the appeal. If a child is getting Medicaid based on SSI, Medicaid should continue as long as he or she gets SSI. Even after SSI ends some children can qualify for Medicaid under state programs. The Law Requires Us To Do Continuing Disability Reviews To Determine Whether Or Not The Child Is Still Disabled The continuing disability reviews (CDRs) must be done at least every three years for recipients under age 18 whose conditions are likely to improve; and The CDRs must be done not later than 12 months after birth for babies whose disability is based on their low birth weight. We also may do CDRs for recipients under age 18 whose conditions are not likely to improve. Representative Payees Must Provide Evidence Of Treatment At the time we do a CDR, the representative payee must present evidence that the child is and has been receiving treatment considered medically necessary and available for his or her disabling condition. This is true in every case unless we determine that requiring such evidence would be inappropriate or unnecessary. If the child's representative payee refuses without good cause to provide such evidence when requested, we will suspend payment of benefits to the representative payee and select another representative payee if it is in the best interest of the child. Or we may pay the child directly, if he or she is old enough. These rules apply to benefits for months beginning on or after the date of the enactment of the new law. The Law Requires A Disability Redetermination At Age 18 Any individual who was eligible as a child in the month before he or she attained age 18 must have his or her eligibility redetermined. The redetermination will be done during the one year period beginning on the individual's 18th birthday. We will use the rules for adults filing new claims to do the redetermination. Important Note About Children In Certain Medical Care Facilities In addition to the new definition of disability, the new law affects children under age 18 who live, throughout an entire calendar month, in certain institutions where a private health insurance pays for their care. The monthly SSI payment for these children will be limited to $30. Previously, the $30 SSI payment limit applied only when Medicaid paid more than one half of the cost of their care. For More Information You can get more information 24 hours a day by calling Social Security's toll-free telephone number 1-800-772-1213. If you want to speak to a representative, you should call between the hours of 7 a.m. and 7 p.m. on Monday through Friday. Our lines are busiest early in the week and early in the month, so it's best to call at other times. Please have your Social Security number handy when you call. Our representatives can give you the address and telephone number of your local Social Security office if you would like to visit the office. If you have a touch-tone phone, recorded information and services are available 24 hours a day, including weekends and holidays. People who are deaf or hard of hearing may call our toll-free "TTY" number, 1-800-325-0778, between 7 a.m. and 7 p.m. on Monday through Friday. The Social Security Administration treats all calls confidentially--whether they're made to our toll-free numbers or to one of our offices. We also want to be sure that you receive accurate and courteous service. That is why we have a second Social Security representative monitor some incoming and outgoing telephone calls. Social Security information is also available on the Internet at http://www.ssa.gov. Social Security Administration SSA Publication No. 05-11053 September 1996 ---------- A Factsheet from Social Security ----------------------------------------------------------------- +--------------------------------+ Social Security Administration February 1997 +--------------------------------+ Welfare Reform and SSI Childhood Disability Background One provision of the Welfare Reform law passed last year changed the SSI definition of disability for children, completely separating it from the definition of disability for adults. The basic definition of disability for the Supplemental Security Income (SSI) program for an adult states that a person must have a condition that is severe enough to prevent him or her from doing substantial work and is expected to last for at least 12 months -- or result in death. SSA uses a multi-step process to decide if an adult meets this definition of disability. One of the most common steps involves the use of a set of evaluation guidelines that contain a list of impairments for each major body system (including mental impairments) that are so severe they automatically mean a person is disabled. If a condition does not meet the criteria on the list, or cannot be considered equal in severity to a condition on the list, then the agency considers vocational factors (age, education, and work experience) to decide if a person has a condition that prevents him or her from working, thus qualifying that person for disability benefits. Because children, especially younger children, generally do not work, the vocational steps in the disability evaluation process do not apply to them. So, until 1990, the decision about a child's disability was based on the criteria in the Listing of Impairments. A 1990 Supreme Court decision ordered SSA to develop another step in the evaluation process, analogous to the vocational rules used for adults, that would consider a child's ability or inability to function in a manner similar to children of the same age. In response to the Court's decision, SSA developed a process known as the Individualized Functional Assessment (IFA). Between 1990 and 1996, the number of children eligible for SSI benefits increased from approximately 350,000 to more than 965,000. About one-third of the children entitled during this period were entitled based on the IFA. In addition, there were anecdotal reports of parents coaching children to qualify for benefits, although studies by SSA, the Office of the Inspector General, and the General Accounting Office did not find any evidence of fraud and abuse. The Welfare Reform Act On August 22, 1996, the Welfare Reform Act was enacted. One of its provisions changed the SSI definition of disability for children. The new law states that a child's impairment--or combination of impairments--will be considered disabling if it causes "marked and severe functional limitations." The new law established a new definition of disability for children and ordered SSA to discontinue the use of the IFA. Because disability is a complex issue, formulating regulations to implement the law was an enormous task. The major challenge was to ensure that the intent of Congress was met while working within the framework established by Congress to add additional criteria to the rules that ensure continued benefit eligibility for severely disabled children. In addition to its own disability policy specialists, SSA consulted with administration and Congressional colleagues. The result is a set of policy guidelines that meet the letter and spirit of the law while protecting the rights of children and families. The New Disability Standard Under the welfare reform law, a child's impairment, or combination of impairments, is disabling if it causes "marked and severe functional limitations." Congress eliminated the IFA process and the language in the conference report clearly indicated that SSA should use listing-level severity as the test for entitlement to benefits. The new law and the conference report language also emphasized the importance of functional assessments. The new rules, therefore, define listing-level severity for functional limitations. The severity of an impairment in the listings is generally shown by a) "marked" limitations in either two broad areas of functioning, such as social functioning and personal functioning; or b) extreme limitations in one area of functioning, such as inability to walk. The new rules reflect both the letter and spirit of the law. They provide an accurate mechanism to ensure that needy children with severe disabilities continue to qualify for SSI payments while fairly implementing the intent of Congress. While eliminating the IFA, and incorporating other specified changes in the listings, the new rules incorporate several features that will help to better evaluate children under the new law. The new rules add an area of "motor" functioning to ensure that limitations from physical conditions are not overlooked. The new rules also emphasize the importance of "functional equivalence" by providing guidelines that direct disability evaluators to consider conditions that are not necessarily defined in the listings, but are as severe as a condition in the listings. For example, guidance is included on the evaluation of chronic, episodic impairments in children, which can be severe but difficult to evaluate. Finally, a new form has been created to guide decision-makers through the new rules to ensure consistency in applying the criteria. Who is Affected? SSA estimates that about 135,000 children, out of approximately 965,000 children who receive SSI, will no longer be eligible for monthly benefits. This is consistent with the lower-range estimates made by the Congressional Budget Office. Most of the children affected by the new definition of disability can be broadly categorized as those with certain mental impairments, such as less severe learning disabilities and behavioral disorders. Although some news articles have alleged that children with impairments such as Down Syndrome, severe mental retardation, autism, or many rare diseases will lose benefits, the new rules provide guidelines for evaluating severe impairments such as these to ensure that such children remain eligible for SSI benefits. In addition, these new rules include more guidance to ensure careful evaluations of children with physical impairments as well as children with severe impairments that re-occur despite periods of remission. Implementing the New Guidelines One of SSA's highest priorities over the next several months will be to make sure that the new disability guidelines are implemented fairly and consistently across the country. SSA was required to notify the parents or guardians of children already getting SSI benefits who are potentially-affected by the welfare reform bill by January 1, 1997. Last December, SSA sent letters to about 263,000 children who may have their cases reviewed using the new guidelines. During February 1997, SSA personnel will be trained on the new procedures. By mid-month, SSA will begin interviewing the parents or guardians of the children affected to get current information about their medical conditions. If additional medical or other evidence is necessary to determine if the child is still disabled under the new law, SSA will obtain the necessary evidence. The first decisions will go out in March and continue going out throughout this fiscal year. Under the law, no benefits will be stopped before July 1, 1997. Letters sent to the parents or guardians of children no longer considered disabled under the new law will explain their appeal rights, including the fact that benefits can continue during the appeals process until a face-to-face hearing is held before an administrative law judge. Administration Safeguards to Ease the Transition for Families President Clinton has made it very clear that he wishes to minimize any adverse effects this legislation may have on disabled children and their families. The President has proposed that Medicaid coverage continue to children who lose their SSI benefits as a result of welfare reform so that the medical needs of needy children and families continue to be met. In addition, SSA is working on procedures to track the effects of the implementation of this law. If the agency discovers that changes are needed in the new law, they will recommend revisions and improvements to the President. February 5, 1997 ---------- Social Security SSA Publication No. 05-10085 June 1997 (July 1996 edition may be used) (Recycle prior editions) +-------------------------------------------+ ----------------------------------------------------------------- Benefits For Children Some people find Social Security taxes an unwelcome deduction from the family's earnings. They're thinking about how they could use the money to pay bills or plan for their children's college education. At the time, Social Security isn't a big ticket item on the family agenda. But the illness or injury or even the death of a parent in a family with young children, suddenly can make Social Security a very important part of the family's survival. Those paycheck deductions for Social Security taxes could make it possible for the family to stay together. For example, some families can get as much as $2,000 a month when the worker is disabled. This factsheet focuses on benefits paid to the children when one or both parents become disabled, retire or dies. Child's Benefits When people think of Social Security benefits, they usually think of older men and women who are retired or who are widows or widowers. If you find it difficult to picture a small child as a Social Security beneficiary, you may be surprised to learn that 3.8 million children receive approximately $1.4 billion each month because one or both of their parents are disabled, retired or deceased. Those dollars are helping provide the necessities of life for the family members and helping make it possible for those children to complete high school. When a parent becomes disabled or dies, Social Security benefits help stabilize the young family's financial future. Who Can Get Child's Benefits The child can be the worker's biological, adopted child or a stepchild. (The child also could be a dependent grandchild.) To get benefits, a child must: ----------------------------------------------------------------- * have a parent(s) who is disabled or retired and entitled to Social Security benefits; or ----------------------------------------------------------------- * have a parent who died after having worked long enough in a job where he or she paid Social Security taxes. The child also must: ----------------------------------------------------------------- * be under age 18; ----------------------------------------------------------------- * be 18-19 years old and a full-time student (no higher than grade 12); or ----------------------------------------------------------------- * be 18 or older and disabled. (The disability must have started before age 22.) What You'll Need When You Apply For Child's Benefits When you apply for benefits for a child, you'll need the child's birth certificate and the parent's Social Security number. Depending on the type of benefit involved, other documents may be required. For example, if you're applying for survivors benefits for the child, you will need to furnish proof of the parent's death. If you're applying for benefits for a disabled child, you'll need to furnish medical evidence to prove the disability. The Social Security representative who takes the claim application will tell you what other documents will be needed. Benefits Can Continue Beyond 18 Normally, benefits stop when the child reaches age 18 unless he or she is disabled. Five months before the beneficiary's 18th birthday, we send the child a notice that benefits will end at age 18, unless he or she is a full-time student at a secondary (or elementary) school. If the beneficiary is under age 19 and still attending a secondary or elementary school, he or she must notify us by completing a statement of attendance. The benefits then will continue until he or she graduates, or until two months after becoming age 19, whichever comes first. If a child who is receiving Social Security benefits is in the mother's (or father's) care, the parent may be able to receive benefits until the child reaches age 16. The child's benefits continue, but the parent's benefits stop unless he or she is age 60 or over and is receiving benefits as a widow or widower or is age 62 or older and receiving retirement benefits. How Much Can The Young Family Get? Within a family, each child may receive up to one-half of the worker's full retirement or disability benefit, or 75 percent of the deceased parent's basic Social Security benefit. However, there's a limit to the amount of money that can be paid to a family. The family maximum payment is determined as part of every Social Security benefit computation and can be from 150 to 180 percent of the worker's full benefit amount. If the total amount payable to all family members exceeds this limit, each person's benefit is reduced proportionately (except the worker's) until the total equals the maximum allowable amount. As an example of monthly benefits, let's say Tom Brown earns $30,000 a year, is age 35, married and has one child. Tom is severely injured in a car accident and is found to be eligible for Social Security disability benefits. Tom, his wife and their child receive $1,595 each month. As another example of how Social Security benefits can help the young family, Sara was age 45 and earning $50,000 when she died, leaving her husband and two children. The husband and children receive $2,370 each month based on Sara's earnings record. For More Information You can get recorded information about Social Security 24 hours a day, including weekends and holidays, by calling our toll-free number, 1-800-772-1213. You can speak to a service representative between the hours of 7 a.m. and 7 p.m. on business days. Our lines are busiest early in the week and early in the month, so if your business can wait, it's best to call at other times. Whenever you call, have your Social Security number handy. People who are deaf or hard of hearing may call our toll-free "TTY" number, 1-800-325-0778, between 7 a.m. and 7 p.m. on business days. The Social Security Administration treats all calls confidentially--whether they're made to our toll-free numbers or to one of our offices. We also want to ensure that you receive accurate and courteous service. That's why we have a second Social Security representative monitor some incoming and outgoing telephone calls. Social Security information is also available to users of the Internet. Type http://www.ssa.gov to access Social Security information on the Internet. ---------- A Factsheet from Social Security _______________________________________________________________ Social Security Administration SSA Publication No. 05-11053 July 1997 (Recycle prior editions) The Definition Of Disability For Children The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 changed the definition of disability for children under the Supplemental Security Income (SSI) program. The definition of disability for children: * requires a child to have a physical or mental condition or conditions that can be medically proven and which result in MARKED AND SEVERE functional limitations; * requires that the medically proven physical or mental condition or conditions must last or be expected to last at least 12 months or be expected to result in death; * says that a child may not be considered disabled if he or she is working at a job that we consider to be substantial work. However, the law did not change the rules which allow certain children already on the rolls to continue to receive SSI even though they are working. The law also changes the way we consider certain behavior problems caused by a child's condition or conditions. CONTINUING DISABILITY REVIEWS ARE REQUIRED BY LAW The law requires us to do a continuing disability review (CDR) to determine whether or not the child is still disabled. The CDR must be done: * at least every three years for recipients under age 18 whose conditions are likely to improve; and * not later than 12 months after birth for babies whose disability is based on their low birth weight. We also may do CDRs for recipients under age 18 whose conditions are not likely to improve. REPRESENTATIVE PAYEES MUST PROVIDE EVIDENCE OF TREATMENT At the time we do a CDR, THE REPRESENTATIVE PAYEE MUST PRESENT EVIDENCE THAT THE CHILD IS AND HAS BEEN RECEIVING TREATMENT CONSIDERED MEDICALLY NECESSARY AND AVAILABLE FOR HIS OR HER DISABLING CONDITION. This is true in every case unless we determine that requiring such evidence would be inappropriate or unnecessary. If the child's representative payee refuses without good cause to provide such evidence when requested, we will suspend payment of benefits to the representative payee and select another representative payee if it is in the best interest of the child. Or, we may pay the child directly if he or she is old enough. THE LAW REQUIRES A DISABILITY REDETERMINATION AT AGE 18 Any individual who was eligible as a child in the month before he or she attained age 18 must have his or her eligibility redetermined. The redetermination will be done during the one year period beginning on the individual's 18th birthday. We will use the rules for adults filing new claims to do the redetermination. IMPORTANT NOTE ABOUT CHILDREN IN CERTAIN MEDICAL CARE FACILITIES In addition to the definition of disability, the law affects children under age 18 who live, throughout a calendar month, in certain institutions where private health insurance pays for their care. The monthly SSI payment for these children will be limited to $30. Previously, the $30 SSI payment limit applied only when Medicaid paid more than half of the cost of their care. FOR MORE INFORMATION You can get recorded information about Social Security coverage 24 hours a day, including weekends and holidays, by calling Social Security's toll-free telephone number, 1-800-772-1213. You can speak to a service representative between the hours of 7 a.m. and 7 p.m. on business days. Our lines are busiest early in the week and early in the month, so if your business can wait, it's best to call at other times. Whenever you call, have your Social Security number handy. People who are deaf or hard of hearing may call our toll-free TTY number, 1-800-325-0778, between 7 a.m. and 7 p.m. on business days. You also can reach us on the Internet. Type http://www.ssa.gov to access Social Security information. The Social Security Administration treats all calls confidentially--whether they're made to our toll-free numbers or to one of our offices. We also want to be sure that you receive accurate and courteous service. That is why we have a second Social Security representative monitor some incoming and outgoing telephone calls