Appendix

Information for Parents of Children Receiving SSI

Prepared by the Bazelon Center for Mental Health Law, Washington, DC 20005-5002 202-467-5730. (12/2/96)

The new welfare law changes children's eligibility for Supplemental Security Income (SSI). As a result, some children, especially those with mental, emotional and behavioral problems, will lose the SSI cash benefits they now receive. Some will also lose their Medicaid. The new law will also make it harder for children to qualify for SSI in the future.

What are the changes?

There are three important changes in how the Social Security Administration (the federal agency that runs the SSI program) decides if a child is eligible for SSI because of a disability.

1. Social Security will use a new definition of disability for children. A child must have a "medically determinable physical or mental impairment which results in marked and severe functional limitations."

2. Social Security will no longer use an "individualized functional assessment" (IFA). This assessment helped examiners decide if a child cannot do the same everyday things as other children the same age-activities like talking, walking or playing sports.

3. Social Security will change the way it considers certain behavior problems caused by a child's mental or emotional condition.

In the next few weeks, the Social Security Administration will announce new rules for these program changes.

What do the changes mean for my child who now receives SSI?

The new law does not stop benefits immediately for any child. If you now receive benefits for a child, the checks will continue coming until at least July 1, 1997.

Social Security will review the cases of all the children whose eligibility may be affected by the program changes. Before January 1, 1997, Social Security must notify the parents or caregivers of these children that the cases will be reviewed to decide if the children are still eligible for benefits. You should receive a notice in late November or early December explaining the review process.

How do I know if I will get a notice?

Not every child who receives SSI will get a notice. Social Security will only send notices to children whose cases have to be reviewed because of the new welfare law.

Children with mental and emotional problems are especially likely to have their cases reviewed. This is because of the change in how Social Security evaluates "maladaptive behavior" and because many of these children became eligible through the IFA.

If I get a notice, will my child's benefits stop?

Getting a notice does not mean your child's benefits will end. The notice will just warn you that Social Security probably will review your child's case and may terminate his or her benefits.

What will happen after I receive a notice?

Social Security will ask if you would like to provide any more information about your child's condition before the review. You have the right to give medical and other evidence about your child's disability and functioning. To decide if your child is still eligible under the new law, Social Security should look at your child's medical records or request information from your child's doctor, therapist, nurse or teacher. If Social Security wants your child to be examined by a doctor, they will pay for it.

Will all children who get the notice have their cases reviewed?

Yes. Social Security already has a good deal of information about some of the children who receive SSI. Your child's case file may have enough information for Social Security to decide if he or she is still eligible under the new law. If so, and if the decision is that your child still qualifies, you will receive a second notice saying your child's benefits will continue.

What should I do if I receive a notice that my child's case will be reviewed?

You should begin to collect current information about your child's disability. It is always helpful to provide as much medical and other evidence about your child as you can, to show exactly how the disability limits what your child can do at home, in school and elsewhere. Also, if you stopped taking your child in regularly for medical care, be sure to start up again.

How will I find out the result of my child's case review?

Social Security will send you a letter about the results of the review. If your child still qualifies for SSI, the letter will simply tell you that benefits will continue.

If the review finds that your child is not disabled according to the new law, then SSI benefits will stop. The letter will tell you that. It will also explain your right to appeal this decision and tell you how to continue getting SSI during your appeal. When you appeal the decision, you may provide additional information about your child's disabling condition.

What if my child's case is not reviewed now?

Only certain children's cases will be reviewed in the next year because of the changes in the new welfare law. However, the new law also requires Social Security to review every child's case at least every three years, unless the child's condition is unlikely to improve.

When it's time for your child's regular review, you will receive a notice. To keep your child eligible for SSI, you will need to show that your child has been receiving treatment that Social Security considers to be "medically necessary and available" for the disabling condition.

What will happen to my child's Medicaid?

If your child's SSI eligibility ends, then the Medicaid that was based on his or her SSI eligibility will also end. If Social Security tells you that your child will no longer get SSI benefits, you should contact your state Medicaid agency immediately to see if your child can qualify for Medicaid through another state eligibility category, such as your family's income.