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2 The SSI Program for Children
Pages 31-70

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From page 31...
... The third section provides a description of the process for determining whether an applicant is eligible to receive SSI benefits. The fourth section offers a description of the process for an applicant to appeal an unfavorable determination of eligibility, suspensions and terminations of benefits, and recurring reviews of disability.
From page 32...
... . In September 2014, an average child SSI benefit was $632.24 (SSA, 2014i)
From page 33...
... Childhood Disability Eligibility Standards from 1974 to 1990 From 1974 to 1990 the Social Security Act set a "comparable severity standard" for the determination of a child's eligibility for the SSI benefit program, meaning that the standard for determining whether a child was disabled enough to receive SSI benefits would be comparable to the adult standard for disability. Specifically, the statute stated that a child would be eligible for benefits "if he suffers from any medically determinable physical or mental impairment of comparable severity" to one that would disable an adult (SSA, 1991a)
From page 34...
... ; • psychoactive substance dependence disorders (112.09) ; • autistic disorder and other pervasive developmental disorders (112.10)
From page 35...
... . Childhood Disability Eligibility Standards from 1996 to the Present In 1996, as part of a series of welfare reform legislative actions, Congress passed the PRWORA, which changed the statutory standard for childhood eligibility for SSI benefits from "comparable severity" to "marked and severe functional limitations," eliminated reference to "maladaptive behavior" in the childhood mental listings, and eliminated the "individualized functional assessment" (SSA, 2012a)
From page 36...
... , located in communities throughout the country, administer the nondisability criteria of citizenship or alien status, residency, employment, income, and resources. State disability determination services (DDSs)
From page 37...
... Also, for the purposes of this report, the number of determinations can be understood as a proxy for the number of applications among children who are in poverty; specifically, determinations will be the number of children for whom applications for SSI benefits have been submitted and who have already been found to meet the nondisability eligibility criteria.
From page 38...
... BOX 2-1 The Child Mental Disorders Listings The Listing of Impairments was developed to ease the administrative burden of determining the functional capacity of each claimant and was revised in 1977 to include criteria that would apply to children under age 18 applying for SSI (IOM, 2007)
From page 39...
... However, since there is no listing, no determination of disability can be made for LD or BIF based on meeting. The complete SSA childhood mental disorders listings are reproduced in Ap pendix B
From page 40...
... (Once benefits are ceased, an individual cannot receive benefits without filing a new application.) REQUIREMENTS FOR SSI ELIGIBILITY For a child to receive SSI benefits, two basic conditions must be met: (1)
From page 41...
... The work, income, and resource eligibility criteria must be met prior to any evaluation of disability. After an application for child SSI benefits is filed, the SSA field offices
From page 42...
... After deeming exclusions are applied, children eligible for SSI may come from households with income above 100 percent of the FPL. As reported in Chapter 5, three-quarters of children receiving SSI benefits were in households with income less than 200 percent of the FPL, without taking into account the income from the SSI benefit (Bailey and Hemmeter, 2014)
From page 43...
... . If there is not sufficient medical evidence to support a finding of a medically determinable impairment, the claim will be denied.
From page 44...
...  ocial function at a level generally acquired by children no more than S one-half the child's chronological age, documented by: (1) An appropriate standardized test; or Mental Disorders Listings, which serve as a standard for determination of disability.
From page 45...
... and including, if necessary, the results of appropriate standardized tests; or 3. Marked impairment in age-appropriate personal functioning, documented by history and medical findings (including consideration of information from parents or other individuals who have knowledge of the child, when such information is needed and available)
From page 46...
... . When deciding whether a child has marked or extreme limitation, SSA considers functional limitations of the child's impairments
From page 47...
... . For children of any age, marked limitation will be decided if a valid score on a comprehensive standardized test designed to measure ability or functioning in a domain is two standard deviations or more below the mean but less than three standard deviations (SSA, 2014f)
From page 48...
... NOTE: Under the disability redesign prototype model, SSA eliminated the reconsideration step of the appeals process in the following states: Alabama, Alaska, California (Los Angeles North and Los Angeles West DDS offices) , Colorado, Louisiana, Michigan, Missouri, New Hampshire, New York, and Pennsylvania.
From page 49...
... On average, only 3.3 percent of allowances are made at reconsideration, and 4.5 percent of allowances are made at the 3  Underthe disability redesign prototype model, SSA eliminated the reconsideration step of the appeals process in the following states: Alabama, Alaska, California (Los Angeles North and Los Angeles West DDS offices) , Colorado, Louisiana, Michigan, Missouri, New Hampshire, New York, and Pennsylvania.
From page 50...
... A termination of SSI benefits occurs when a recipient is ineligible for 12 consecutive months; the terminated recipient cannot receive disability benefit payments without submitting a new application. Terminations can occur when a recipient dies, or after 12 consecutive months of suspension.
From page 51...
... Those who meet adult standards and go on to be recipients of adult SSI benefits are not counted as terminations from the child SSI program, even though they are no longer recipients of child SSI benefits. Those who do not meet the adult standards at redetermination are counted as terminations.
From page 52...
... These three key data elements are discussed in the following sections. Diagnostic Categories for Determinations of SSI Benefits The SSA Program Operations Manual System (POMS)
From page 53...
... During public information gathering meetings with the SSA, the SSA staff informed the committee that secondary impairment codes are neither consistently nor accurately recorded by examiners, and recommended that the committee avoid use of the secondary impairment data. Additional information on the rates of secondary impairments for mental disorders in children and also on the reliability and consistency of secondary impairment data can be found in the U.S.
From page 54...
... developmental disorders 112.11 Attention deficit disorder/attention 3140* deficit hyperactivity disorder 112.12 Developmental and emotional 3150 disorders of newborn and younger infants Learning disorder (LD)
From page 55...
... The SSA does not collect any information on race or ethnicity at any point during the adjudication process. Recipients A recipient is a child who is receiving SSI disability benefit payments.
From page 56...
... As detailed below, the sources of data regarding the prevalence of mental disorders in the general population and in the SSI population can differ on all of these factors, adding considerable challenges to their comparisons. In order to look at trends in prevalence as required by the task order,
From page 57...
... Furthermore, methodological difficulties are compounded when information about cases of mental disorders are not routinely monitored or collected by state or national agencies. We know how many cases of measles or rabies occur because reporting is required; however, no official, nationwide record is kept of the number of cases of ADHD or ASD.
From page 58...
... Additional information on surveillance systems that collect data on mental disorders is included in Appendix D Advantages • All potential cases identified have been brought to the attention of health or education service providers as being in need of help; this indicates a level of severity.
From page 59...
... These databases are used to recruit individuals into a random sample who are interviewed in person or by telephone. The NHANES is an example of a national survey that then conducts direct interviews with and assessments of children; the NHIS is a national survey in which information on child mental disorders is obtained through parent reports to an interviewer.
From page 60...
... . As SSI benefits rely on diagnosed cases, the prevalence of benefits in the SSA database can increase even though "true" prevalence is static.
From page 61...
... The trends observed in the SSI program are a product of variation in the cases of disability that lead to an application for benefits and subsequent selection by the disability adjudication process. Only children whose families have applied for benefits on their behalf and who sequentially meet all of the eligibility criteria can become recipients of SSI benefits.
From page 62...
... . Once a child becomes a recipient of SSI benefits, he or she will continue to receive benefits until suspended or terminated or until he or she turns 18.
From page 63...
... Because the adjudication process only evaluates children for disability after they meet the income and resource criteria, the identified cases of disability are only among poor children. As illustrated by the yellow box in Figure 2-4, SSI recipients are a small subset of children in the United States who are simultaneously in low-income households and meet the requirements of having a "severe, medically determinable impairment." (Medically determinable impairment
From page 64...
... See Box 2-3 for the definition of prevalence in the SSI program for children. Challenges for Comparing SSI "Prevalence Trends" to Other Prevalence Trends in the General Population To accomplish the goals of the task order, the committee compared trends in the prevalence, as illustrated by Figure 2-5.
From page 65...
... National surveys are designed to estimate the prevalence of mental disorders among all children, regardless of their income, and regardless of the severity of their disease. In contrast, the SSI adjudication process restricts eligibility for the SSI benefits to those children who meet the income and resource criteria and also meet the requirements of having a severe, medically determinable impairment.
From page 66...
... the DSM and ICD or any vary depending on the other current taxonomy survey/study. for mental disorders in children.
From page 67...
... Differences in cases identified also include differences in how disorders are classified for the SSI program ver sus in national surveys or clinical settings. • For the purposes of this report, SSI prevalence is either the propor tion of children in low-income households, or the proportion of all children in the United States who are recipients of SSI benefits for the selected mental disorders.
From page 68...
... I-5-4-30-a. Processing supplemental security income childhood disability cases based on Pub.
From page 69...
... 2013c. DI 25205.005: Evidence of a medically determinable impairment.
From page 70...
... 2015b. Disability evaluation under Social Security: 112.00 Mental disorders–childhood.


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