Social Security disability programs are frequently confusing to many people. Parents of special needs children often ask questions about the differences between the Supplemental Security Income program (SSI) and the Social Security Disability Insurance program (SSDI). The short answer is that SSDI doesn’t directly provide financial support to parents with disabled children. SSI is a financial needs-based program for adults and children with disabilities.
In contrast, SSDI pays individuals and members of the insured’s family if a serious illness or disability occurs. In other words, SSDI benefits working individuals (and their families) because the productive individual has paid into Social Security over a certain period of time. SSDI isn’t a useful program for low income parents with disabled children.
Discussions about the differences between SSDI and SSI frequently occur because Social Security terms and criteria are often discussed without context. This article focuses on SSI payments to disabled children and dependent persons less than 18 years of age.
Social Security Disability and Supplemental Security Income Programs
SSA administers both SSDI and SSI programs. SSA’s rules to decide if an individual is disabled may differ from criteria used in private disability programs and/or other federal government programs. Let’s focus on SSI first:
Supplemental Security Program, or Title XVI of the Social Security Act puts forth the specifics of the program. Most importantly, SSI first focuses on parental or guardian income of the disabled child in order to qualify for SSI benefits.Click on USC Code 1381 to 1383f to Subchapter XVI Chapter 7 Title 42) to learn more.
In Title XVI, the children of less than 18 years is considered disabled if he or she suffers from a medically-determined physical and/or mental impairment (or combination of these) causing marked, severe limitations in function. SSA considers that qualifying impairments are expected to last a minimum of 12 months and, in many cases, last for an indefinite period or result in death.
In the language of the law, a medically determinable impairment is a type of impairment caused by psychological, physiological, or anatomical abnormalities that may be defined by laboratory or clinical techniques. Medical evidence is needed to establish the physical and/or mental infirmity that consists of medically-defined symptoms and signs. In other words, if doctors or medical clinicians can’t determine the specific medical cause of the individual’s problems, the individual’s description of symptoms isn’t enough to satisfy SSA’s requirements.
Unfortunately, many people believe that SSA eligibility standards in use are based on medical and technological data that’s decades too old. Nonetheless, it’s important for families to make sure that doctor, hospital, and clinic records are complete and thorough when requesting SSI benefits for a dependent child.
Importance of Medical Treatment and Providers
SSA requires information from the “medical treating source,” including doctors, psychologists, and others who currently provide, or provided in the past, the applicant with medical evaluations and treatments. Ideally, the treater(s) have ongoing relationships with the applicant. SSA considers the medical treater(s) as the most accurate source of medical evidentiary information about the severity and/or nature of the impairment or condition of the applicant.
When added information or tests are needed, SSA frequently considers the current medical treater(s) as the best source of testing or examination. However, SSA never directly acts or expects the treater(s) to state that the applicant is disabled, regardless of his or her condition, regarding work or school activities. SSA reviews the medical information and considers the applicant’s functional limitations and challenges that result.
According to the Social Security Act, SSA considers evaluations and reports prepared by state and board-licensed:
Doctors or physicians (M.D.s and D.O.s),
Certified psychologists or psychiatrists for the purpose of establishing the applicant’s intellectual function.
Optometrist reports are used to define the individual’s visual acuity/visual fields. (Note that “legal blindness” isn’t enough to satisfy the SSA standard of blindness.)
Podiatrists’ reports are used to establish foot, ankle, etc., conditions.
Speech-language pathologists (SLPs) are required to establish the individual’s level of speech/language impairment. (This may be important when considering the level of impairment of a deaf child.)
Reports and evaluations prepared by a licensed hospital, clinic, or healthcare facility are also deemed acceptable by SSA. Other professionals, including licensed clinical social workers, nurse-practitioners, audiologists, teachers of the deaf, and physicians’ assistants may submit evaluations to support the applicant’s SSI claim.
Non-medical service providers that are engaged in providing ongoing services to the child may provide additional insight but, for purposes of Social Security law, aren’t as relevant as the medical evaluation and evidence submitted by providers. Parents may request reports from school counselors, early interventionists, and other caregivers as part of the record of the child’s ability to function.
Disability Determination in the SSI Application Process
Many SSI disability claims are first processed at the local SSA office level. The local SSA office first verifies the claimant’s eligibility criteria (non-medical items) such as his or her age, marital status, current Social Security coverage, citizenship or legal resident status, and employment (if any). The local SSA office verifies the applicant’s living arrangement details and resources.
After processing, the local office sends the SSI claim to the state agency, frequently called the Disability Determination office. The DDS office typically relies on information from the applicant’s medical providers and resources. When the body of evidence isn’t enough to make a decision, DDS typically arranges a consultative exam (CE) to gather more information.
A request from SSA to schedule a CE is relatively common. If you’ve applied for SSI for your child and receive a request, take it in stride. SSA says that the child’s medical treaters are viewed as preferred sources to the CE examiner.
SSI Determination Process
After the CE meeting, SSA considers the application to make a decision. An adjudicative team including a medical/psychological consultant and a specialist disability examiner review the applicant’s file. At this time, the team may believe that more information is required. They may contact medical/psychological treaters to request additional information at that point.
The child applicant must be considered disabled according to SSI criteria in order to receive benefits. The local SSA office about the determination is notified about the approval or rejection of the SSI application. If the applicant is now considered disabled, SSA completes any outstanding paperwork and calculates the monthly benefit amount to begin disbursing benefits. If the applicant is not considered disabled at this point, the application is rejected. However, SSA retains the application and file at the local office level in the event of an appeal.
Parents or guardians may appeal at the DDS level or via an administrative judge in the Office of Disability Adjudication & Review (ODAR). At this point, SSA assigns a new adjudicative team to review the original disability determination.