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. The children who are going to be reviewed under the new disability definition began getting information notices from Social Security beginning Thanksgiving week. About sixteen thousand California children are receiving the notices.
There are three important changes in how the Social Security Administration (SSA) decides if a child is eligible for SSI because of a disability.
1. SSA 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. SSA will no longer use an "individualized functional assessment" (IFA). This assessment helped examiners decide if a child met the old disability standard by looking at how the disability affected the child's everyday activities--activities like talking, walking or playing sports.
3. SSA 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.
Getting a notice does NOT mean your child's benefits will end. The notice is just to warn you that SSA will review your child's case and MAY terminate his or her benefits. If Social Security reviews your child's case and decides your child does not qualify under the new standard, you will receive a redetermination decision and an opportunity to appeal. Even if you do not appeal, SSI benefits will continue through July of 1997.
Yes. If your child does not get a notice, your child is not going to be reviewed under the new welfare law. Not every child who receives SSI will get a notice. SSA will only send notices to children whose cases have to be reviewed because of 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, the new law requires you to show that your child has been receiving treatment that SSA considers to be "medically necessary and available" for the disabling condition.
Yes. SSA already has a good deal of information about some of the children who receive SSI. Your child's case file may already have enough information for SSA 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.
Social Security will review your child's case to see if he or she qualifies under the new disability standard. You will know when Social Security is looking at your child's case because you will receive another notice from SSA asking if you would like to provide any more information about your child's condition before the review. SSA will send you releases to sign so that they can ask for recent information from your child's doctors and others who treat your child.
If your child is a regional center client, let your regional center case manager know that you received the information notice from Social Security and that you will need help when Social Security begins to review your child's case.
If your child receives services through County Mental Health, let the clinic your child visits know that you received the Social Security notice and that you will need help when Social Security begins to review your child's case.
If your child receives health services through a clinic, let the clinic know about the Social Security notice. Let your doctor know too.
When Social Security reviews your child's case, Social Security will want recent information about your child's condition. It is important that your child keeps seeing his or her doctor and others that treat your child.
If you appeal the notice saying your child does not qualify for SSI under the new standard, your SSI and your Medi-Cal will continue while you appeal. If your SSI stops, your Medi-Cal based on SSI will stop. However, when you receive the notice saying your Medi-Cal will stop, you will also receive an application to fill in and send back. It is important that you do that immediately so that the County Welfare Department can determine your Medi-Cal eligibility under another program.
This information sheet was prepared based on materials developed by the Bazelon Center for Mental Health Law, The Arc, and the National Center for Youth Law.
PAI #5072.01