Parents of children who have chronic illnesses or diseases are frequently challenged to find the right resources to help address all of the consequences of a serious medical diagnosis. This is true for all parents, but low-income parents can be especially challenged. Finding and accessing appropriate resources such as medical care, special education, physical therapy, occupational therapy and behavioral therapy, child care, transportation, proper nutrition, medication, and visits to doctors and specialists can sometimes be overwhelming for families with limited resources.
The Social Security Administration’s Supplemental Security Income benefits program is vital to the health and well-being of disabled children. This program provides a monthly cash benefit of up to $733 per month. In most states, a person who qualifies for SSI is also eligible for Medicaid. Some states also provide an additional supplement to the $733 per month SSI benefit amount.
While the program provides needed assistance to children with disabilities, it is not easy to obtain SSI benefits, and except in very narrow circumstances that qualify as “dire need,” or where a child’s illness is terminal, such benefits cannot be obtained quickly for even the very needy. In order for a child to receive SSI benefits, his parent must apply on behalf of the child. To be eligible, the child must have a condition that qualifies him as disabled under SSA rules and regulations, and the family must have limited resources. While the application process is easy, denial of claims at the initial application level is typical. It is also easy to appeal a denial by filing a “Request for Reconsideration.” However, 90 percent of Requests for Reconsideration are denied. Those denials may be appealed by filing a “Request for a Hearing Before an Administrative Law Judge.” Unfortunately, the time it takes from the date of requesting a hearing can be anywhere from 12-24 months, which is a long time to wait for a low-income family under the stress of caring for a disabled child.
While SSI is designed for “disabled” children, the Social Security Administration has a very restricted definition of disability:
- The child must have a physical or mental condition(s) that very seriously limits his or her activities; and
- The condition(s) must have lasted, or be expected to last, at least 1 year or result in death.
SSA’s definition of the term “disability” is not the same as a physician’s understanding of the term, and not always the same as a layperson’s understanding. In order to meet the definition and qualify for benefits, the claimant must establish through medical records and other evidence that he meets the criteria under one of the SSA’s “listings” of childhood impairments, or functionally equals the listings. In spite of these hurdles, and the amount of time it takes to appeal a denial of a valid claim until a claimant can present the evidence to an administrative law judge, parents of disabled children who are financially and medically eligible should pursue SSI benefits because the cash stipend and attendant Medicaid can do much to improve the lives of children with serious health conditions.
Lisa Radtke Bliss is the Director of Experiential Education, Co-Director of HeLP Legal Services Clinic, and an Associate Clinical Professor at Georgia State University College of Law, focusing on interdisciplinary education, the development of clinical legal education in the context of a medical-legal partnership, and implementation of best practices in legal education. The Health Law Partnership (HeLP) Legal Services Clinic is part of the Health Law Partnership, a medical-legal collaboration among Georgia State Law, Children’s Healthcare of Atlanta and the Atlanta Legal Aid Society.