Are U.S. children with ADHD eligible for SSI benefits?
Possibly. Prior to Welfare Reform, officially known as Professional Responsibility and Work Opportunity Reconciliation Act (PRWORA), conditions such as ADHD were contained in a section of the Social Security regulations known as the "Listing of Impairments." SSI benefits were automatically granted, as long as the parent provided sufficient medical or psychological documentation proving the child had the claimed disability. Now, maladaptive behavior categories, which for the most part contained emotional or educational disabilities along with ADHD, have been eliminated. Consequently, children with ADD or ADHD as their only disability would not automatically qualify for Social Security benefits.
Under the new law, a child must have "marked and severe functional limitations." While cases of severe ADHD may still qualify under the new definition, less severe cases which do not meet the new definition would not.
What qualifies as a marked and severe functional limitation?
Generally, ADHD must result in "marked" functional limitations in at least two basic areas to qualify for SSI. For school age children, this could mean that the child's condition "seriously" affects his or her ability to develop, play, learn, socialize, or engage in other daily activities appropriate to the child's age. For younger children, this would mean that the child is functioning — developing, playing, learning, socializing, or engaginge in other daily activities — at a level that is between one-half to two-thirds below what would be expected of an average child of the same age.
This determination must be made without consideration for accommodations. For example, if the child's IEP requires a a small special education classroom, consideration must include how the child would function in a typical classroom without special structure or support.
How much money is available?
Benefits were in amounts up to $500 per month in 1999.
Other than income, are there any other benefits?
If your child qualifies for SSI, then he or she may also qualify for Medicare.
Who do I contact to start this process?
Call the Social Security Administration's toll-free number at 800-772-1213. A representative will schedule a time for you to visit the local office.
What is required to show that my child might qualify?
You will need a complete medical and functional history for your child. (Be sure to keep a copy of everything you give to Social Security. They tend to lose things.)
Specific items may include:
- Names, addresses and telephone numbers of all your child's doctors and the dates of all visits in the past year.
- Names, addresses and telephone numbers of any psychologists, nurses, physical or occupational therapists, speech and language therapists, mental health therapists, counselors, or anyone who has worked with your child and may have information about how the child functions.
- Medical records, including any medicines prescribed for your child, treatments, medical test results, and any notes pertaining to his or her medical care.
- A complete copy of the child's school record, including the IEP, test scores and assessments.
- Written evaluations by current and former teachers.
If I submit all of these documents, do I still have to fill out all of the forms?
Yes. The forms will essentially be your voice during much of this process. Answer all questions completely and provide as much information as possible. Explain every item in detail and don't be bashful about using additional paper — and don't forget to attach any extra paper to the appropriate form.
Who makes the determination about my child's eligiblity?
Eligibility is decided by the Disability Determination Service (DDS) of Social Security. The DDS makes a decision initially based on the written information in medical and other records submitted. When DDS does not have enough information to make a decision, it requests, at no cost to the applicant, a consultative examination (CE) by an approved psychologist. If the DDS subsequently rejects the application for eligibility, the parent may request "reconsideration," a process in which a three member team who had nothing to do with the initial decision reviews it. Reconsideration stems from timely action taken by the parent to request a second opinion. At that point the parent may appear in person at an informal hearing or simply submit additional documentation.
What happens at the hearing?
The DDS will hear testimony about your child's condition and functional limitations.
Should my child attend this hearing?
Yes. The hearing officer will want to see your child and ask him or her questions to help determine the severity of the disorder. These people deal with children all the time and are usually good at making the child feel comfortable during this process.
What if the hearing officer decides that my child is not eligible?
You will receive a written notice with the reasons for the decision. The notice will also tell what your appeal rights are.
You can file a Request for Hearing by an Administrative Law Judge. The form for this appeal is available at your local Social Security office. You have 60 days from the date you receive the denial notice to file the appeal. You can request benefits pending appeal if you file within 10 days of receiving the denial notice. Depending on how many cases are waiting to be heard, it may be weeks or even months before your appeal will be heard.