The SSI program provides cash assistance to low-income people with substantial disabilities. SSI recipients in almost all states gain access to Medicaid coverage, even when their incomes may be above the usual state requirements for eligibility for the program. Nonetheless, SSI also has financial eligibility requirements, although household incomes can range up to as much as twice the federal poverty level. The maximum income support is currently about $6,000 per year; this money can be used for any need that a child may have. SSI sets a fairly severe standard of disability for eligibility: estimates are that only about 1 to 2 percent of U.S. children would meet the disability standards, well below estimates of the numbers of children with health-related limitations of activity (the current estimate is that 7 to 8 percent of U.S. children have health-related limitations of activity ) (NCCD, 1995). Current presumptive eligibility criteria include a birth weight of less than 1,200 grams for a child claimant less than 1 year of age, with a planned reevaluation at 12 months of age to determine ongoing clinical severity. In 2004, 16,349 children were approved for the receipt of SSI under the presumptive eligibility criterion of a birth weight of less than 1,200 grams. An additional 2,452 children with birth weights between 1,200 and 2,000 grams were also enrolled in the program (SSA, 2005b; Title XVI Only Disabled Child claims applications filed 1995-2004; Title XVI Disability Research File, obtained from the SSA Office of Disability Programs).
The eligibility determination process can be complex, with the person (or family) applying to the Social Security Administration, which then refers the case to the state's Disability Determination Service, which operates under rules established by the federal government. The state staff, who are usually lay personnel, review the child's medical records and supporting evidence to determine whether the child meets SSA's listed criteria for eligibility. The determination of eligibility can be difficult, especially for very young children.
SSI expenditures for children grew rapidly in the early 1990s, after major expansions in clinical eligibility for SSI (with new allowable diagnoses) as well as other efforts to improve the access of children with disabilities to the program were implemented. SSI (and related Medicaid) expenditures thus represent another high-cost item for children with disabilities and range from $12 billion to $15 billion per year (Mashaw et al., 1996).
For children who are severely disabled, SSI eligibility can continue into adulthood. Under the SSI program, a redetermination of eligibility status for SSI is undertaken by use of the eligibility criteria for adults when the child reaches age 18. In contrast to the criteria for children (that the impairment results in severe functional limitations), the criteria for adults require proof that the individual cannot sustain gainful employment. If an improvement is possible but cannot be predicted, the case will be reviewed about once every 3 years and is then reviewed every 7 years if improvement is not expected.
Although it is not known how many individuals enrolled in the SSI programs for adults and children were born preterm, preterm birth and its possible adverse long-term health outcomes generate public costs through the SSI program. These public costs can extend far into the future for any child born preterm, potentially for the entire life course. The latter may span many decades, as average the life expectancy is 77 years for children born in 2005.
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