When a Child Receiving SSI Disability Becomes an Adult: Age 18 Redeterminations
How Social Security attempts to make age 18 redeterminations fair for children receiving disability benefits through SSI.
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Generally, when children who receive Supplemental Security Income (SSI) disability benefits turn 18, they must be reevaluated as adults in what's called a redetermination, or sometimes an "age 18 redetermination." The way Social Security assesses adult applications for disability is different than how they assess children. Sometimes this can result in a loss of benefits, but Social Security does make some special considerations for this situation to ensure fairness.
Transitioning from Children to Adult Requirements
The requirements for evaluating a child versus an adult are similar. Adults and children can each qualify for benefits by meeting or equaling a specific listing. But for children who qualified for SSI because their functioning in six domains was inadequate (called being "functionally equivalent to the listings in severity"), the assessment will change. Adults who don't meet a listing are granted disability benefits if their physical or mental limitations affect their ability to do work activities (called a medical-vocational allowance).
This difference is due to the different expectations that are placed on children versus adults; the adult element focuses on work, while the child requirements focus on functioning level. This is done because most children are not expected to work to support themselves, while nearly all adults are. Below are the three elements that can be used to qualify for disability benefits for children and adults.
Below is a comparison of how these elements are evaluated for children and adults.
Meeting or Equaling a Listing as a Young Adult
For children who were receiving SSI because they met or equaled the requirements of a listing, there is a strong likelihood that they will be able to do so with the adult listings. The childhood listings are generally the same as the adult listings, often using the same language, but even where they differ, the listings in the "Childhood Blue Book” and the "Adult Blue Book” are intended to be equally severe. Therefore, childhood impairments that still exist as the child turns 18 and become adults generally transfer into adult impairments that meet disability listings.
In some cases, there is a child's listing for an impairment but no corresponding adult listing. One example is for anorexia and other eating disorders. There is a child's listing for eating disorders, but no adult listing. In that case, the 18-year-old will need to be granted a medical-vocational allowance for eating disorders to continue to receive disability benefits.
Functional Equivalency and Inability to Work
As mentioned, there are children who qualified for SSI not because their condition met or equaled a listing but because it was found to be functionally equivalent to the listings. This means that they have marked or severe impairments in at least one aspect of their functioning. As adults, these children who don't meet a listing need to be able to show that they are unable to work in order to get a medical vocational allowance.
Social Security determines inability to work by using a Residual Functional Capacity (RFC) to assess the applicant's exertional and non-exertional limitations.
For disabled children who are turning 18, the normal assessment done for of adults may not fully explore their level of impairments. Social Security realizes this and gathers information for assessing young adults' limitations differently.
What Social Security Looks At
For children turning 18, Social Security will look at the following areas to assess their ability to work.
- Functioning in educational programs. Social Security will look at how the child did in educational programs, including schooling. Problems that arose in school, such as difficulty paying attention in class, interactions with other classmates, and physical limitations noted in the classroom will all be considered. Social Security considers limitations in these non-work environments because impairments found here will likely translate into difficulties in the workplace.
- Community experiences including on-the-job training, and work experience (including volunteer jobs). Specifically, Social Security will look at how the child performed in the community, and any accommodations or supports the child needed because of his or her disability. Social Security will also consider treatments that were being received during this time (including medications), and the effects of the treatment, both good and bad, will be considered.
- Work-related stress. Social Security will consider statements from sources familiar with the young adult about his or her ability to handle stress in the community.
All of these factors will help Social Security to get a better picture of how the child will be able to manage in a work environment.
The evidence that is used for children turning 18 is different from the evidence used in adult cases. In addition to medical records that can provide the medical evidence and reasoning behind a child’s impairments, Social Security needs to know how such medical issues impact the child’s abilities. The sources of evidence Social Security uses for children turning 18 includes the following.
- Doctors. Statements from treating physician(s) regarding how the child's impairments could affect his or her ability to do work.
- Other professionals. Statements from other treating health care professionals that would generally not be considered by Social Security. Such health care providers include physical therapists, occupational therapists, chiropractors, social workers, and other individuals who provide some level of medical care to the child. Social Security will consider their medical opinions about the child’s impairments and the effects of those impairments on their ability to work because they would be able to provide important insight into how the child will adapt to a work environment. For example, a physical therapist could talk in depth about a child’s physical limitations and how such limitations could hinder his or her abilities to perform a job.
- Family and community members. Statements from those who have contact with the child on a regular basis, including parents, family friends, and others close to the child. These individuals will be able to provide strong insight into the severity of the child’s impairments and the impact of those impairments on their level of functioning. Individuals close to the child may see struggles and limitations of the child that are not evident to those who only see the child on particular occasions.
- School. Statements from school programs, including evaluations from teachers and other education providers. The individuals from school programs see the child on a daily basis and may be able to provide information that is not otherwise available. If the child still has an Individual Education Plan (IEP), that will be considered as well. (And just because children meet their IEP goals does not necessarily bar them from continuing to receive disability benefits.)
Social Security understands the differences between children just turning 18 and those who are already adults. The agency considers anyone from 18 to 25 to be a young adult. It is because of the similarities between older adolescents and young adults that the agency provides unique assessments to gain a full picture of the young adults and their impairments before deciding whether they are able or unable to work any job and thus that their benefits should be continued or discontinued.