Children with juvenile diabetes and low family income may be eligible for SSI disability benefits. To qualify as a disability, a child’s diabetes must generally require daily insulin or 24-hour-a-day adult supervision, unless there are other complications or health problems present.
There are two ways for a child to qualify for Supplemental Security Income on account of a disability. One is by meeting the requirements of one of Social Security’s official disability listings, and the other is by showing that their limitations functionally equal the listings.
Social Security’s listing for juvenile diabetes applies to either Type 1 or Type 2 diabetes mellitus, but it only applies to children under six years old. For children under six years old to qualify for SSI disability under the listing, they must simply require daily insulin.
After age six (and for children under age six who don’t need daily insulin), Social Security will look at whether the child’s medical condition can be considered as severe as that discussed in the listing. In other words, if the child’s treatment needs amount to the same type of adult medical supervision required by daily insulin, Social Security will consider the child’s condition just as severe as that in the listing, and will approve benefits.
For example, if your child needs 24-hour-a-day supervision by adults to take care of insulin injections and monitor food intake and exercise levels, Social Security will find that your child’s condition is disabled. (See C.F.R. § 416.926a, which says that any time a child has a requirement for 24-hour-a-day supervision for medical reasons, that child will qualify for disability.) Some children are six years old or older but can’t control their own diabetes through monitoring their own food intake and watching for hypoglycemia. In deciding whether the child needs constant adult monitoring, Social Security will take into account how long the child has had diabetes, the maturity of the child, whether the child has hypoglycemia unawareness, and whether the child has any intellectual disability or attention deficit. Other children may be capable of monitoring their insulin but simply have more complex medical situations and need more monitoring than others.
Social Security will also consider several domains of functioning to decide whether the child has marked or extreme limitations due to the diabetes. Social Security will take into account how the child’s daily life is affected by diabetes management, including how many episodes of hypoglycemia the child has at school and how many school days the child has to miss due doctor's appointments or hospitalizations. Social Security will also consider whether the child’s studies and school performance or social interactions are severely affected by hypoglycemia or other diabetes symptoms (such as the frequent need for urination, extreme fatigue, or needing to monitor their blood glucose levels). In addition, if your child suffers any complications from diabetes, such as blurred vision, Social Security should take this into account when determining the severity of your child’s limitations.
It’s important to keep records of your child’s daily blood glucose levels and how often your child becomes hypoglycemic, both in school and out of school, as well as how many days of school your child misses due to illness, treatment needs, or hospitalizations.
The federal SSI benefit is currently $735 per month, but few children on SSI actually receive that amount. If the child’s parent or parents are working, part of their income will be attributed to the child (read our article on how Social Security deems family income). This could mean that the child might only get a couple of hundred dollars in SSI payments. On the other hand, some states supplement the federal SSI benefits with a state supplementary payments that can add on anywhere from $10 to $200 to the monthly payment.
The SSI payment can be used to pay for the child’s medical treatment, any medical copays or uncovered costs of daily insulin injections, and healthy food for the child. Some families have also racked up debts due to medical bills for doctors’ visits or insulin delivery pumps, or other costs that were not covered by insurance. SSI can be used to pay off these debts or just to help pay the family rent or mortgage if the mother or father is taking time off work to supervise the child’s diabetes. For more information, you may want to read Nolo’s article on the types of supports that a child’s SSI can pay for.