A diagnosis of cancer in your child can be devastating news for a parent. Supplemental Security Income (SSI), a program that provides disability benefits for low-income children, can potentially provide crucial financial support. Medical insurance through Medicaid and other related services can also ease the burden on the family (in some states, Medicaid automatically comes with SSI).
Despite the seriousness of a cancer diagnosis, your child still must meet Social Security's basic disability requirements in order to qualify for benefits. Most importantly, your child must either have been disabled for the past 12 months (or be expected to be disabled for 12 months or more or have a disability that is expected to result in death).
This issue can be problematic in cases of childhood cancer where treatment was early and effective. However, if your child's treatment was lengthy and involved or caused long-lasting side effects, you can most likely convince Social Security that the disability lasted or can be expected to last a year or more. It is tremendously important in cases of childhood cancer to provide evidence that covers a span of time to show the lasting effects of the cancer or the treatment.
If the impact of the cancer treatment is yet unknown, Social Security may have to delay making a decision on the case.
Some childhood cancers are so serious and have such a poor prognosis that they qualify for expedited approval. Social Security has a compassionate allowance program that lists the specific childhood cancer diagnoses that qualify for this expedited treatment. The childhood cancers that qualify under this program are:
Children can also qualify for an expedited decision under the compassionate allowance program for cancers that are not specific to children. Some examples include:
If your child has one of these diagnoses, file a standard disability application for Supplemental Security Income. When Social Security sees the medical evidence supporting the diagnosis, it will mark the file for expedited consideration. This means that you may not have to submit any additional medical evidence and your child's claim will likely be processed in three or more weeks.
There are still three different avenues by which your child may be determined to be disabled due to cancer: by "medically meeting a listing," "medically equaling a listing," or "functionally equaling the listings."
Children with cancer can be found disabled if they meet certain medical requirements contained in Social Security's listing for childhood cancer (listing 113). The diagnoses that may meet a listing, depending on the extent of the cancer, how long it has lasted, and the child's response to therapy are:
For some of these cancers, a simple diagnosis is sufficient to receive disability for 24 months. For others, the cancer will be considered disabling only if the cancer has spread to another part of the body, referred to in the listings as "distant metastases," or if the cancer re-occurs after treatment.
For some cancers, Social Security will consider the intensity and duration of the cancer treatment. Therefore, it is important that your medical records show:
Social Security will review treatment notes, pathology reports, biopsy reports, imaging scans, and lab work as well as hospital records to determine whether your child meets the listing. Once the listing is met, the child will be found to be disabled without having to demonstrate any limited functioning as a result of the medical condition.
If a listing is not met, a child may still experience significant medical issues that can considered of equal severity to a listing. The cancer may not be the primary disabling factor, but there may be a residual impact on a body part or function that may be considered to equal a listing. In this case, the child's condition will be reviewed under the listing for that body part. For example, retinoblastoma can impact your child's vision, so Social Security would look to see whether your child meets the low vision listing.
Or, your child may have had treatment for a cancer that impacted a particular body part. For example, chemotherapy can cause neuropathy and may impact your child's ability to walk or to use his or her hands due to pain. These symptoms can be reviewed under the listing for joint dysfunction and, if the impairment is severe enough, your child's condition may equal that listing. Often, children can equal a listing when the combination of all their symptoms and impairments are equal in severity to the requirements of a listing.
The side effects of cancer treatment that Social Security will consider include:
Some children may not satisfy the medical criteria to meet or equal a childhood disability listing but nonetheless may be severely impacted by their illness or a combination of conditions. In this case, Social Security may find some children disabled because they have severe limitations in their ability to carry out certain tasks and engage in day-to-day activities. This is called "functionally equaling" the listings in general.
In order to be found disabled this way, you must show that your child has "marked" limitations in two of the six "domains" (areas) of functioning or an extreme limitation in one area of functioning. The areas of functioning are:
Many of your child's limitations in functioning may arise from the side effects of the cancer treatment. For example, chemotherapy can cause fogginess and fatigue, which can impact your child's ability to both acquire and use information as well as attend to and complete tasks. You will likely need reports from your child's teachers as well as doctors to document problems with learning and paying attention.
Some nervous system cancers and/or the treatment for such cancers may cause dizziness and balance issues. This may limit your child's functioning in the domain of moving about and manipulating objects.
A child's health and wellbeing is limited if, due to a suppressed immune system, they are in and out of the hospital due to various infections. If they miss a lot of school because of the hospitalizations or doctors visits, or spend much of the time in bed, this can be considered an extreme limitation in the domain of health and wellbeing. School records documenting absences as well as emergency room records and other related evidence should be submitted to prove this limitation.
For further information on the domains of functioning and how to prove your child has marked or extreme limitations in these areas, see our article on how to get SSI for a child by functionally equaling the listings.