Social Security Benefits For Children: Why Is Approval So Difficult?

When thinking about recipients of social security benefits, we typically focus on adults.  We think about people who were injured in accidents and receive social security disability benefits because they are unable to work. Or we think about seniors who are retired and rely on social security benefits as their income.  However, children are can also be eligible to receive social security benefits.

Under the Social Security Administration's Supplemental Security Income (SSI) childhood disability program, low-income children under the age of 18 who have a disability may be entitled to monthly benefits.  However, according to the Center on Budget and Policy Priorities, the Social Security Administration (SSA) rejects 60% of applicants for SSI for children.  The National Organization of Social Security Claimants' Representatives reports that less than 25% of low-income children with disabilities receive SSI.

The Rules
SSI is available to low-income people who are 65 or older, or are blind or disabled.  Children under the age of 18 are eligible to receive SSI benefits if they meet the Social Security Administration's definition of disability, and if the income of the child's family falls within the eligibility limits.  If the child works, the child's income cannot exceed $1040 per month for 2013. 

According to the Social Security Administration (SSA) the child's medical condition must be debilitating and cause the child to have "marked and severe functional limitations."  In addition, the disability must have existed for at least 12 months, or must be expected to result in the child's death.
The actual amount of the monthly payment varies from state to state because some states add additional sums to the SSI payment.  For 2013 the maximum payment from the SSA is $712 per month. 

The Case of Maziah Mills-Sorrells
Based on the SSA's rules, it would seem as if 2-year old Maziah Mills-Sorrells of Philadelphia, Pennsylvania would easily qualify.  Maziah was born with a rare condition called Klumpke's palsy.  Nerve damage that occurred during her birth has resulted in her left arm being permanently paralyzed.  In addition to having no use of her left arm or hand, she has balance issues and decreased ability to move around without support.  As a result of her condition Maziah cannot navigate stairs, tie her shoes, put on clothes, or use the potty.

In addition, the combined income of Maziah's parents is $17,000-- below the poverty level and below the income  level for SSI eligibility.  While the majority of Maziah's medical expenses are paid by Medicaid, Maziah's family is responsible for medical expenses that Medicaid does not cover.  With an income of just $17,000 it is difficult for Maziah's family to keep up with all of Mariah's medical expenses as well as other family bills. 

Despite medical evidence of Maziah's disability and the low-income of Maziah's family, the SSA has denied Maziah SSI benefits three times.

Why are so many applications denied?
It is not clear why Maziah's application was denied three times or why so many children's SSI applications are denied.  Just like applications for Social Security Disability (SSDI) benefits, the SSA applies strict rules in determining SSI benefit eligibility.  For example, the child's impairment must be one that is on the SSA's list of debilitating conditions.  If it is not on this list, then it must be equal in severity.  If a child's condition is not on this list, it is more difficult to get approved for SSI benefits.  In Maziah's case even though the judge reviewing her case found that Maziah was unable to perform several basic daily activities of life and that she was also limited in her ability to play, the judge determined that she did not qualify for SSI.

According to a Raleigh social security benefits attorney, whether a child is approved for social security benefits also largely depends on the case that is presented in the child's application.  Supporting information from not only the child's physicians, but also from therapists and teachers can be critical in whether or not an application is approved.  The SSA will also require an independent examination of the child.  A decision will take 3-5 months.  While in most cases the initial application is denied, the SSA provides several avenues for appeal.  In some cases the application is eventually approved.  However, this can take years.

Alternatives to SSI
Sadly, the reality is that many seemingly qualified children will not receive SSI benefits.  However, there are resources available to these children and their families.  Medicaid is available to low-income children and typically covers the majority medical expenses.  State-run Children's Health Insurance Programs provide health insurance to children who do not qualify for Medicaid.  State health departments also offer Children with Special Health Care Needs programs that provide health services to children with specific special needs.  If the child's disability was caused by another person's negligence, the child may be able to recover damages by pursuing a personal injury lawsuit.
The media is fraught with stories about how people frequently abuse the social security disability system.  At the same time statistics show that the majority of both child and adult applications are denied.  How can the SSA ensure that deserving applicants receive disability benefits and also ensure that fraud is discovered?

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