The Future of Children, Princeton - Brookings: Providing research and analysis to promote effective policies and programs for children.

The Supplemental Security Income (SSI) program, administered by the Social Security Administration (SSA), provides income assistance to low-income people who are elderly, blind, or disabled, including children. In 1990, a Supreme Court decision (Sullivan v. Zebley) held that SSA's test for determining whether children were "disabled" (and thereby entitled to SSI assistance) was unlawfully restrictive. Following this decision, the number of children in the program grew dramatically, from approximately 300,000 in 1989 to about 1 million in 1996.¹¹⁸ As the numbers swelled, the program came under attack. A series of press and television stories alleged that children were being "coached" to misbehave in order to get "crazy checks."¹¹⁹

Although subsequent investigation revealed no evidence of widespread abuse of the program,¹²⁰ Congress took up the issue during the welfare reform debates in 1996. Disagreements arose concerning the criteria for determining children's eligibility for SSI, the meaning of "disabled," and the degree of impairment necessary to justify assistance. Consequently, the 1996 law made a number of changes to SSI. Specifically, the law:

• Modified the definition of childhood disability, requiring that a child have an impairment that results in "marked and severe functional limitations" in order to be eligible for SSI benefits;


• Required that SSA use the new definition to redetermine the eligibility of children already receiving benefits, if it might lead to termination of their benefits;


• Eliminated the "medical improvement" test for 18-year-olds (which had allowed children to continue to receive benefits after age 18 unless their condition had medically improved to the extent that they were no longer disabled), and instead required that SSA use the adult criteria for disability to redetermine eligibility for children turning 18.

Under the new definition of childhood disability, an estimated 100,000 children lost their eligibility for SSI.¹²¹ In 1997, SSA issued interim regulations interpreting the phrase "marked and severe functional limitations."¹²² Many critics contended that this interpretation was unduly restrictive. Indeed, when SSA issued the regulations, several U.S. senators who were instrumental in drafting the SSI provisions of the 1996 law sent a letter to the president claiming that this interpretation was inconsistent with their intent.¹²³

In September 2000, SSA issued revised final regulations.¹²⁴ Although the basic interpretation of "marked and severe functional limitations" did not change, some advocates saw the regulations as an improvement, because they simplified and clarified the process for determining childhood disability.¹²⁵ Also, some are encouraged that SSA has undertaken a project with the American Association of University-Affiliated Programs to examine ways they might improve the evaluation of childhood disability claims. Advocates are hopeful that the process of determining disability in children will continue to improve as the project progresses.

In addition to questions about the definition of childhood disability, another concern is that adolescents who should continue to receive benefits are losing them. SSA data indicate that between 1997 and 2000, just over 90,000 adolescents (nearly half the SSI recipients who went through eligibility redeterminations at age 18) lost their eligibility for SSI benefits.¹²⁶ However, the number of adolescents who are expected to remain ineligible once all appeals processes are exhausted is expected to drop to about 70,000.¹²⁷ Also, the proportion of adolescents losing their benefits appears to have decreased each year since 1997.

As adolescents lose SSI eligibility, many also lose access to medical care through Medicaid.¹²⁸ Advocates for disabled teens argue that applying adult eligibility requirements to children turning 18 creates an unfair burden because the adult criteria are based partially on work histories, which most teen SSI recipients do not have. Advocates are also concerned that eliminating the medical improvement test for 18-year-olds treats them like new applicants, with no transition period as provided in other programs.¹²⁹

Although the 1996 law amended the SSI program, it is not clear whether SSI will be part of the discussions about TANF reauthorization. No part of the SSI program requires reauthorization. Nonetheless, key issues concerning children and SSI that may surface as TANF legislation is considered are summarized in Box 10.