Under the new law, the definition of childhood disability is no longer linked to the definition of disability for adults. The reference to "comparable severity" in the old law has been deleted.
The new definition says: (1) an individual under the age of 18 shall be considered to be disabled under SSI if that child has a medically determinable physical or mental impairment, which results in marked and severe functional limitations, and which can be expected to result in death or which has lasted or can be expected to last for a continuous period of at least twelve months; and (2) no individual under the age of 18 who engages in substantial gainful activity may be considered disabled.
In addition to the new definition of disability for children, the law mandates two changes to current evaluation criteria in SSA's regulations. SSA must: (1) discontinue the individualized functional assessment (IFA) for children; and (2) eliminate maladaptive behavior in the domain of personal/behavioral function in determining whether a child is disabled.
In most States, individuals who are eligible for SSI are also eligible for Medicaid. These changes will result in some children losing SSI, and therefore Medicaid eligibility. However, many of the children affected could still continue to be covered under Medicaid because they meet other Medicaid eligibility criteria. States are required to perform a redetermination of Medicaid eligibility in any case where an individual loses SSI and that determination affects the individual's Medicaid eligibility.
Section 204(a) of the new law provides that SSI payments, for all beneficiaries, including children, may only begin as of the first day of the month following: (1) the date the application is filed or, if later, (2) the date the person first meets all eligibility factors. This is a delay in SSI eligibility in comparison with the old law.
Under Section 211 of the new law, SSA is required to redetermine the eligibility of recipients under age 18 by August 22, 1997. No SSI-eligible child may lose benefits by reason of a redetermination of disability using the new definition earlier than July 1, 1997.
Also under Section 211, SSA is required to send notices to the representative payees of all affected recipients no later than January 1, 1997.
Related Fact Sheets:
Link Between Medicaid and Temporary Assistance for Needy Families (TANF) - Fact Sheet #1
Link Between Medicaid and the Immigration Provisions of the Personal Responsibility and Work Opportunity Act of 1996 - Fact Sheet #3
Increased Federal Matching Rates for Increased Administrative Costs of Eligibility Determinations Under Welfare Reform - Fact Sheet #4
Last Updated: 10/18/96