Disability for Children Confined to a Hospital for a Calendar Month
Disabled children are eligible for a special Supplemental Security Income program if they are confined to a hospital for an entire calendar month. Parental deeming does not count while the minor is hospitalized.
EligibilityFor a minor to receive the special $30 Supplemental Security Income benefit they must meet the following criteria. The minor must be
2) Less than 18 years old
3) Confined to a hospital an entire calendar month and
4) Private insurance or Medicaid (or a combination) must pay for at least 50% of the hospitalization expenses for the month.
It*s also important to note eligibility does not begin until the application is filed. A baby could be obviously disabled and otherwise eligible, but the baby cannot receive benefits before the claim has been initiated. For example, baby boy is born with Down Syndrome in September, but the parents do not initiate the claim for disability until October. Baby boy will not receive benefits for September even though he otherwise meets all the eligibility criteria.
DisabledIn order to qualify for the special benefit, the minor must be disabled according to Social Security regulations. This requires the minor to have an impairment that has lasted or is expected to last for a continuous period for not less than 12 months, or be expected to or actually end in death.
Additionally, the impairment must
1) Meet or be of equivalent severity to (commonly called equals) one of the listing level impairments
2) Have at least one *extreme* limitation in the six assessed domains or
3) Have at least two *marked* limitations in the six assessed domains.
Confined for an entire calendar monthThe minor must be admitted to the hospital for an entire calendar month. While the meaning seems self evident an emergency room visit doesn*t count because the minor has not yet been admitted and therefore confined. This can be important if the initiation of the hospitalization occurs on the first of the month via the emergency room.
For example * baby boy doesn*t wake for his 10:00 PM feeding. The parents rush baby boy to the hospital, where the emergency room begins assessing baby boy. They find that he had a SIDS episode that the parents happened to catch in time. However, imaging shows that the hypoxic event caused brain damage. Baby boy is admitted at 1:00 AM and released to home care 50 days later. Baby boy was not confined for an entire calendar month since he was not admitted and therefore confined until 1:00 AM on the 2nd day of the month.
Pays at least fifty percentThe minor must have private insurance, Medicaid, or a combination of the two pay for at least 50% of the hospitalization cost for the month. This can delay the Social Security eligibility determination if the hospital does not cooperate. The Social Security state agency doctors can assess a disabling impairment and note that the minor meets the medical requirements for disability, but the final determination cannot be made until the hospital verifies that private insurance or Medicaid is paying for at least 50% of the hospitalization costs for the initial month. More on this below.
Parental Deeming and Release to HomeNormally Supplemental Security Income is means tested and parental income and resources are deemed to the minor. However, parental deeming does not apply for the special $30 benefit. This is assessed differently depending on if the confinement initiates at birth or at some point after birth.
Confinement begins at birth
Confinement at birth literally means just that * the minor is born in the hospital. A home birth gone wrong requiring hospitalization the same day doesn*t count. The baby must be born in the hospital. The rules deeming note that deeming begins, *after the month the child comes home to live with the parent(s) (e.g., the month following the month the child comes home from the hospital)* or it begins the month, *of birth when a child is born in a parent*s home.* (POMS SI 01310.145(B)(1)). For example, baby boy is born in September but not released home until December. Parental deeming begins in January.
Confinement begins after birth
If the confinement begins after birth the deeming rules are different. Rather than deeming having never initiated as in a hospital birth situation confinement after birth means that deeming applies, but is waived. In order for deeming to be waived the minor must be
1) Disabled and
2) Receive the special $30 benefit and
3) Be eligible for Medicaid under a state home care plan and
4) Otherwise would be ineligible for benefits (POMS SI 01310.201)
Note that this is an and criteria; failing one of the four prongs of the test prevents waiver and parental resources will be deemed.
The benefit is only $30. Why apply?The minor*s payment rate for the month of confinement is capped at thirty dollars. This raises the question of why go through the time and effort to take advantage of the program? Doing so has some ancillary benefits which are the real benefit to the program.
By going through the process of applying for Supplemental Security Income the Social Security Administration must make a determination in the matter. A favorable determination leads to a finding of *disabled* by the Administration and eligibility for Supplemental Security Income. Because the minor is eligible for Supplemental Security Income the minor receives Medicaid as a pendant benefit to the Supplemental Security Income payments.
Another important ancillary benefit is the Social Security disability finding is often used to determine eligibility for other forms of assistance. For example, the Medicaid Buy In for Children (in Texas) requires a showing of disability. However, if the Social Security Administration already has made a finding of disabled this is controlling and attaching the Social Security decision to the MBIC application establishes the disability.