Age 18 Redeterminations and Continuing Disability Reviews

After a child or adult receives SSI benefits, there are still points at which they are at risk for losing those benefits. These times are known as Age-18 Redeterminations and Continuing Disability Reviews.  It is essential to be prepared for these assessments, as they can result in an abrupt discontinuation of benefits.

AGE-18 REDETERMINATIONS

Age-18Redeterminations came out of the welfare reform legislation of 1996.  Basically, the age-18 regulations call for every child receiving SSI to go through a disability determination upon turning age 18.  These cases are treated as brand new cases by Social Security, not as continuing reviews.  In other words, there is no presumptive eligibility for adult SSI benefits based on child SSI.  The adult eligibility guidelines are used in making the age-18 decision.

Here are a few guidelines regarding these Redeterminations:

• Focus on work limitations: It is very important to thoroughly describe and document how the disability impacts any type of work the applicant has done.  Describe all types of assistance received when working.
• Be honest about limitations: Many people have a difficult time discussing how their disabilities limit them. However, it is crucial to explain all of these limitations during the age-18 Redetermination process.
• Work closely with school personnel: School reports of limitations are extremely important.  Itis important that these limitations be presented in comparison to all students,not to other students with disabilities. Also, schools should not just report how a student is doing academically, but also on whether or not they have any disability-related problems with vocational programs or interacting with others.

CONTINUING DISABILITY REVIEWS

Continuing Disability Reviews (CDRs) are periodic reviews used to determine if a person continues to be eligible for benefits (i.e., continues to have a severe disability).  How often a person has a CDR depends on his or her disability. The decision is based primarily on one of the following classifications,which is made at the time benefits are originally granted: 

Medical Improvement Expected (MIE): If a person is expected to improve medically, he or she will have are view in 6 to 18 months after the initial decision.  An example of such a condition is a fracture that is expected to heal.

Medical Improvement Possible (MIP): If it is possible that a person will improve medically, or if improvement is unpredictable, he or she will have a review every 3 years.

Medical Improvement Not Expected (MINE): If a person’s disability and its impact on the ability to work is considered permanent, review will occur every 5 to 7 years. 

In order for Social Security to terminate benefits via a CDR, it must demonstrate that medical improvement has occurred.  During the CDR, Social Security considers the person’s current condition and compares it to his or her condition on the date of the most recent favorable decision.

Eight Steps are used to determine continuing disability:

Step1:  Is the individual engaged in Substantial Gainful Activity?

Step2:  Does the current impairment(s) meetor equal a listing? 

Step3:  Has there been medical improvement of those impairments that were present at the date of the last favorable decision? 

Step4:  Is the medical improvement of those impairments related to the ability to work? 

Step5:  Do any exceptions apply?

Step6:  Is there a severe impairment or combination of impairments considering all of the claimant’s current impairments? 

Step7:  Can the claimant return to his or her past relevant work?

Step8:  Can the claimant do other work? 

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