At age 18 a young person is considered an adult under the Social Security Act and their status under that program changes dramatically. Parents with children suffering from severe mental or physical medical impairments must be prepared for those changes. This article will briefly summarize the law and then recommend steps families can take to protect their entitlement to these important benefits.The Social Security Disability system acts as a safety net for people suffering from severe medical impairments which make work activity impossible. Generally the Social Security Disability Insurance (“SSDI”) program is for people who have worked and paid FICA taxes and have become disabled — and sometimes for their children who are disabled. Supplemental Security Income (“SSI”) benefits is for people who are totally disabled by their medical problems and indigent. “Totally disabled” and “indigent” are terms specifically defined in the Act and Regulations.The most common scenario we have seen in our law practice is the family whose child is diagnosed with a severe mental impairment in their early teens. To help their child the family begins psychiatric care and counseling, and seeks help from their local school district via IEPs, social work assistance and classroom modifications. The next few years can include waves of calm and crisis with regular battles over treatment and medication; often resulting in family frustration and resignation.
New Transition programming at many high schools provides structure and additional assistance for impaired young adults through age 21. By this time many families have stopped active mental health treatment and have limited the visits to occasional brief medicine management sessions with a psychiatrist.
After Transition assistance ends, or now at age 26 when parents can no longer keep disabled children on their health insurance plans, families look for assistance — for both monthly cash assistance for children who cannot maintain full-time employment, and, more important, for Medicaid insurance for treatment and medications. However, the Medicaid program in Illinois is limited to four categories of eligibility. One of these categories includes people who are “totally disabled.” However, the Medicaid definition for “total disability” is strict and often appears more stringently defined than Social Security’s. Getting SSI approval through the Social Security program is often the best way prove total disability for Medicaid coverage.
Families need to plan. “Total disability” under both programs requires medical proof of the inability to work. Diagnosis alone will not prove total disability. People with mental illness work every day. The issue in your child’s application will be whether we can prove that their day-to-day symptoms are so severe that sustained work activity is impossible. Proof of the severity of these symptoms comes from current psychiatric and therapist medical charts.
Parents regularly complain that “If only Social Security could come live at our home for a week….” However, that is not going to happen. Further, SSA regularly discounts the testimony of the disabled Claimant, and the family members, because of their perceived financial motivation to exaggerate symptoms to get the benefits.
Social Security’s Regulations and Rulings put great weight on the findings of the treating psychiatrist and therapist. In our practice we always strongly encourage treatment with a therapist, in conjunction with ongoing psychiatric care. Financial and time pressures often limit a psychiatric sessions to “medicine management.” Those clinic charts therefore tend to be skimpy and do not delve into daily activities limitations, social functioning issues and concentration, persistence problems. Those basic daily problems ARE the focus of SSDI/SSI adjudication and therapists tend to be much more helpful in documenting those limitations.
Ongoing continual treatment with good communication documents the severity of the young adult’s mental health issues. This leads to better treatment, and better evidence, if the family needs to access SSDI/SSI benefits. This win/win scenario can provide much needed assistance to families facing these issues.
For more information please do not hesitate to call or email our office. We provide free consultations and never charge an attorney fee unless the application is approved. More information can be gathered at our website www.RabinSSlaw.com.
Jeff Rabin is the founder The Law Offices of Jeffery A Rabin & Associates, Ltd., a law firm focused in the representation of disabled individuals seeking SSDI/SSI benefits. With offices in Des Plaines, Winfield, Libertyville, Joliet and Chicago Jeff and his team help people throughout northern Illinois. With more than 50 years combined experience in this area of law the firm has worked closely with NAMI and other groups and agencies throughout the community.
Jeff can be reached at The Law Offices of Jeffery A Rabin & Associates, Ltd., 636 S. Des Plaines River Road, Suite 300, Des Plaines, IL 60016. Their telephone number is 847-299-0008 and email is jeff@RabinSSlaw.com. The website is www.RabinSSlaw.com.
