Reinterpreting Disability: Changes in Supplemental Security Income for Children

On February 20, 1990, in Sullivan v Zebley, the Supreme Court of the United States struck down the Social Security Administration's criteria for determining eligibility of children with disabilities for Supplemental Security Income (SSI). This dramatic decision held that the existing regulations for the program discriminated against children, because children were required to meet a stricter standard than adults who applied for SSI. This decision overturned the current rules and procedures for the determination of access to a major federal benefits program and, in most states, to additional benefits through assured Medicaid eligibility. The Court also mandated that the Social Security Administration make changes that will significantly alter and liberalize access for children. Because many pediatricians may be unaware of the issues and the potential advantages for children in their care, we summarize below some of the pertinent background and implications of this landmark decision. BACKGROUND AND DESCRIPTION The Supplemental Security Income Program of the Social Security Administration, enacted by Congress in 1972, provides an income supplement to lower income disabled Americans, both children and adults. Persons older than 18 years of age who have a health problem that causes major disability and prevents participation in substantial gainful activity may receive cash benefits as part of a social policy effort that began in the Roosevelt era of the 1930s, although specific disability programs did not begin until the 1960s. Children also may receive cash benefits under certain similar conditions. The SSI program was designed primarily as a social benefit program to improve the financial standing of aged, blind, and disabled individuals, but it also brings automatic eligibility for Medicaid for individuals who qualify for SSI in 31 states and the District of Columbia.