TN 31 (01-00)

A. BACKGROUND

On August 22, 1996, the President signed P.L. 104-193, the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, which includes significant changes affecting the title XVI childhood disability evaluation determination process. P.L. 105-33, the Balanced Budget Act of 1997, enacted August 5, 1997, amended certain provisions of the earlier law. This legislation affects:

• All child disability applicants who file applications on or after August 22, 1996;

• Most childhood disability applicants whose claims for benefits are finally adjudicated on or after August 22, 1996; and

• Many current beneficiaries.

This subchapter explains the provisions of the laws and provides Disability Determination Services (DDSs) instructions for processing disability redetermination cases including both childhood (under 18) and age 18 cases in which a disability redetermination will be performed.

B. POLICY - PROVISIONS OF THE LAWS

1. Childhood Disability Redeterminations

According to the provisions of P.L. 104-193, within 1 year after the date of enactment, SSA must redetermine the eligibility of individuals under the age of 18 who were eligible for supplemental security income (SSI) based on disability as of August 22, 1996, and whose eligibility may terminate by reason of the new law. The cases are to be redetermined using the eligibility criteria for new applicants. The medical improvement review standard (MIRS) in section 1614(a)(4) of the Act and 20 CFR 416.994a, used in continuing disability reviews (CDRs), shall not apply to these redeterminations (section 211(d)(2)).

P.L. 105-33 changed the time limit for performing the disability redetermination to 18 months from enactment (i.e., by February 22, 1998) or as soon as practicable thereafter. This means that a disability redetermination may be done after February, 22, 1998, if, during a CDR or other disability review, it is determined that a disability redetermination is appropriate. The way in which childhood disability redeterminations are likely to be identified and initiated changed significantly upon completion of the cases initiated during the year following enactment of P.L. 104-193. Childhood disability redetermination cases now will most likely be identified by the DDS among cases first initiated as CDRs. The probability of such occurrences is expected to diminish over time and eventually disappear. (See DI 28005.003.)

2. Age 18 Disability Redeterminations

According to P.L. 104-193, SSA must redetermine the eligibility of individuals who were eligible for SSI based on disability in the month before the month in which they attained age 18 using the rules for determining initial eligibility for adults. The MIRS used in CDRs does not apply to these redeterminations (section 212(b)).

P.L. 105-33 changed the time limit by adding “either during the 1-year period beginning on the individual's 18th birthday or, in lieu of a CDR, whenever the Commissioner determines that the individual's case is subject to a redetermination under this clause.” The effect of the change is to eliminate the time limits on SSA to initiate an age 18 disability redetermination only during the one year period following the individual's 18th birthday. This means that not only will disability redeterminations be appropriate as the individual attains age 18, but may be appropriate for individuals who attained age 18 on or after August 22, 1996, if the individual was not subject to a disability redetermination or its equivalent after attaining age 18. (See DI 23570.010B.1.b.) Age 18 disability redeterminations are an ongoing workload. The changes in the law mean that cases can be identified for redetermination not only as age 18 is attained but also during a later CDR if, for some reason, they were not previously selected for a disability redetermination.