Social insurance provisions for children with disabilities in selected industrialized countries.

Children With Disabilities Under Programs in the United States In the United States, low-income families who have a child or children with a disability may currently be eligible for cash benefits paid under the Supplemental Security Income (SSI) program, which is financed from general revenues. For many years, the number of eligible children remained fairly steady because the standard used required that the severity of their condition "meet or equal" the specifications in the Listings of Medical Impairments. Under the previous standard, there were less than 300,000 children with severe disabilities on the rolls in any given year. However, in 1990, the U.S. Supreme Court ruled in Zebley v. Sullivan that the Social Security Administration (SSA), by using a different standard for children than that used for adults, was discriminating against children with disabilities. In other words, because the adjudication process for children stopped at the meet or equal step in the determination procedure, instead of providing children with an individual functional assessment as is afforded adult claimants with disabilities, SSA was not complying with the statute defining disability for children. Following the Court's decision and directions to find a new way to adjudicate childhood disability claims, SSA consulted with childhood disability experts and developed a new standard that uses an individualized functional assessment for children whose impairments do not automatically meet or equal specifications in the listings. SSA also agreed to notify all childhood disability claimants who were denied benefits since 1980 because their impairments were not severe enough and to determine if those claimants wished to have their cases reexamined. The combination of the retroactive effort, expanded eligibility criteria, increased attempts at outreach by both SSA and State and private organizations as well as the economic recession of 1990-91--that caused more families with disabled children to meet the program's low-income standards--resulted in 883,415 children and young adults (under the age of 21) with disabilities receiving SSI benefits in December 1994.(1) Consequently, particularly in the last year or so, there has been growing concern occasioned not only by the rapid increase in the rolls, but also by allegations in the press that some parents are misusing the checks meant for their children's care or are coaching their children to act inappropriately in order to be eligible for benefits. These concerns (such as the labeling of and stigmatization of children with disabilities) along with other issues raised by parent groups and special education teachers led to the creation in 1994 of the National Commission on Childhood Disability as part of the legislation that made SSA an independent agency. The Commission's task is to undertake a comprehensive review of the SSI program for children with disabilities and to develop recommendations for redesigning the program. Specifically, the Commission's mandate is to examine: (1) whether the SSI definition of disability is an appropriate one and, if no what alternative definition would be appropriate; (2) whether the needs of disabled children can be met most effectively through cash benefits, vouchers, expanded health coverage, or some combination of these; and (3) how the SSI program can be restructured to improve the chances that children who receive benefits will achieve their full work potential as adults.(2) In addition to the work of the National Commission, the National Academy of Social Insurance established the Committee on Childhood Disability--a nonpartisan group of national experts--in response to a study request from the House Ways and Means Committee of the 102nd Congress. In their work, the Committee drew upon the Academy's Disability Policy Panel as well as the views of 12 additional experts in government, academia, and in the private sector. …