Module #2

The Medical Continuing Disability Review and the Age 18 Redetermination

This toolkit will help you understand the Supplemental Security Income (SSI) program’s two types of medical reviews that will face transition-aged youth (ages 14 through 25).  Using this toolkit, you can explain the medical review process to youth, their families, and others who assist them.

Overview of the Medical Continuing Disability Review (CDR) Process

All child and adult recipients will be subject to a medical CDR, from time-to-time, to determine if they continue to meet SSI’s disability criteria.  The review will determine if the recipient’s condition has medically improved and, if it has, will determine if that improvement renders the recipient no longer disabled under SSI criteria.  If there is no medical improvement, or if there has been some improvement but the individual still meets the disability criteria, SSI benefits will continue.  If there has been medical improvement and the individual’s disability no longer meets SSI’s criteria, benefits will be terminated subject to the right to appeal that decision.   

The CDR review schedule depends on the likelihood that an individual’s condition will medically improve.  In the majority of cases, categorized as Medical Improvement Possible, the review occurs every three to five years.  Reviews are scheduled more often if a case is categorized as Medical Improvement Expected, or less often if categorized as Medical Improvement Not Expected.

You can expect many 14 to 16 year olds to have a medical CDR, with all youth getting SSI's Age 18 Redetermination between ages 18 and 19 (see below). Young adults will likely face a medical CDR at age 22 or later.

The Medical CDR for children will use SSI’s disability criteria for children, while adult CDRs will use the disability criteria for adults.  See our toolkit, Understanding the Basics of SSI and Appeals, which explains the differences in the childhood and adult disability criteria.  Also, see this toolkit’s Print and Go Tip Sheet, Navigating the Medical CDR or Age 18 Redetermination.

CDR Process for Youth Under 18

All children under 18 will get a full medical CDR while most adults will go through a much shorter “mailer process”.  In the child’s case, Social Security Administration (SSA) staff will typically take a number of first steps:  

  • A personal contact (at SSA’s field office or by phone) with the parent or other person who serves as the representative payee.
  • SSA will ask the parent/payee to complete required forms, including forms that ask about the child’s disabilities or medical condition, and the type of educational services they receive.

After these initial steps, the case is forwarded to the State Disability Determination Services (DDS) office which, under contract with SSA, does the full CDR work up and makes a decision.  The DDS will, in many cases, find after the CDR that the child is still disabled and SSI will continue with a new review date set for the future.  If the DDS finds the person no longer disabled, as it will in many cases, SSA must send out a notice letting the parent/payee know of the decision and of the right to appeal that decision.

Since the childhood disability criteria considers how well the child functions in school and non-school settings, compared to non-disabled peers, VR counselors should urge parents to make sure to address these issues on any SSA forms they fill out.  Parents must also make sure that SSA receives any special education records that address these issues.

CDR Process for Youth Age 18 or Older Getting SSI as an Adult

The adult CDR process is similar to that described for children with a few differences: 

  • Approximately 20 percent selected for a full medical CDR.  The remaining 80 percent will go through the mailer process. 
  • SSA’s Self-Help Mailer, asks the beneficiary or his/her parent/payee to provide medical, employment, educational, and other relevant information for the past 2 years.  About 8 percent of those completing the form will be selected for a full CDR, with the remaining 92 percent considered still disabled with SSI continued. 
  • SSA refers full Medical CDRs to the State DDS, which will focus on the beneficiary’s ability to work despite their medical condition.  It is less likely that SSA/DDS will seek information from educators unless the young adult was in a public school program within the past two years.  School records can be important, however, if they would reflect on disability-related deficits that would be relevant in the workplace.  
  • Like children’s CDRs, SSA often starts with a personal contact and will ask the beneficiary or his or her parent/payee to complete a number of required forms.  Here again, the VR counselor should urge the beneficiary or parent/payee to carefully complete these forms or ask a service provider or SSA for assistance. 

In many adult SSI cases, SSA will find after the CDR that the person is still disabled and SSI will continue with a future review date set.  If the DDS/SSA finds the person no longer disabled, as it will in many cases, they must send out a notice letting the person, or payee, know of the decision and that it can be appealed.

The Age 18 Redetermination

All children who receive SSI will be subject to an Age 18 Redetermination.  This review will usually occur between ages 18 and 19.  It will determine whether the beneficiary meets the separate SSI disability criteria for adults.  Unlike the medical CDR, which looks for evidence of medical improvement, the Age 18 review is a new, initial determination, and follows the same review process used for any new adult application.  If SSA, through the State DDS, determines that the beneficiary’s condition meets SSI’s disability standard for adults, benefits will continue with a new review date set.  If it determines that the condition does not meet the adult disability standard, as it will in many cases, SSI benefits will be terminated subject to the right to appeal.

Special Rules that Apply to Medical CDRs and Age 18 Redeterminations

Active Use of Ticket to Work or Working with VR Puts a Hold on a Medical CDRs for Adults 

SSI recipient or Social Security Disability Insurance beneficiaries, ages 18 to 64, can use or “assign” their “ticket” to receive services through an organization called an Employment Network (EN).  The purpose of the EN’s free services is to help a recipient reach a work goal.  The EN only gets paid if the recipient meets certain levels of progress toward an employment goal. 

A recipient can also get free services from a State VR agency to support a work goal.  Although the recipient may not, in most cases, assign the ticket the State VR agency serving them, they are still treated as getting services through the Ticket to Work program for the purposes of putting a hold on a medical CDR.

Retaining SSI, following a medical review, can be a key to successful VR outcomes:

  • SSI is a key source of income to the youth and the family.If that income stops, the youth and family may find it more challenging to focus on a VR plan.
  • Also, any loss of SSI may eliminate Medicaid eligibility in most states, also making it more challenging to focus on a VR plan.

A Hold on Medical CDR if Recipient Meets “Timely Progress” Requirements: 

This discussion applies only to medical CDRs for adults over 18.  If a recipient has assigned their ticket to an EN or is receiving services from a State VR agency through a written, individualized plan of employment (IPE), SSA will put a hold on their scheduled medical CDR if the person is making “timely progress,” through incremental steps, toward self-supporting employment.   

A person can meet timely progress requirements by working and having their wages incrementally increase over a period of years. 

A person can meet timely progress requirements by making incremental progress in an education or training program, including: earning a high school diploma or GED; earning credits toward a college or community college degree; or meeting progress in a technical, trade, or vocational school. 

A person can also meet timely progress requirements with a combination of work and education/training program activity. 

If a person has either an assigned ticket or active case with a State VR agency and meets timely progress requirements a medical CDR will not be scheduled while the plan and timely progress continue. 

Introduction to the Section 301 Safety Net

Section 301 allows SSI to continue after SSA finds the youth to be no longer disabled if he or she is involved in a vocational or other program that will likely lead to employment and no future need for SSI. To get 301 protection the youth must generally meet two criteria:  1) the VR or other program had to start before SSA found the recipient to be no longer disabled; and 2) staying in the program has to make it more likely he or she will not qualify for SSI in the future.  As noted below, in some cases the second part of the criteria does not need to be met. 

For transition-aged youth, some common ways to keep benefits using section 301 are as follows: 

The 18 to 21 year old remains in school, getting special education services with an individualized educational program (IEP).  In these cases, there does not need to be a vocational program involved and there is no need to separately show that it is likely the person will not qualify for SSI in the future. 

The young person is enrolled in a demonstration program, such as the Promoting Readiness of Minors in SSI (PROMISE) project.  With demonstration projects, like PROMISE, there must be a written plan designed to enhance employment prospects but there is no need to separately show that it is likely the person will not qualify for SSI in the future.  The PROMISE-related 301 protection is available to youth both before and after age 18. 

The young person no longer attends the public school and is now being served by the State VR agency with an IPE and a work goal.  In this case there will need to be a finding that this makes it more likely that the recipient will not qualify for SSI in the future. 

Although the recipient would have a separate right to continued SSI benefits by appealing, sometimes they fail to appeal, do not ask for continued benefits, or the appeals are exhausted while section 301 protections continue.

You should always look to refer a consumer to an attorney or advocate for representation as soon as you are aware the individual has received a notice denying their SSI application or terminating their right to continue getting SSI.