What If I'm Not Sure If My Child is Considered "Disabled"?

  For many parents, recognizing that their child may have a disability is not a single moment, but a gradual realization full of questions and uncertainty. When government benefits depend on whether a child meets a particular definition of “disabled” that uncertainty can feel daunting. If you’re unsure whether your child qualifies as disabled under the law, you are not alone. Schools, state agencies, and federal programs may be using different definitions.

This article explains how the SSA (Social Security Administration) defines “disability.” The SSA oversees two key programs, SSI (Supplemental Security Income) and SSDI (Social Security Disability Insurance), both of which provide monthly cash assistance to eligible individuals with a disability. These programs are often the primary financial support that our children with disabilities may rely on throughout their lives.

SSA definition of “Disabled”

The definition of a disability, for federal government benefit purposes under the SSA, varies depending on whether the person is a child or an adult.

For persons under 18:

    A child is considered disabled if they have a physical or mental condition that very seriously limits their activities and is expected to last for at least 12 months or result in death.

For persons 18 or over:

    An adult is considered disabled if they are unable to engage in any substantial, gainful activity (like full-time work), due to a physical or mental condition that is expected to last for at least 12 months or result in death.

In all cases, whether a child or an adult, the disability must be medically proven. Objective medical evidence can be established through diagnostic tests, imaging, psychological evaluations, or clinical assessments. A simple self-reported statement of symptoms is not enough. There must be medical records.

Notice that the definition of a disability for adults is more rigorous than for children. If a child is receiving SSI benefits, then at age 18 there is a re-determination process. A child may be considered disabled and qualify for SSI benefits, but then lose eligibility for SSI benefits at 18 if they do not meet the adult definition of disabled. If that happens, the SSI program may seek repayment for benefits it believes were incorrectly paid.

The SSA provides a list of medical conditions that may qualify as being a disability. The following list is not a complete list. It is provided to give some examples:

·       Musculoskeletal issues: arthritis, back injuries, fibromyalgia

·       Heart conditions: heart failure, high blood pressure

·       Vision or Hearing Loss

·       Lung problems: asthma, cystic fibrosis

·       Neurological disorders: cerebral palsy, epilepsy, Parkinson’s

·       Mental health conditions: autism, depression, anxiety, PTSD, schizophrenia

·       Immune system disorders: lupus, rheumatoid arthritis

·       Skin conditions: dermatitis, severe burns

·       Digestive problems: liver disease, irritable bowel syndrome

·       Kidney issues: chronic kidney disease

·       Blood disorders: anemia, bone marrow failure

Severity Matters

Qualifying for SSI or SSDI isn’t just about having a medical diagnosis. It is also a question of how much the condition affects a person’s daily life and ability to function. If an impairment has only a “minimal effect” on a person’s ability to perform basic work tasks or daily activities, he or she may not be considered disabled under the SSA definition.

The SSA does consider the combined impact of all conditions, even minor ones. A combination of several non-severe impairments can, together, be found severe enough to meet the disability requirement.

The burden is on the applicant to provide medical evidence to prove the existence and severity of the condition. Once benefits are approved, the severity of a person’s disability determines how often the SSA conducts a review to ensure they still have a qualifying disability. Conditions where an improvement is not expected will be reviewed less frequently than those where improvement is possible.

Should I Create a Special Needs Trust When I'm Unsure If My Child Will Be Considered Disabled as an Adult?

Many parents are unsure if their child will qualify as disabled as an adult, especially when the child is still young and continuing to develop. It can be hard to predict how the child’s condition will change over time.

In many cases, creating a Special Needs Trust for your child is still the safest and most flexible option. If your child qualifies as disabled at 18 and receives SSI or Medicaid, the Special Needs Trust protects their eligibility for these programs. On the other hand, if your child does not qualify as disabled and becomes fully independent, the Special Needs Trust can simply function like a regular trust. In other words, there is no downside to having the Special Needs Trust. There are only major risks, if you don’t have it.

Many conditions are unpredictable. Some children improve for a period of time, but then experience worsening symptoms later as adults or in the aging process. A Special Needs Trust protects against future uncertainty. If a child suddenly receives an inheritance, a lawsuit settlement, life insurance proceeds, or a large gift, they may be disqualified from SSI and Medicaid programs. Once assets are in the child’s name, it cannot be undone without penalties, spend-down requirements, or a Medicaid payback. Creating a Special Needs Trust early ensures that any future inheritances, gifts, or assets can flow into the trust automatically and never jeopardize your child’s vital public benefits.

SSI is extremely helpful as a financial support. On top of that, Medicaid is also a very important asset, because it provides healthcare coverage, residential services, supported employment options, adult day care options, and long-term services and supports. A Special Needs Trust ensures you never unintentionally disqualify your child from these services.

Even if your child does not qualify as “disabled” and does not receive government benefits, if they have neurodivergence, intermittent disabilities, or fluctuating mental health needs, they may be vulnerable to impulsive spending or scammers and predatory creditors. A Special Needs Trust can revert to an ordinary trust that allows someone you trust to manage your child’s funds when needed – without labeling the child as permanently disabled.

By creating a Special Needs Trust early for children who might need disability-related assistance as adults, parents protect against the uncertainty of not knowing their child’s future. The Trust acts as a financial safety net that adjusts to reality as it unfolds and protects eligibility for public benefits at any point in the child’s life by ensuring your estate never accidentally disqualifies your child in the future. If something happens to you, no one can step in and “fix” a poorly timed inheritance or a lost benefit. The Special Needs Trust guarantees the right structure is already in place without a crisis, without court involvement, and without last-minute panic.