TN 32 (03-04)
DI 23570.010 Disability Redeterminations - Age 18 Cases
A. POLICY - REQUIREMENTS OF THE LAW
P.L. 104-193, as amended by P.L. 105-33, requires that all disability beneficiaries who were eligible as children in the month before the month in which they attained age 18 have their eligibility redetermined under the adult standards for initial claims within 1 year of their 18th birthday, or in lieu of a CDR, if the Commissioner determines that the individual's case is subject to a disability redetermination. SSA's policy is that any individual who attained age 18 on or after August 22, 1996, and who was entitled as a child in the month before the month of attainment of age 18 will be subject to a disability redetermination instead of a CDR if a disability determination under the adult standards had not been completed after attainment of age 18.
The disability redeterminations will be done using the disability criteria for initial claims (except for step 1, the SGA step of the sequential evaluation process for adults). The MIRS will not apply.
a. FO/Automated Identifications
Identifications are made each year for those individuals attaining age 18. Initiation of these cases will be controlled through the Post Entitlement Operational Data Store (PE ODS) system and will also be identified in the Disability Control File (DCF). These cases will be received by the DDS with a flag from the FO identifying them as age 18 redeterminations.
b. Cases Identified as Disability Redeterminations in the DDS
Individuals who attained age 18 in the past, but on or after August 22, 1996, and are subject to a disability redetermination, may be identified during the CDR process. If, upon receipt of a CDR, the DDS examiner finds that the individual was eligible in the month before the month of attainment of age 18 and an age 18 disability redetermination or a determination under the adult initial claims standard was never done, a disability redetermination is required. Before making a determination, send notices advising both the individual and payee that a disability redetermination will be done rather than a CDR. This notice should be sent as soon as possible after the DDS recognizes that a disability redetermination is appropriate.
NOTE: In rare instances, if an age 18 redetermination decision was made within the last 12 months and soon afterward a CDR decision is found pending, the DDS examiner should apply a “no decision” to the CDR case providing that the medical diary has not matured and will not mature in the next 3 months. If the above conditions are met, the DDS must return folder to the FO requesting that the record be updated to reflect the diary period established by the DDS at the time the age 18 redetermination was processed. See DI 13005.020C.4.c. for FO procedures.
A disability redetermination is not appropriate if the individual has had a favorable determination under the adult initial claims standard after attainment of age 18.
Examples of cases in which an age 18 disability redetermination is not required:
an age 18 disability redetermination has already been done;
a favorable title II adult determination (CDB, HA), that was not an adoption, was done after age 18; or,
a CDR after age 18 resulted in a continuance based on meeting or equaling a listing, or on a residual functional capacity assessment plus consideration of vocational factors. However, if the Comparison Point Decision (CPD) was a childhood determination and the case was continued based on no medical improvement (MI), or no MI related to the ability to work, the determination does not constitute a determination under the adult initial claims standard and an age 18 disability redetermination is required.
NOTE: For cases that meet the above criteria, complete the SSA 832 as usual for a favorable determination.
The FO will provide a notice initiating the disability redetermination in those cases identified as they attain age 18. A special notice will be required for those cases identified by the DDS during a CDR as requiring a disability redetermination or in situations in which a CDR was erroneously developed within 12 months after the age 18 redetermination was made (and the medical diary has not matured or will not mature in the next 3 months). The special notice must be sent by the DDS prior to the issuance of a determination and must inform both the individual and payee that a determination under the initial adult standard will be used. (See DI 23570.100 for example.)
NOTE: Separate notices should be sent to the individual and the payee.