TN 2 (07-16)
DI 25201.011 Making a Determination for Youth in Foster Care When the Application Effective Date Is On or After the Attainment of Age 18
A. Background for policy on youth transitioning out of foster care applications
Youth receiving federal foster care (Title IV-E) payments are not usually eligible for Supplemental Security Income (SSI) because the foster care payment exceeds the SSI federal benefit rate. Eligibility for foster care payments usually ends at age 18.
When a youth in foster care is not eligible for SSI before age 18, the application effective date is the attainment of age 18. The disability determination only needs to cover the period beginning with the attainment of age 18 (using the adult rules) because there is no eligibility before age 18. The determination does not need to cover the period before age 18 attainment under the childhood disability rules.
B. Definitions related to youth transitioning out of foster care applications
1. Attainment of age 18
A person attains age 18 on the day before his or her 18th birthday. For additional information attainment of age 18, see DI 25201.010B.
2. Application effective date
For Title XVI claims, the application effective date is the first day of the month following the later of the date the claimant:
For additional information about the SSI policy on application dates, see SI 00601.009.
C. Policy for youth transitioning out of foster care applications
For youth transitioning out of foster care, SSA may take an application for SSI up to 180 days before the person attains age 18 and becomes eligible based on non-medical factors. The field office (FO) forwards the case to the Disability Determination Service (DDS) for a medical determination.
When processing a claim for a youth in foster care, who is not eligible for SSI prior to age 18, the DDS must place the case in medical hold, following the instructions in DI 25201.011E.4. in this section.
D. Procedure when the claimant meets non-medical eligibility factors before attainment of age 18
If the claimant meets non-medical eligibility factors for any month prior to the attainment of age 18, follow normal procedures in DI 25201.005 and DI 25201.010.
E. Procedure when the claimant does not meet non-medical eligibility factors before age 18
1. FO identification of youth in foster care cases
When the youth in foster care does not meet the non-medical eligibility factors before he or she attains age 18, the FO:
Establishes the Supplemental Security Record (SSR) with a claim type of "DI;"
Completes the SSA-3368-BK (Disability Report-Adult);
Identifies a third-party contact on the SSA-3368-BK if the applicant is the foster care agency.
Identifies the date the claimant attains age 18 as the Potential Onset Date in item 3 of the SSA-3367 (Disability Report-Field Office);
Includes the remark "Youth in Foster Care - Hold determination until age 18 attainment. No payment due before age 18 attainment." as the explanation for the Potential Onset Date (POD) on the SSA-3367;
Adds a "Special Handling" flag annotated "Youth in foster care - no payment before age 18" to the electronic folder; and
Adds a message "Youth in foster care - no payment before age 18" to the Alerts and Messages tab in the electronic folder.
2. DDS case receipt
When you receive a Youth in Foster Care case, use the preliminary record that the FO established and follow normal procedures in SM 06001.101 and SM 06001.120. Receipt the case in as an adult disability (DI) claim, even though the child is under age 18.
3. Case development for youth transitioning out of foster care cases
Follow normal case development procedures in DI 22505.001 through DI 22505.028. If you need to obtain additional evidence with a consultative examination, follow DI 22510.015.
Determine whether the evidence will be sufficient and current at age 18 based on the evidence in the case.
Obtain updated evidence closer to age 18, if needed.
4. Medical evaluation and determination
Evaluate the evidence using the adult sequential evaluation process when you have sufficient evidence to make the determination. Use the appropriate adult evaluation forms.
If the claimant is disabled under the adult rules, establish the onset date for disability as of the attainment of age 18 (or at a later date, if appropriate)
Do not input the determination until the claimant has attained age 18. If the claimant has not attained age 18, put the case in medical deferment status with code "IO" as the Reason for Deferment. For the instructions on medical deferment, see SM 06001.202 and SM 06001.220B.
REMINDER: If you establish an onset date before the attainment of age 18, the file must include the appropriate child evaluation forms. For claims with both a child and adult determination, see DI 25230.001.
5. Disability determination notices
a. Allowance determination
Follow the notice preparation procedures in DI 26535.016.
NOTE: If you establish the onset date as the date the claimant attains age 18, the determination is fully favorable. If the onset date is after the attainment of age 18, the determination is partially favorable and you must prepare a personalized denial notice (PDN). For information on the PDN requirement see DI 26530.005.
b. Denial determination
Follow the notice preparation procedures in DI 26535.021.