How to Get SSI Benefits for a Premature Baby
Learn how premature babies can qualify for Supplemental Security Income (SSI) benefits.
Premature babies, those born before 37 weeks, often suffer from low birth weight and underdeveloped lungs and other organs. They have a greater risk of developing serious infections and respiratory distress syndrome (causing lack of oxygen), which can in turn cause long-term problems. Despite advances in medical care, a small percentage of premature babies will suffer a permanent disability such as cerebral palsy, hearing loss or deafness, low vision or blindness, lung disease, or cognitive, motor, or social development problems.
Premature infants who suffer serious impairments may be medically eligible for disability benefits through Supplemental Security Income (SSI) if they have severe functional imitations—that is, the child’s condition must seriously limit activities—that are expected to last at least one year. To be financially eligible for SSI, the child and his or her parents (or stepparents) cannot make over the SSI income limits or own too many assets (not counting a house).
How Long Does It Take to Get SSI for a Preemie?
It can take three to five months for the SSA to determine whether your premature baby (often called a "preemie") is eligible for disability benefits through SSI. But knowing that babies with serious difficulties often need financial help right away, the SSA grants immediate SSI benefits to children who are likely to be found medically eligible for benefits. If your baby’s birth weight was low or your baby has been diagnosed with cerebral palsy, you may qualify for these immediate “presumptive disability” benefits. See our article on presumptive disability benefits for the threshold weights to qualify for presumptive disability based for low birth weight.
If your baby was born prematurely but does not meet the requirements for low birth weight, above, and does not have cerebral palsy, you will have to wait for the SSA to make its regular disability determination on your case.
How Can Premature Babies Qualify for SSI?
The Social Security Administration (SSA) does not have a disability listing for premature babies. However, if your child has a diagnosed injury or illness common in premature infants, such as bronchopulmonary dysplasia or retinopathy of prematurity, you can apply for benefits under that underlying disability just as an older infant or child would (see below).
But if your child is one of the many premature infants who suffers from cognitive or motor developmental delays, the SSA has an official listing to be used in assessing developmental and emotional disorders in newborns and infants. Social Security Listing 112.12, Developmental and Emotional Disorders of Newborns and Younger Infants (Birth to Age One), sets out the requirements for how severe a deficit or delay in areas of motor, cognitive/communicative, or social functioning must be to qualify for disability benefits. If your premature infant has any of the following six developmental symptoms, he or she will automatically qualify for disability benefits under this listing.
- Cognitive/communicative functioning typical of children half of the child’s chronological age.
- Motor development typical of children half of the child’s chronological age.
- Development or function typical of children only two-thirds of the child’s chronological age in two or more areas (that is, social, motor, and/or cognitive/communicative).
- Failure to sustain ongoing, reciprocal social interaction, as evidenced by either:
- inability by six months to participate in vocal, visual, and movement-based social exchanges (for example, trading facial expressions)
- failure by nine months to communicate basic emotional responses, such as cuddling or exhibiting protest or anger, or
- failure to attend to a caregiver’s voice or face or to explore an inanimate object for a period of time appropriate to the infant’s age.
- Apathy, demonstrated by a lack of response to either:
- visual stimulation
- sounds, or
- Overexcitability or fearfulness, demonstrated by a grossly excessive response to either:
- visual stimulation
- sounds, or
The above developmental delays or emotional disorders must be documented in your child's medical records, and, if necessary and available, an age-appropriate test. For instance, the Bayley Scales of Infant Development assesses the cognitive and motor skills of infants starting at birth. Formal testing is not always required, however – obvious delays and symptoms can be recorded by a doctor and corroborated by information you provide. For instance, in infants a few months old, a pediatric specialist should be able to discern abnormal development in imitation or production of sounds or difficulty with sucking or swallowing.
Qualifying for Standard Children’s Disabilities
The following are common medical problems suffered by preemies that the SSA recognizes through its official listings. To qualify for disability under any of them, your child must satisfy the requirements in the specific listing.
The most frequent problems that premature infants suffer are a result of undeveloped lungs. Specifcally, many preemies develop what’s called respiratory distress syndrome (RDS), also known as hyaline membrane disease. RDS occurs when the lung tissue of premature infants collapses because of the lack of a chemical called surfactant. RDS can injury the lungs permanently, leading to bronchopulmonary dysplasia, an obstructive lung disease. You apply for disability for these types of lung problems under listing 103.02, chronic pulmonary insufficiency.
Eye development can be disrupted when a premature birth occurs, leading to abnormal blood vessel development. This is called retrolental fibroplasia, or retinopathy of prematurity, which can cause low vision or blindness. Post-labor treatment of respiratory distress syndrome with excessive oxygen can also lead to retinal damage. The required severity of vision loss can be found in listing 102.02, loss of visual acuity.
Deprivation of oxygen after birth or ear infections, to which premature infants are prone, can cause permanent hearing problems or deafness. The required severity of hearing loss can be found in listing 102.10, hearing loss.
Deprivation of oxygen at birth can also cause cerebral palsy (CP), a problem where the brain can’t adequately control motor functions (preemies are eight times more likely to be diagnosed with cerebral palsy). For information on qualifying for disability due to CP, see Nolo's article on getting disability for cerebral palsy. Other motor function problems that are not due to cerebral palsy can be found under listing 111.06, motor dysfunction due to neurological disorder.
Many premature babies suffer from intraventricular hemorrhage, bleeding inside a brain ventricle. The severity of the problem and any functional impairment it caused would be assessed under listing 111.00, neurological disorders in children.
Mental disorders in a child under one year of age are evaluated under the listing discussed above, listing 112.12, on Developmental and Emotional Disorders of Newborns and Younger Infants. The SSA does not use the following listings for children under one year:
- listing 112.02, organic mental disorders, or
- listing 112.05, intellectual disability (e.g., low IQ).
Applying for Disability Benefits for Conditions Caused by Premature Birth
Call the SSA at 800-772-1213 to set up an appointment to submit an application for SSI through your local SSA office. After you submit all the necessary medical and financial information to the SSA, a claims examiner and medical consultant will request your child’s medical records and consider your child’s claim to make a decision on whether your child is entitled to SSI disability benefits.