How to Get SSI Benefits for a Premature Baby

Premature babies—also referred to as "preemies"—are often born with health issues such as low birth weight or underdeveloped organs that may later cause serious complications. Preemies are at a greater risk of developing serious infections and respiratory disorders that make it difficult to get enough oxygen at this crucial stage, which can result in 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, poor vision, lung disease, or neurodevelopmental conditions. Preemies from low-income households who have significant health impairments may qualify for Supplemental Security Income (SSI) from the Social Security Administration.

What Is Considered a Premature Baby?

The average pregnancy term is 40 weeks. Children born before 37 weeks are considered premature (or "preterm"). Preterm births can be further classified into subcategories depending on how late in the pregnancy the birth occurred.

The earlier into a pregnancy term that a baby is born, the more likely that the baby will have delays in physical and mental development compared with babies born at 40 weeks ("full-term"). Parents of infants who seriously struggle to meet developmental milestones compared with other children their age can get SSI disability benefits for their child.

Getting SSI for Premature Babies ("Preemies")

In order for your premature infant to qualify for SSI, you'll first need to show that your family's income and assets are below the resource threshold for this needs-based program. If your total resources are over these limits, you won't be eligible to receive SSI, no matter how severe your child's developmental delay is.

Provided that your family meets the financial requirements for SSI, you'll also need to show that your child meets or equals a "listing." A listing is a medical condition that Social Security considers disabling in children when there's documentation of specific functional limitations in the child's medical records. While there isn't a specific disability listing for premature birth, there is one for developmental disorders in toddlers, as well as several listings that cover common illnesses diagnosed in preemies.

Listing 112.14, Developmental Disorders in Infants and Toddlers

Your child may satisfy the requirements of listing 112.14, Developmental disorders in infants and toddlers, if you submit medical documentation showing they have: 1) a delay or deficit in the development of age-appropriate skills, 2) a loss of previously acquired skills, or 3) both. You'll also need to provide evidence that your child has an "extreme" limitation in one, or a "marked" limitation in two, of the following functional areas:

• planning and controlling motor movements
• learning and remembering
• interacting with others, and
• regulating physiological functions, attention, emotion, and behavior.

Social Security defines "marked" limitations for children younger than the age of 3 as functioning at a level that is more than one-half, but no more than two-thirds, of what is typical in children of the same age who don't have any impairments. If your child's medical record contains standardized testing, "marked" limitations are defined as test results that are between two and three standard deviations below the mean.

"Extreme" limitations for children younger than 3 years old are defined as functioning at a level that is less than one-half of what is typical in children of the same age, or standardized test results that are three or more deviations below the mean.

To meet the requirements of listing 112.14, your child's medical records must contain evidence of developmental delays or emotional disorders, preferably from an age-appropriate cognitive assessment such as the Bayley Scales of Infant Development. But you don't necessarily need formal testing to meet the listing— sometimes obvious delays can be observed by a doctor and recorded in their notes. For example, a pediatrician should be able to discern abnormal production of sounds or difficulty with sucking in infants a few months old.

Childhood Listings for Common Illnesses Found in Premature Babies

If your child's pediatrician hasn't found any developmental delays but has diagnosed a medical condition stemming from your child's early birth, your child could still qualify for SSI by meeting the requirements of the listing specific to their condition. Social Security maintains the following listings for childhood disorders that are more common in preemies:

• Listing 102.02, Loss of visual acuity. Premature babies may have abnormal blood vessel development in the eyes. Post-labor treatment of respiratory distress with excessive oxygen can also lead to retinal damage. Severe vision loss in children is covered by this listing.
• Listing 102.10, Hearing loss. Ear infections are common in premature babies, which can cause permanent hearing problems. Children under the age of 5 who have an average air conduction hearing threshold of 50 decibels or greater in the better ear can meet the listing for hearing loss.
• Listing 103.02, Chronic pulmonary insufficiency. Premature babies often have fragile lungs that are susceptible to scarring and inflammation. Infants and toddlers who've undergone multiple hospitalizations, oxygen supplementation, or tracheostomy may be eligible for SSI under this listing.
• Listing 111.07, Cerebral palsy. Preemies—especially those who are very or extremely preterm—are more likely to be diagnosed with cerebral palsy, a neurological condition that affects motor functions. Infants and toddlers with an extreme limitation in basic movements such as standing up from a seated position will likely meet this listing.

If your child doesn't meet the requirements of a listed impairment, you may still be able to get them disability benefits by proving that their limitations are "functionally equivalent" to the listings. You can do this if your medical records show that your child has marked or extreme limitations in two major areas of functioning (using information, completing tasks, interacting with others, moving around, self-care, and physical well-being).

SSI for Low Birth Weight "Micropreemies"

Babies who are born extremely premature and have a very low birth weight are sometimes called "micropreemies." Because micropreemies often need help right away, they may qualify for presumptive disability benefits. Presumptive benefits are Social Security's method of making immediate payments to applicants who are very likely to be found medically disabled.

For parents of micropreemies, this means that their underweight newborn can qualify for presumptive disability if they were born at or below certain birth weights and corresponding gestational ages. You can find the specific weights and ages in the low birth weight section of our presumptive disability article.

How Long Can a Premature Baby Receive SSI Benefits?

If your child is approved for SSI, they can continue to receive SSI until they turn 18, at which time Social Security will reevaluate them under the adult disability criteria (a process known as redetermination). To be considered disabled after age 18, your child will need to show either that they meet one of the adult medical listings or that they can't work at any full-time job.

If the child is still disabled when they turn 18 and one of their parents is retired or receiving Social Security Disability Insurance (SSDI), the child may also qualify for SSDI as a "disabled adult child" even if they wouldn't otherwise meet the SSDI work credits eligibility requirement.

Additional Government Assistance for Premature Babies

Children who are designated as having special health care needs may be able to receive additional services from several federal health programs. In order to be eligible for these services, the child must require health care and related services beyond those generally needed by other children. (Most children who qualify for SSI benefits will be eligible.) Learn more in our article on benefits for children with special health care needs.

Families who meet the SSI low income and asset requirements are also likely to qualify for Medicaid. Medicaid is administered by states, not the federal government, and most states offer "medically needy" programs that help people who are slightly above the financial cutoff for Medicaid eligibility to become eligible by deducting medical expenses from their income.

How to Apply for Social Security Benefits for Preemies

You can apply for SSI by calling 800-772-1213 (TTY: 800-325-0778) from 8 a.m. to 7 p.m., Monday through Friday, or you can set up an appointment to apply through your nearest Social Security field office. After you submit all the necessary medical and financial information, a disability claims examiner will request medical records from your child's doctors and make a decision on whether your child is disabled.

While you aren't required to have an attorney to apply for Social Security benefits, you may want to consider getting help from an experienced disability lawyer, especially if you've already applied and gotten denied. Your attorney can gather any outstanding medical records that could show developmental delays in your child, handle all communications with the Social Security Administration, and represent your child at a disability hearing (if necessary).