Under Social Security regulations low birth weight babies may qualify for Social Security disability (Supplemental Security Income – SSI) benefits.

It is important to note that Social Security does not specifically consider whether the child is premature or not. Social Security considers the birth weight of the child:

“Low birth weight” is defined as a birth weight under 1,200 grams (2 pounds 10 ounces) or under 2,000 grams and small for gestational age.

Social Security does provide SSI disability benefits to certain low birth weight infants, whether or not they are premature. A child who weighs less than 1200 grams (about 2 pounds, 10 ounces) at birth can qualify for SSI on the basis of low birth weight, if otherwise eligible. A child who weighs between 1200 and 2000 grams at birth (about 4 pounds 6 ounces) AND who is considered small for his or her gestational age may also qualify. For this second category of low birth weight infants, the following chart shows the gestational age at birth and corresponding birth weight that satisfies our “small for gestational age” criterion.

However, even newborns over 1,200 grams may qualify for SSI depending on their gestational age. Listed below are the gestational ages and birth weights that may qualify a child for Supplemental Security Income benefits (re-formated from the Social Security website for easier viewing):

37-40 weeks — Less than 2000 grams (4 pounds, 6 ounces)

36 weeks — 1875 grams or less (4 pounds, 2 ounces)

35 weeks — 1700 grams or less (3 pounds, 12 ounces)

34 weeks — 1500 grams or less (3 pounds, 5 ounces)

33 weeks — 1325 grams or less (2 pounds, 15 ounces)

If the newborn weight is equal to, or less than, the specified amount, based on the newborn’s gestational age, the newborn may be able to qualify for SSI benefits. For more information, check out the Social Security FAQ.

Yes. Under some circumstances, Social Security can immediately start Social Security disability benefits, and continue to pay benefits for up to six months, while the state agency component of Social Security makes a formal decision of whether the child is disabled. These are called “Presumptive Disability” cases.

Basically, Social Security is saying that the child is probably disabled, and as such will pay benefits, while it reviews the case to confirm the presumed disability.

Here are the conditions that may qualify:

• HIV infection;
• Total blindness;
• Total deafness;
• Cerebral palsy;
• Down syndrome;
• Muscular dystrophy;
• Severe mental retardation (child age 7 or older); and
• Birth weight below 2 pounds, 10 ounces.

According to Social Security (POMS DI 11055.230):

The presumptive disability/blindness payments end the earliest of:

• The month in which the Disability Determination Services (DDS) makes a formal finding on whether the claimant is disabled or blind;
• The month for which the claimant is paid the sixth monthly payment based on PD or PB; or
• The month in which the claimant no longer meets one of the other eligibility requirements for SSI (e.g., excess income/resources).

If the Social Security state agency decides that the condition is not severe enough for SSI, you do not have to pay the money back. And that is very good news.

However, (you knew there had to be a however, didn’t you?) payments on presumptive disability cases CAN be considered overpayments (which a parent/guardian may have to pay back) if:

• The claim is disallowed due to ineligibility based on non-medical factors; or
• Social Security subsequently determine that it computed the amount of payment in error.

Or, put in English, if the child is later denied for non-medical reason (for example, if the household makes too much money or has too much in assets) or if Social Security got the benefit amount wrong.

See Social Security publication for a general overview. See  DI 11055.230 Presumptive Disability (PD) and Presumptive Blindness (PB) Provisions for more information about the overpayment issue.