A child who is not categorically eligible for Medicaid at the time that residential treatment in a Therapeutic Residential Child Care Facility (TRCCF) or Psychiatric Residential Treatment Facility (PRTF) is required, must become eligible for Supplemental Security Income (SSI) in order to qualify for benefits through the Child Mental Health Treatment Act beyond the first 30 days of residential treatment. The SSI Eligibility is essential because if the child qualifies for SSI, the child will also become eligible for Medicaid. Medicaid eligibility is necessary for the State to contribute to residential treatment costs beyond the first 30 days. In order to gain SSI eligibility, certain criteria must be met. Financial and medical requirements are two main parts of the SSI eligibility determination.
The family should apply for SSI benefits for their child through their local Social Security Administration (SSA) office. The Community Mental Health Center (CMHC) is available to assist the family in the application process.
In order to meet SSI financial eligibility criteria, the child must have limited income and assets. For children who will be in a residential treatment facility and out of the home for longer than a temporary absence, the parents' income is not considered, only the income and assets that the child possesses.
Disability Determination Services, which is part of the Colorado Department of Human Services, is responsible for disability determination based on the SSI criteria outlined by the Social Security Administration (SSA). In order for a child to meet SSI disability eligibility criteria, the mental illness must be determined to be a disabling condition that has lasted, or is expected to last for a year. This determination will rely heavily upon documentation of the disability and the level to which it impacts life functioning. The family will be required to submit comprehensive documentation from the child's providers and as much supporting information as possible, including prior treatment reports, school reports and IEPs, records from hospitalizations and former therapists, etc.
An SSI Checklist in the Child Disability Starter Kit developed by the Social Security Administration can help in the application process.
If SSI eligibility is determined, the child is eligible for benefits beginning with the month following the month of eligibility. This first benefits payment may be retroactive. Medicaid eligibility will begin the first day of the month following the calendar month of placement. Provider reimbursement will be retroactive to the date of Medicaid eligibility. If the child is determined not eligible for SSI, the parent is liable for the cost of care beyond the first 30 days of residential treatment.
An eligible child will lose SSI and Medicaid eligibility upon returning home, unless the parent's financial status has changed and the family income is low enough to qualify for SSI.