Individuals and parents affected by autism may be eligible for social services benefits programs. Knowing the options and how to access them can open doors for help.
Autism is not a single, uniform disorder. It is referred to as a spectrum disorder because the symptoms occur in different ways and with varying degrees of severity. As such, the level of disability will vary greatly among individuals with autism.
People with autism usually don’t look physically different from anyone else. Rather, autism manifests in their behavioral and cognitive (thinking, planning, communicating and learning) processes.
There is no blood test or imaging study — such as X-ray — that diagnoses autism. The diagnosis is made by observing behaviors and developmental deficits that meet the diagnostic criteria in the American Psychiatric Association’s Diagnostic and Statistical Manual, Fifth Edition (DSM-5). Essentially, autism is characterized by three overall features, known as the autism triad:
- Impaired social interactions
- Impaired verbal and non-verbal communication
- Rigid thoughts and repetitive behaviors
These features range in severity, but they are often severe enough to cause significant disability.
So then, is autism considered a disability? It depends. While some people are offended by the term, others embrace it. Regardless, it is used by the Social Services Administration (SSA) in determining who is eligible for autism disability benefits.
Is Autism a Developmental Disability?
Yes, autism spectrum disorder is a developmental disability, based on a neurodevelopmental (brain-related) disorder. The disorder occurs when brain development is impaired by a number of structural and functional abnormalities.
These developmental abnormalities begin in the fetus and continue through childhood. Most of these abnormalities are caused by a number of faulty genes, and the many possible combinations of these genes may explain why there are so many different ways that autism can appear.
Abnormalities that occur in autism are also influenced by environmental factors that disrupt normal brain formative processes. Some of these occur during pregnancy while others occur after birth.
These genetic and environmental factors result in impaired brain development, beginning during pregnancy and ending when the brain stops developing in adulthood (mid-20s).
Is Autism a Learning Disability?
Yes, although autism is mostly defined by its behavioral characteristics, it is fundamentally a learning disability. Even the behavioral aspects can be tied to impaired learning. For example, it appears that the communicative limitations in autism are largely due to impaired learning of communication skills.
The learning disability in many autistic individuals is somewhat paradoxical. Some may be unable to learn in a classroom environment, yet they can successfully memorize a phone book on their own.
Disabled learning has many effects on an autistic individual’s ability to function in life. Traditional educational activities are often nearly useless for autistic people. They tend to resist formal teaching, and their behaviors can be disruptive in classrooms. They also have difficulty learning from experiences and may be unable to predict things that are important, such as when a bus will come to pick them up.
Learning to do meaningful tasks, such as those required by a job, may be impossible for individuals with autism. Although many people with autism have learning impairments that are relatively mild, autism is a learning disability with far-reaching consequences for many affected people.
Can Someone Receive Disability Benefits for Autism?
Yes, the Social Security Administration (SSA) has two kinds of autism disability benefits for eligible individuals, including:
- Social Security Disability Income (SSDI): This is intended for adults who have worked in the past but now cannot due to disability
- Supplemental Security Income (SSI): This is for disabled children and adults of lower income, and they do not need to have worked in the past to qualify
The various medical conditions and eligibility criteria are specified in the Social Security Administration’s Impairment Listing Manual, also known as the “blue book.”
Parents of children under 18 with autism may qualify for SSI benefits, and people with autism who are 18 or older may qualify for either SSI or SSDI benefits. Adults with autism who have never worked may be eligible for SSDI benefits, based on their parents’ employment history.
The SSA provides a free, downloadable booklet titled “Benefits for Children With Disabilities.” While not specific to autism, it is a useful resource and starting point for understanding federal SSA programs for parents of children with disabilities. The booklet also covers SSDI benefits for adults who have been disabled since childhood.
Autistic individuals whose level of disability does not meet the requirements of the SSA may still be eligible for “medical-vocational allowance” benefits. This is a catch-all category where the SSA takes a closer look at people’s disability. They see if there are limitations in the ability to function in daily activities and job situations that may fall short of the requirements for SSI or SSDI.
In most states, people with autism may qualify for a “Medicaid Waiver,” which is the 1915(c) Home and Community Based Services state program. Medicaid waivers are intended to provide the support needed to keep disabled people in the community instead of in an institution, such as a nursing home. Medicaid waivers may have different names in different states.
There are also other waivers available state by state, such as the “Katie Beckett Waiver.” This program is specifically designed for children under 19 who have disabilities. The U.S. government website includes a comprehensive list and search engine that allows users to look up all the various waivers available in their particular state.
Families of children who receive social security disability and SSI benefits for autism may be eligible for medical benefits, including:
- Medicaid and Medicare
- Children’s Health Insurance Program
- Special access to health care services under the Children with Special Health Care Need provision of the SSA
Social Security Disability Income (SSDI)
Social security for adults with autism includes both the SSI and SSDI programs. Social security disability benefits for autism may carry over from childhood to adulthood for people who were receiving social security disability for autism on their parents’ social security record.
The SSDI program is for adults who are disabled from working. It is usually based on the recipients’ income before they became disabled. If the disability began before age 22, however, it can be based on the recipient’s parental income.
Once a child reaches age 18, the blue book adult criteria for disability determination takes effect, and these differ from the childhood criteria.
Supplemental Security Income (SSI)
Does autism qualify for SSI? Yes, but under very specific criteria.
For children, the qualifying criteria for SSI for autism are listed in Section 112.10 of the blue book. The criteria are very specific and require thorough documentation. They require all of three criteria to be present:
- Social interaction impairment
- Communicative deficits
- Behavioral patterns that result in significant impairment to function
If all three criteria are satisfied and appropriately documented, SSA then determines if the child’s function meets their criteria for severely limited function. These are also described in Section 112.10 of the blue book.
Receiving SSI Benefits for a Child with Autism
Social security for children with autism is designed to help parents with limited resources cover additional expenses that occur when caring for a disabled child with autism.
The SSI benefit is a monthly payment that helps parents of children with disabilities, and adults with disabilities, who have lower income and limited resources. The amount of the payment may differ between states because some states supplement the SSI for children with autism.
Eligibility for SSI disability benefits for a child with autism depends on the income and resources that are available to the child and other people living in the child’s household. These income rules also apply if the child is away at school but still under the parents’ care and control.
Once a child is receiving SSI for autism, the SSA will review the child’s medical condition to make sure that the disability criteria are still being met. This usually happens every three years. Parents are required to provide evidence of the child’s limitations and proof that the child has been receiving medically necessary treatments.
When a child turns 18, the rules for receiving SSI change but the coverage can continue. In many cases, individuals who were not eligible for SSI before their 18th birthday become eligible because of income requirements.
In determining eligibility, the SSA will require the applicant’s formal permission to contact any professionals who are involved in the child’s care, including:
When applying for SSI for a child with autism, proper documentation such as medical and school records is key to the application process. Applicants do not have to provide the medical documentation with the application because the SSA contacts the doctors directly to obtain it. The SSA may arrange for the autistic person to undergo specific medical and functional testing (at their expense) to determine medical eligibility.
For eligibility criteria for adults with autism, the appropriate resource is the blue book’s Adult Listings (Part A). Unlike the child listings, the adult listings in the blue book do not have a specific listing for adult autism. Adults with autism must prove that, due to their autism, they are unable to function at a level high enough to meet the SSA’s threshold criteria for gainful employment.
If you or a loved one is suffering from a substance use disorder due to a co-occurring mental disorder like autism, The Recovery Village is here to help. Contact us today to learn about treatment plans that can work with your situation.
Boucher, Jill; Anns, Sophie. “Memory, learning and language in autism spectrum disorder.” Autism & Developmental Language Impairments, February 13, 2018. Accessed June 18, 2019.
Centers for Disease Control and Prevention. “Autism spectrum disorder (ASD): Diagnostic criteria.” April 26, 2018. Accessed June 18, 2019.
Medicaid.gov. “State waivers list.” (n.d.). Accessed June 18, 2019.
Park, Hye; Lee, Jae; Moon, Hyo; et al. “A short review on the current understanding of autism spectrum disorders.” Experimental Neurobiology, February 2016. Accessed June 18, 2019.
Qian, Ning; Lipkin, Richard. “A learning-style theory for understanding autistic behaviors.” Frontiers in Human Neuroscience, August 15, 2011. Accessed June 18, 2019.
Social Security Administration. “112.00 Mental disorders – Childhood.” (n.d.). Accessed June 18, 2019.
Social Security Administration. “Benefits for children with disabilities.” January 2019. Accessed June 18, 2019.
Social Security Administration. “Listing Of Impairments – Adult Listings (Part A).” (n.d.). Accessed June 18, 2019.
Social Security Administration. “Part I – General information.” (n.d.). Accessed June 18, 2019.
Social Security Administration. “Part II – Evidentiary requirements.” (n.d.). Accessed June 18, 2019.
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