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The president will have to make some difficult decisions about trims to many programs as part of any deficit-cutting deal. One target could be the children's SSI, Supplemental Security Income program. It provides a check each month to more than a million low-income kids with severe disabilities. In less than a decade, the program has grown by nearly 40 percent, mostly because of kids diagnosed with problems such as ADHD and bipolar disorder. That rise in costs has put it the sights of federal budget cutters.

Jenny Gold of our partner Kaiser Health News has the story.

JENNY GOLD: By the time Hulston Poe was two years old, his mother, Suzanne, knew there was something wrong. He had tantrums several times a day, often injuring himself and others.

Ms. SUZANNE POE: Hitting his head against the wall, screaming, yelling, kicking, biting. And this temper tantrum would go on for a good hour at least.

GOLD: Poe is a single mom with two kids trying to put herself through college. She lives in Des Moines, Iowa. When things got tough with her son, she quickly sought help, but local caseworkers said there wasn't much they could do.

POE: I remember one time I dropped my son off at preschool; within 15 minutes they told me to come back and get him - 15 minutes. I hadn't even gotten out of the garage yet.

GOLD: Doctors diagnosed the four-year-old with severe ADHD and recommended SSI. In May, Hulston began receiving a monthly check of $674, and perhaps more importantly, Medicaid. Poe says his new coverage got him to the right doctors and the extra money helps her afford an appropriate daycare, a private tutor, and medication.

POE: I can see light in his eyes again. You know, he just looks so much happier.

GOLD: When the SSI program began in 1974, the majority of recipients had disabilities like cerebral palsy, blindness, and mental retardation. Then, over the past 30 years, the rate of low-income kids on SSI quadrupled, following a Supreme Court case that expanded eligibility, welfare reform, and an increase in the number of children diagnosed with disabilities.

Much of the growth has come from kids like Hulston with ADHD, or what's called other mental disorders. They now make up over half of recipients.

Professor RICHARD BURKHAUSER (Cornell University): We are overusing this program to the detriment of children.

GOLD: Richard Burkhauser is a professor at Cornell and an expert on Social Security. He argues that some of the needy families that are no longer eligible for welfare benefits turn to SSI instead.

BURKHAUSER: The issue is, has there been a stupendous increase in the number of kids out there with other mental conditions, or is the SSI kids program increasingly being used as a more general welfare program to help poor kids?

GOLD: And since the federal government picks up more of the tab, states have an incentive to shift low-income children into SSI from other programs like welfare. Two-thirds of those kids then end up staying on SSI as adults.

Republicans in Congress have proposed limiting benefits for kids with ADHD, which they say could save the federal government $1.4 billion over the next 10 years. But child advocates say the move would target a critical lifeline for very vulnerable kids.

Ms. REBECCA VALLAS (Community Legal Services): Cutting the SSI program could have disastrous consequences for families, many of which are already struggling well below the poverty line.

GOLD: Rebecca Vallas is a lawyer at Community Legal Services in Philadelphia. She says the jump in SSI numbers can be explained by a national increase in child poverty and better access to health care, so children get diagnosed earlier.

VALLAS: I think a lot of the skepticism about the children's SSI program really is thinly veiled skepticism about the legitimacy of mental health disorders.

GOLD: Last month, Suzanne Poe visited Washington, D.C. to tell Congress how important the SSI program has been for her son.

POE: The reason why I applied for disability was not because that's what I want to live on for the rest of my life or my son's life. I want to achieve things in life. I want my family to be self-sufficient, and right now that's not happening.

GOLD: For now, she says SSI is what's holding her family together.

For NPR News, I'm Jenny Gold.

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