Katie Beckett Waivers: Eligibility & How to Apply | Citizen Health

The Citizen Health Team

September 11, 2026

Key takeaways

• The Katie Beckett waiver lets some children with disabilities, chronic illness, or those requiring significant mental health support access Medicaid coverage based on the child's own income and medical needs, not the family's income or existing commercial/private insurance coverage.
• Children must meet specific criteria: state residency, an age cutoff (usually 19), an institutional level of care, and the child's own income and resource limits.
• Your state may call it TEFRA, Katie Beckett, or institutional deeming, so the name you search for matters.
• Most of the application process is paperwork: doctor letters, evaluations, and therapy notes showing the level of care your child needs.

If your child needs complex care at home but your household earns too much for regular Medicaid, the Katie Beckett waiver may provide an alternative way for them to access Medicaid coverage/funding. 

This waiver means coverage is determined based on an evaluation of your child's income and medical needs instead of your family income, so care can happen at home instead of in a facility. That one change opens a door for a lot of families who were told no before. 

This waiver also comes with its own rules and a name that changes depending on where you live.

We'll walk through: what this waiver is, who qualifies, how to apply, what it covers, and where to get free help if you get stuck. 

And if pulling records together is the part slowing you down, tools that gather your child's records in one place can take that piece off your plate.

What Is the Katie Beckett Waiver?

The Katie Beckett waiver is a Medicaid waiver that lets states skip counting parents' income and existing private insurance coverage when deciding whether a child with a disability can get Medicaid.

It was created under the Tax Equity and Fiscal Responsibility Act (TEFRA) of 1982, which is why some states refer to it as TEFRA.

That naming split matters when you search. 

Depending on where you live, the same option may be called TEFRA, Katie Beckett, or institutional deeming, or it may sit inside a bigger waiver.

So if someone tells you your state doesn't have "Katie Beckett," try the federal language instead (i.e., TERFA), since that's the wording state agencies use internally. 

Title 42 Code of Federal Regulations 435.225 lays out the criteria for this eligibility group.

Ask whether your state has elected to cover it. Sometimes the answer is that they use a different name for it, and sometimes the answer is that they haven't taken the option at all.

Does My State Offer a Katie Beckett Waiver, and How Is It Different From Regular Medicaid?

Every state decides on its own whether to offer this, so coverage is uneven.

Some run a standalone Katie Beckett program with no waitlist. Others fold it into a home and community-based services waiver with a cap on how many kids it can serve.

Medicaid.gov's state overviews page links to every state Medicaid agency. Open your state's page and search it for "TEFRA," "Katie Beckett," and "institutional deeming" one at a time, since most states use only one of those words.

If none turn anything up, call your state Medicaid line and ask:

"Does the state cover children under the institutional deeming eligibility group in 435.225?" 

That question usually routes you to someone who handles these applications.

Regular Medicaid vs. Katie Beckett Waiver

As for how the Katie Beckett Waiver differs from regular Medicaid, both get your child to the same coverage, just through different doors:

Because qualification is not based on what you earn, families generally don't have to cut their income or spend down savings to keep a child covered, as long as the child still meets the medical eligibility criteria.

Note: Some states do charge a monthly premium or parental fee on a sliding scale tied to family income, so ask your state whether one applies before you plan around the coverage.

Who Qualifies for the Katie Beckett Program?

Eligibility for Katie Beckett comes down to three things: where you live, your child's medical needs, and your child's income and resources. 

Residency and age

Children must be U.S. citizens or qualifying immigrants and live in the state where you're applying. Most states cover children under age 19, though some stop at 18.

If your child is within a year or two of that cutoff, ask now what adult pathway follows. Call your state's Medicaid agency or Department of Health Services and ask what your child transitions to at that age and when you need to apply. If you aren't sure which office handles this in your state, Medicaid.gov lists a contact number for every state agency.

The Katie Beckett program is for children who live at home or in the community, not in a facility.

Institutional level of care

This is where most of the review happens. The state looks at whether your child needs the kind of care usually given in a hospital, nursing facility, or intermediate care facility. Your child doesn't have to be in one of those places; the need just has to be comparable.

Needs that often meet the standard include:

• Complex medical needs, like tube feeding, respiratory support, or frequent hospital care
• Developmental disabilities that affect daily functioning
• Significant physical disabilities requiring hands-on help through the day
• Conditions needing ongoing skilled nursing or therapy

Because the decision rests on documented daily function and not the diagnosis alone, two children with the same condition can get different answers. 

There are also possibilities for individuals with chronic illnesses or mental health support needs that meet special eligibility criteria to receive Medicaid coverage. 

If you feel your child has medical or daily living complexities and this waiver would help access necessary support services, it is worth applying to see whether coverage is possible.

Income and resources

Here, the state can ignore the family's income and look only at the child's income and resources. That limit is usually low, which works in most families' favor since few kids have income of their own.

Some states also run a cost comparison confirming that care at home costs no more than institutional care. You don't usually submit anything for this. The state runs it from the records you've already provided.

How Do I Apply for the Katie Beckett Medicaid Waiver for My Child?

The form itself is usually short. It's the paperwork behind it that takes time, so here's the sequence:

Two important things that can help:

How to request records without slowing yourself down

Ask each provider for the complete file, not a summary. If you're unsure what you need, ask for everything and sort it later.

Most records departments take requests by portal, email, mail, or fax. Ask which they accept before you send anything, since some departments only act on one.

If fax is the only option and you don't have a machine, online fax services can send from your phone or computer. 

Look for one that will sign a business associate agreement and states it encrypts documents in transit and at rest. That language tells you the service is set up to handle medical records, and free or ad-supported fax apps usually are not.

For the full process, including what to do if a provider delays or refuses, see our guide on how to request medical records.

How to get a doctor's letter that actually addresses level of care

Print the level-of-care language from your state's page and bring it to the appointment. 

Doctors write stronger letters when they know which standard is being applied, and a letter that describes the diagnosis without addressing daily care needs is one of the most common reasons an application stalls.

Who Can Help With a Katie Beckett Waiver Application?

You don't have to figure this out alone, and you shouldn't have to pay for help.

Three places to try:

Family-to-Family Health Information Centers:

One per state, staffed largely by parents of children with disabilities. Find yours in the Family Voices directory, and mention the Katie Beckett or TEFRA pathway when you call.

Protection and Advocacy agencies:

They handle denials and delays at no cost. Locate yours through the Administration for Community Living. Call once you have the written denial, since that letter states the reason.

Hospital financial counselors:

Ask your children's hospital. They often keep the current application packet on hand.

What Medicaid Services Does the Katie Beckett Waiver Cover?

Coverage varies by state and rests on medical necessity, but most programs share the same core categories.

Children approved this way are covered by Medicaid like any other enrollee, with providers billing Medicaid directly.

Big equipment almost always needs prior authorization, with a doctor documenting medical necessity first.

And Medicaid provides coverage that can sit alongside the plan you already have. That matters when private insurance does not cover extended in-home nursing hours or supplies past a yearly cap.

Respite is the benefit families leave unused most often, usually because they don't know where to find a provider. Once hours are approved, the non-profit ARCH National Respite Network has a state-by-state respite locator you can search.

Keeping Coverage After Approval

Approval isn't permanent. Some states re-review yearly, and others approve for longer, so the only date that matters is the one on your approval letter.

What renewal asks for

You'll need to show your child still meets the level-of-care standard, usually with fresh documentation.

Three things can help make that easier:

• Set a calendar reminder 90 days before the renewal date, so you can request updated evaluations without rushing your child's doctors.
• Ask providers you see that year to note daily care needs in the visit summary, so you're not chasing letters later.
• Confirm the renewal date yourself. Call the number on your approval letter and ask for it in writing. A centralized Katie Beckett Medicaid team usually mails the notice, but a missed notice is still a missed deadline.

If you get a denial

A denial isn't the last word, and the clock starts the day the notice arrives.

If you were told no over the phone and never received anything in writing, request the written decision before you do anything else. Your appeal rights and your deadline both run from that notice, so until it arrives you have nothing to file against.

Once the notice is in hand:

• Read it for two things: the reason given and the deadline to request a fair hearing. Both are printed on the notice.
• Ask for the hearing in writing before that deadline. The notice tells you where to send the request. If it lists only a mailing address, send it by certified mail so you have proof of the date, and keep the receipt.
• Call your Protection and Advocacy agency with the notice in hand. It's free, and this is what they do.

A denial isn't always permanent

Eligibility is judged on your child's needs at the time you apply, so a "no" this year doesn't settle the question for next year. 

Families often reapply after something changes: a new diagnosis, a hospitalization, a shift in the level of daily care your child needs, or a change in your household's income or size. 

States also update their own rules and slot counts, so a program that was closed or full when you applied may look different later.

If you were denied, ask the agency in writing why, and ask how long you have to appeal. Appeal windows are short in many states and are usually counted from the date on the notice, not the date you opened it. 

If you were waitlisted instead, ask where you sit on the list, whether the state re-ranks by urgency, and whether you need to do anything to stay on it. Some states drop families who don't confirm annually.

Keep the file you built. Add to it as new records come in, and note the date of anything that shows a change in need. A reapplication moves much faster when the paperwork is already current.

If Your Child Doesn't Qualify

A denial or a waitlist stings, especially after months of gathering paperwork. But this waiver is one door among several, and the records you pulled together carry over to most of the others.

Here are the pathways families most often move to next, from other waivers to monthly cash benefits to savings accounts that don't count against Medicaid limits.

1915(c) home and community-based services (HCBS) waivers:

These cover many of the same services for children with disabilities. Medicaid.gov's HCBS overview explains how they work, and your state agency can tell you which ones fit and where waitlists stand.

SSI-linked Medicaid:

Children with significant functional limits may qualify for SSI (Supplemental Security Income), which in most states brings Medicaid with it. Social Security's Child Disability Starter Kit lists the records they'll ask for, and it overlaps heavily with the file you already built.

Medicaid Buy-In under the Family Opportunity Act:

This lets some families over the income limit buy Medicaid coverage for a child with a disability, but only some states have taken the option. The National Organization for Rare Disorders (NORD) keeps an interactive map where you can check your state's rules.

Achieving a Better Life Experience (ABLE) accounts:

Not coverage, but tax-advantaged savings that don't count against the asset limits tied to SSI and Medicaid. Find more details at ablenrc.org.

Where to Go From Here

The Katie Beckett waiver exists because a child's access to Medicaid shouldn't hinge on what their parents earn. 

Getting through it takes paperwork and patience, but the path is knowable: 

• Find your state's version/name for this waiver
• Learn the level-of-care standard, meaning what type of medical care needs qualify
• Gather the records
• Send a complete file
• Calendar the renewal.

If the record-chasing and the deadline-watching are the parts wearing you down, that's the part you can hand off. Citizen Health was built by rare disease caregivers who have sat where you're sitting. 

Ari, our AI teammate, gathers records across providers, drafts letters and forms for you to review, and keeps renewal dates from slipping, so you can spend that time on your child instead of on the filing.

Frequently Asked Questions (FAQs)

What is the Katie Beckett waiver and who qualifies for it?

It's a Medicaid pathway that allows states to cover children with significant disabilities or complex medical needs at home, using the child's own income and resources rather than the family's. It came from the Tax Equity and Fiscal Responsibility Act of 1982 and is named after Katie Beckett, whose case prompted the change.

What does the Katie Beckett waiver cover?

Coverage varies by state, but programs commonly include medical services, therapies, durable medical equipment, in-home nursing, personal care support, and respite. Your child's care team documents medical necessity, and the state Medicaid program reviews the request.

Who qualifies for the Katie Beckett waiver in Georgia?

In Georgia, eligibility rests on the child's disability and medical needs rather than family income. Children generally must be under 19, meet an institutional level of care standard, and be able to safely receive care at home. Families can apply for Medicaid online at gateway.ga.gov or through a local Division of Family and Children Services (DFCS) office. Georgia also lists a Katie Beckett Medicaid contact line on its state Medicaid site, which is the best place to check for the current number.

How long does Katie Beckett take to get approved?

Timelines vary by state and often run several months from the day you apply. Delays usually trace back to incomplete medical documentation or a backlog on the state's side, so applying early with a complete file gives you the best shot at a smooth review.

Does Katie Beckett cover autism?

Children with autism can qualify when they meet their state's medical eligibility criteria. Approved coverage may include behavioral, occupational, and speech therapies documented as medically necessary. The decision rests on the level of care the child requires rather than the diagnosis alone.

Can my child keep private insurance and have Katie Beckett Medicaid?

In most cases, yes. Medicaid can act as secondary coverage alongside your plan, which is often what makes the difference for services private insurance does not cover. Your state Medicaid office can confirm how the two coordinate.

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