Katie Beckett Waiver Explained: Eligibility, Benefits & Application

The Katie Beckett Waiver, sometimes called the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA), is a Medicaid waiver that provides home-based care for children with complex medical needs. It is particularly valuable for families affected by long-term disability, because eligibility is not affected by the parents' income. In fact, one of the waiver's unique features is an eligibility assessment based solely on the child's income and resources. It is an option for families whose income might otherwise disqualify them from Medicaid benefits. It is available in 24 states, with state-specific variations in eligibility and application processes. The waiver has helped keep families together and cut the need for institutional care.

In this guide, we’ll define the Katie Beckett Waiver and explain how to apply for it. However, families may still find it helpful to consult a special needs attorney to evaluate their options.

Historical Background of the Katie Beckett Waiver

Mary Katherine Beckett was born in 1978 in Cedar Rapids, Iowa. She spent some time in the hospital during her earliest years. Then, in 1981, doctors agreed that she could be cared for at home. The problem was that Medicaid would only pay for institutional care. Not only did Katie and her family feel that caring for her at home would be better for her, but the institutional care cost almost six times as much as supportive home care.

The situation was far from ideal, and Katie's mother convinced President Ronald Reagan of this. In 1982, Congress passed the Katie Beckett Waiver, allowing states to fund home-based care for severely disabled children based on their income alone.

Since then, the Katie Beckett Waiver has been enacted in some form in 24 states. This waiver allows many people under the age of 19 who have serious conditions related to their disabilities to stay at home, rather than be placed in an institutional setting.

Home care offers many advantages, most importantly, keeping families together. Children with special needs can live with loved ones who understand their needs better than institutional caregivers. Therapists and professionals often form close, lasting relationships with families, contributing to a strong support system.

Who is Eligible for the Katie Beckett Waiver?

The Katie Beckett program is for children (those under age 19) who have disabilities or complex medical needs. It’s especially valuable for children who are not eligible for Medicaid because of their parents’ income or assets, because eligibility for the waiver only takes into account the income and assets of the child. This program helps pay for pediatric home care nursing that private insurance does not cover.

Here are the general eligibility requirements for the Katie Beckett Waiver. A person must:

• Be under the age of 19
• Be a U.S. citizen or eligible non-citizen
• Meet income and resource requirements
• Meet the Social Security Administration’s disability requirement
• Live at home
• Require care typically offered in a hospital or nursing home

Currently, the Katie Beckett Waiver is active in some form in 24 states. However, since the waiver is run by states, eligibility and application processes will vary depending on where you live. You can go to Kids Waivers and search for your state, to see if your state has this waiver.

If your state has a Katie Beckett Waiver, you’ll need to speak with a Katie Beckett social worker to discuss what types of care and services are available and if you qualify for them. Your social worker can also walk you through the application process. Typically, an eligibility decision is made within 90 days.

Even if your state doesn’t offer the Katie Beckett Waiver, it is likely it may have another Medicaid-funded program that can help provide needed services in the home.

What Services Are Covered by the Katie Beckett Waiver?

If your child qualifies for the Katie Beckett program, they are eligible for a full range of services covered by Medicaid. You can start using these services right away—there is no waiting period.

Here are some examples of the types of care this waiver will cover:

• Doctor visits
• Hospitalizations
• X-rays
• Lab tests
• Prescription drugs
• Dental and hearing screenings
• Behavioral health screenings
• Physical, occupational, and speech therapy
• Medical equipment and supplies

Coverage varies a little by state, as does the definition of “institutional-level” care, so check your state’s program for more specific information.

Key Benefits and Important Considerations of the Katie Beckett Waiver

The Katie Beckett Waiver is a Medicaid waiver that can pay for at-home care for children who would otherwise need to be placed in an institution. It is particularly important for families who would otherwise be separated from their disabled children.

Eligibility is not affected by parents' income, and it provides payment for a variety of at-home services. Katie Beckett waivers are administered by states, so you should check with your home state to see if you qualify. Even if your state doesn’t offer the Katie Beckett Waiver, it may have another Medicaid-funded program that can help provide needed services in the home. Children approaching age 18 should consider applying for Supplemental Social Security so that they can continue receiving benefits after the waiver ends.

The Bottom Line

The Katie Beckett Waiver is a Medicaid waiver that provides at-home care for children with complex medical needs, It assesses eligibility independently of parental income. The comprehensive range of care services covered under the waiver include doctor visits, hospitalizations, therapies, and medical supplies. Families can consult with a Katie Beckett social worker to navigate the application process and explore the specific services and eligibility criteria in their state. If the waiver isn't available in their state, families should explore other Medicaid-funded programs to pursue necessary home care services.