What Is the Katie Beckett Program?

1. Background / Purpose

   • The Katie Beckett program (sometimes called TEFRA because of the Tax Equity and Fiscal Responsibility Act) is a Medicaid pathway for children under age 18 (in Georgia) who have significant disabilities / medical needs. (pamms.dhs.ga.gov)

   • Normally, when applying for Medicaid, a child’s eligibility is counted together with parents’ income and assets (“deemed” from parents). But under Katie Beckett, the state may ignore parents’ income — eligibility is determined based largely on the child’s needs. (Georgia Medicaid)

   • The name comes from a girl (“Katie Beckett”) whose story helped change Medicaid rules, so children could receive care at home rather than being institutionalized. (Wikipedia)

2. Not a Traditional “Waiver” for Extra Services

   • Important: In Georgia, Katie Beckett is not a “Home & Community-Based Waiver” in the sense of giving extra services. Rather, it’s a “deeming waiver” — it makes the child eligible for regular state Medicaid benefits by changing how financial eligibility is calculated. (Georgia Department of Community Health)

   • Once accepted, the child gets full Medicaid (“state plan”) services: doctor visits, hospital, equipment, therapies, etc. (Georgia Department of Community Health)

3. Level of Care Requirement

   • Even though it’s not about diagnosis alone, a key part of applying is demonstrating that the child requires an “institutional level of care” — meaning, in a hospital, nursing facility, or similar — but can be cared for safely at home. (Georgia Department of Community Health)

   • Also, the cost of caring for the child at home must not exceed the cost of institutional care, at least in the state’s calculation. (Georgia Department of Community Health)

Who Is Eligible (in Georgia)

Here are the main eligibility criteria for Katie Beckett in Georgia:

• Child is 18 years old or younger. (Georgia Department of Community Health)

• The child meets federal disability criteria for Medicaid.

• The child is financially ineligible for SSI (Supplemental Security Income) because of income or resources, but for Katie Beckett you ignore parents’ income / resources. (Georgia Department of Community Health)

• The child requires an institutional level of care (hospital, skilled nursing, or intermediate-care facility-level) but can live at home. (Georgia Department of Community Health)

• It must be cost effective: the cost to care for the child at home is not more than the cost of institutional care. (Georgia Department of Community Health)

• To maintain eligibility, there is an annual review of Medicaid eligibility, but for the medical “level-of-care” determination, Georgia now authorizes at least two years if the standard is met.

Also, per Georgia Medicaid policy, once the child turns 18, there are specific steps / transitions. (pamms.dhs.ga.gov)

How to Apply (in Georgia)

Here’s a simple breakdown of how parents can apply for Katie Beckett in Georgia:

1. Get the Application

   • You can apply online via Georgia Gateway: www.gateway.ga.gov

   • Or, request paper forms from the Centralized Katie Beckett Medicaid Team: phone 678-248-7449, fax 678-248-7459. (Georgia Medicaid)

   • The physical address (for submitting applications) is: 2211 Beaver Ruin Road, Suite 150, Norcross, GA 30071.

2. Gather Documentation

   • Medical records (e.g., past 12 months) from all providers who treat your child: doctors, therapists, etc.

   • Clinical forms: There is a “Medical Necessity / Level-of-Care” statement that your child’s treating physicians (and perhaps other professionals) will need to fill out. (Georgia Medicaid)

   • Cost-effectiveness form: because part of the eligibility is comparing cost of home care vs institutional. (Georgia Medicaid)

   • Financial / eligibility info: your child’s income, resources, household info. (Georgia Department of Community Health)

3. Submit the Application

   • Complete all parts carefully. According to some guidance, do not date certain forms until the day you are ready to submit, to avoid mistakes. (jones.k12.ga.us)

   • Submit all forms (application, medical forms, cost form, etc.) together to the Katie Beckett Team.

   • After submission, your application will be reviewed by the Katie Beckett team, and medical documentation is sent to a review contractor (in Georgia, via a pediatric / nurse / neurologist team) to decide level of care & disability.

4. Decision & Approval

   • If your child meets the criteria, the Katie Beckett Team will “certify” Medicaid eligibility.

   • Because of the 2024 change, the medical level-of-care approval is good for at least two years (if the standard is met).

5. Renewal / Ongoing

   • You still need to do a Medicaid eligibility review every year. (Georgia Medicaid)

   • Provide updated documentation as requested. If you don’t complete required reviews, coverage might be terminated.

   • Report changes (address, household, income) as required by Medicaid. According to Georgia resources, changes should be reported within 10 days. (Autism Toolkit of Georgia)

Benefits of Katie Beckett

What do you gain if your child is approved under Katie Beckett?

• Full Medicaid Coverage: Your child will have access to the full suite of Medicaid services for children, including medical care, hospital visits, equipment, and therapies. (Georgia Department of Community Health)

• Ignore Parental Income: Because parents’ income/resources are “waived,” families who make too much for traditional Medicaid may qualify. (Georgia Medicaid)

• No Waiting List: In many states (including Georgia for this program), there’s no “slot-limited” wait list — Katie Beckett eligibility is not a capped waiver. (Kids' Waivers)

• Access to Home Care Services: Once eligible, children can receive in-home skilled nursing and personal care (via other Medicaid programs such as GAPP) so they don’t have to go to a facility just to get coverage. (Salvation Private Home Care)

• Therapy Coverage: With Medicaid, children may receive therapies covered under state plan, including Adaptive Behavior Services (ABS) / ABA therapy (if eligible). (Georgia Medicaid)

• Reduced Financial Burden: Because Medicaid covers many services, costs like co-pays, therapy bills, medical equipment, and so on may be much lower or eliminated compared to private pay.

How ABA (Applied Behavior Analysis) Therapy Works Under Katie Beckett / Medicaid

Since many parents want to know specifically about ABA therapy (especially for children with autism), here’s how it ties in with Katie Beckett in Georgia.

1. Medicaid Covers ABA (ABS)

   • Georgia Medicaid does cover Adaptive Behavior Services (ABS), which includes ABA therapy, for individuals under 21. (Georgia Medicaid)

   • The services need to be medically necessary and prescribed by a licensed physician or other authorized clinician. (Georgia Medicaid)

   • To get ABA therapy covered, providers must submit a prior authorization (PA) to Medicaid under the correct codes. (mmis.georgia.gov)

2. Limits / Rules on ABA under Medicaid

   • According to Georgia Medicaid policy (CareSource is one Medicaid plan in Georgia, but their policies reflect state rules), there are some limitations:

     • Only one agency or organization can provide ABA to a child at a time. (CareSource)

     • The therapy must use ABA analysis techniques. Some activities are not covered: e.g., non-ABA “life coaching,” services that fall under what the school should provide (IEP), or services that are more “custodial” rather than clinical.

     • Also, behavioral treatment must be focused on behaviors related to core autism symptoms — Medicaid may not cover ABA for behaviors that are not part of ASD (for example, behaviors due to ADHD or generalized anxiety).

   • There are also rules about provider qualifications: Medicaid requires registered / certified behavioral analysts to deliver or oversee ABA. (Georgia Medicaid)

3. Process for Getting ABA Approved

   • Your child needs a confirmed diagnosis of Autism Spectrum Disorder (ASD) via DSM-V from a licensed physician, psychologist, or other licensed professional. (Georgia Medicaid)

   • Once you have the diagnosis, your ABA provider (or Board Certified Behavior Analyst, BCBA) will develop a treatment plan / behavior plan that outlines the goals, behaviors to address, and frequency of therapy.

   • That plan is submitted to Medicaid via a prior authorization request. (mmis.georgia.gov)

   • If approved, Medicaid will pay for the ABS / ABA therapy services, within the guidelines and limits.

4. Why Katie Beckett Helps with ABA

   • Because Katie Beckett makes your child Medicaid-eligible, it unlocks access to ABA via Medicaid (if your child meets ABA coverage criteria).

   • Without Katie Beckett, you might not be Medicaid-eligible (because of your family income), so your child would rely only on private insurance or out-of-pocket — which may not cover as much or may be too costly.

   • Once on Medicaid, the financial burden for ABA may be significantly reduced, since Medicaid will cover (or co-pay less) for these therapy services, depending on the plan.

Things to Be Careful About / Common Pitfalls

• Documentation Is Critical: Applications often fail or are delayed because of missing or weak medical documentation. Make sure you provide detailed records: diagnoses, functional reports, evaluations, therapy notes, hospital records, etc. (Latarcsha Britt)

• Medical Necessity: For the level of care determination, your child’s providers (doctors, therapists) must clearly describe why the child needs a high level of care — not just “this is my diagnosis,” but how much care / what intensity.

• Prior Authorization for ABA: Even after Medicaid eligibility, ABA isn't automatic — you need to go through PA process, and the provider’s plan must align with Medicaid rules.

• Renewals: Missing renewal paperwork or failing to report changes can jeopardize your child’s coverage, so mark your calendar for annual eligibility reviews.

• Provider Selection: Not all ABA providers accept Medicaid. After approval, you’ll need to find a BCBA / ABA provider in your area who takes Georgia Medicaid.

• Appeal Rights: If your application is denied (either for the waiver or for ABA services), you can request reconsideration or a Medicaid hearing.

Additional Resources / Support

• Georgia Behavior Associates: They have a very helpful guide for parents applying for Katie Beckett / Medicaid to access ABA. (georgiabehavior.com)

• Autism Toolkit of Georgia: Provides information about Medicaid, how it works with autism services, and application help. (Autism Toolkit of Georgia)

• Georgia Department of Community Health (DCH): Their Medicaid website has Katie Beckett program info, forms, and contact numbers. (Georgia Medicaid)

• Parent-to-Parent (Georgia): Parent advocacy / support groups can often help with navigating the paperwork, gathering documentation, and understanding medical necessity.

Summary (In Plain Terms)

• The Katie Beckett program is a special way for children with serious needs to get Medicaid, even if their parents make too much for “normal” Medicaid.

• It’s not about giving extra “waiver-only” services — it's about making full Medicaid available to the child, based on their medical needs.

• Once on Katie Beckett, your child can get medical care, therapies, equipment, etc., covered by Medicaid, including ABA therapy, if they qualify for that.

• The application can be a lot of work — you’ll need to gather medical records, fill out forms, get clinical statements — but the payoff (in terms of access to care and lowering costs) can be huge.

• After approval, be ready to stay on top of renewals and the ABA authorization process.