Medicaid guide for families

The Katie Beckett program: Medicaid at home for children with disabilities

The Katie Beckett or TEFRA option lets a state give Medicaid to a child with significant disabilities who lives at home, counting only the child's own income, not the parents'. It is optional, so not every state offers it, and some states serve the same children through waivers with their own rules.

Last verified: September 2026

Find your starting point How to apply

The short answer

If you only read one thing today

  • Call your state Medicaid agency and ask by name for the "TEFRA" or "Katie Beckett" option. Find the number on Medicaid.gov's state directory.
  • Apply even if you earn "too much." Under the TEFRA option, parents' income and resources are not counted.
  • Your child does not need to be in a hospital. They need to need that level of care, with safe care at home.
  • If your state has no TEFRA option, ask about 1915(c) waivers for children, and ask to be added to any waiting list.
  • Start a folder now with diagnoses, recent evaluations, and a list of your child's daily care needs.

This page is general information, not medical or legal advice. Rules differ by state and change over time. Confirm every detail with your state Medicaid agency.

Where the name comes from

Katie Beckett was a little girl in Cedar Rapids, Iowa. After viral encephalitis at five months old, she needed a ventilator and spent more than two years living in St. Luke's Methodist Hospital. Medicaid would pay for her care only while she stayed there, even though her doctors and her parents, Julie and Mark, wanted her home.

At a news conference on November 10, 1981, President Reagan described a girl whose hospital care cost Medicaid $6,000 a month, when care at home would cost $1,000 a month that her parents could not afford and Medicaid could not pay. Katie went home in time for Christmas. In 1982, Congress created the state option that CMS says grew out of her family's advocacy.

Source: Ronald Reagan Presidential Library: The President's News Conference, November 10, 1981; Minnesota Governor's Council on Developmental Disabilities: Katie Beckett (reprint of NPR, November 8, 2010); Medicaid.gov (CMS): Implementation Guide, Children under Age 19 with a Disability

What the law actually says

Section 134 of the Tax Equity and Fiscal Responsibility Act of 1982 (Public Law 97-248, enacted September 3, 1982) added paragraph (e)(3) to section 1902 of the Social Security Act, under the heading "Medicaid coverage of home care for certain disabled children." It took effect October 1, 1982.

At the state's option, a child can be covered if the child:

  1. is 18 years of age or younger and qualifies as disabled under section 1614(a) of the Social Security Act (the SSI definition);
  2. requires the level of care provided in a hospital, nursing facility, or intermediate care facility, as determined by the state;
  3. can appropriately receive that care outside an institution;
  4. would cost Medicaid no more at home than in an appropriate institution; and
  5. would be eligible for Medicaid if living in a medical institution.

Source: GovInfo (U.S. Government Publishing Office): Public Law 97-248, 96 Stat. 324, Section 134; GovInfo: 42 U.S.C. 1396a (Social Security Act section 1902), paragraph (e)(3); eCFR: 42 CFR 435.225, Individuals under age 19 who would be eligible for Medicaid if they were in a medical institution

Why your income as a parent does not count

Normally, when a child lives with a parent, Medicaid counts the parent's income and resources as available to the child. That is called deeming. A person in an institution is generally treated as living alone, so nothing is deemed to them.

The TEFRA group is judged as if the child were in an institution. CMS explains that this means eligibility is evaluated without regard to a parent's income or resources, even when the parent lives with the child. For example, a state that uses its special income level compares only the child's income with that standard, which CMS says in most cases is 300% of the SSI federal benefit rate.

Source: Medicaid.gov (CMS): Implementation Guide, Children under Age 19 with a Disability

TEFRA option or "Katie Beckett waiver"? Why the words get mixed up

People use "Katie Beckett" for two different things. The TEFRA option is a Medicaid state plan eligibility group under section 1902(e)(3). A 1915(c) waiver is a home and community-based services program that a state designs for a target group, with a maximum number of participants the state chooses. The Katie Beckett name is also often used loosely for waivers. The difference matters most when it comes to waiting lists, covered below.

Source: Medicaid.gov (CMS): Implementation Guide, Children under Age 19 with a Disability; Medicaid.gov: Home and Community-Based Services 1915(c); Minnesota Governor's Council on Developmental Disabilities: Katie Beckett (reprint of NPR, November 8, 2010)

Programs at a glance

Four pathways, one goal: care at home.

These are the types of programs to ask about. Your state decides which ones it offers and what they are called.

Pathway 1 · State plan option

TEFRA / Katie Beckett option

Who it is for
Children 18 or younger who meet the SSI disability definition, need the level of care given in a hospital, nursing facility, or intermediate care facility, can appropriately be cared for at home, and whose home care is not expected to cost Medicaid more than institutional care.
What it can help with
Medicaid eligibility for the child. The state uses the rules of its other Medicaid groups, judged as if the child were in an institution, so parents' income and resources are not counted.
How you get on it
Application. You apply for Medicaid for your child, then the state checks disability and level of care. It exists only in states that choose to offer it.
Official page: CMS guide Official page: 42 CFR 435.225

Pathway 2 · Waiver

1915(c) home and community-based services waivers

Who it is for
People a state chooses to target, which can be by age or diagnosis. CMS lists examples such as autism, cerebral palsy, epilepsy, and technology-dependent children. Each person must need an institutional level of care.
What it can help with
Services at home or in the community. CMS lists examples such as case management, personal care, home health aide, habilitation, and respite. Federal rules also let states cover waiver participants who would be eligible if they were in an institution.
How you get on it
Often a list. Each state sets the maximum number of people a waiver serves and may keep a waiting list.
Official page: 1915(c) overview Official page: 42 CFR 435.217

Pathway 3 · Your state's version

State programs that carry the Katie Beckett name

Who it is for
Children your state defines. Names, ages, and structure vary. Tennessee's Katie Beckett program, for example, serves children under 18 and has Parts A and B.
What it can help with
Depends on the program. Tennessee, for example, says its program provides services and/or helps pay for medical care that private insurance does not cover.
How you get on it
Application or referral, as your state describes. Section 1115 of the Social Security Act also lets the Secretary of Health and Human Services approve state demonstration projects, which is one more way states design coverage.
Official page: Tennessee example Official page: Section 1115

Pathway 4 · Check first

Other Medicaid your child may already qualify for

Who it is for
Children who may qualify through another Medicaid group. Louisiana, for example, collects household financial information to check other, less burdensome Medicaid programs before enrolling a child in TEFRA.
What it can help with
Regular Medicaid coverage. If your child already has Medicaid, a waiver may be the question to ask about, for services at home.
How you get on it
Application. One Medicaid application usually starts the review. Your state agency can tell you which group fits.
Official page: find your state agency Official page: Louisiana FAQ

Which program should I ask about?

Four quick questions

Answer what you can. We will highlight the pathways above that are worth raising when you call. This is only a starting point. Your state Medicaid agency makes every eligibility decision.

Want to see what your state offers? Try our Medicaid waiver finder by state, or size up costs with the therapy and equipment cost explorer.

State examples we checked

What official state pages say today.

We only list states whose details we confirmed on an official state page in September 2026. This is not a complete list. If your state is not here, it may still offer the option. Check the Medicaid.gov state plan amendment search and the State Waivers List, or call your agency.

Georgia

TEFRA/Katie Beckett

For children 18 or younger who meet the SSI disability definition and live at home. Family income is set aside.

Centralized Katie Beckett Medicaid Team: 678-248-7449. Apply at gateway.ga.gov or through your local DFCS office.

Official page

District of Columbia

TEFRA/Katie Beckett

For children 18 or younger who need an institutional level of care. Only the child's income and resources count: income under 300% of SSI and resources under $4,000.

DHCF: (202) 442-5988 or HealthCheck@dc.gov. DC says it decides within 60 calendar days of a completed packet.

Official page

Louisiana

Act 421 Children's Medicaid Option (TEFRA)

For children under 19 who meet an institutional level of care. Louisiana says there is no waiting list and no enrollment cap.

Medicaid: 1-800-230-0690 or 421-CMO@la.gov.

Official page

South Carolina

TEFRA

For children 18 or under. Only the child's income and resources count: gross monthly income below $2,982 (South Carolina's limit effective January 1, 2026) and countable resources at or below $2,000.

SCDHHS Member Help Center: (888) 549-0820.

Official page

Wisconsin

Katie Beckett Medicaid

For children under 19 who meet the Social Security disability definition and a functional level of care.

888-786-3246, DHSKatieBeckett@dhs.wisconsin.gov, or online at access.wi.gov.

Official page Official page

Idaho

Katie Beckett Program

For children under 19. Idaho may charge a premium based on family income, and says eligibility is not affected if a family cannot pay it. Idaho's apply page also lists a household income limit among its criteria, so ask Idaho how its income rules apply to your family.

Apply for Medicaid at idalink.idaho.gov or 1-877-456-1233, and write "Katie Beckett" at the top of the application.

Official page Official page

Maine

Katie Beckett (MaineCare)

MaineCare coverage for children at home with long-term disabilities or complex medical needs. Maine says a child may qualify even if the family makes too much money for MaineCare, if the child meets the other requirements.

Maine DHHS: (207) 287-3707. TTY: Maine relay 711.

Official page

Tennessee

Katie Beckett Program (Parts A and B)

For children under 18 who are not Medicaid eligible because of their parents' income or assets. It has two parts, A and B.

Self-refer at tenncareconnect.tn.gov. Regional lines: West (866) 372-5709, Middle (800) 654-4839, East (888) 531-9876.

Official page

How to apply, step by step

From first call to a decision.

States run this process differently, but the official pages we read follow the same broad path.

  1. Find your state Medicaid agency

    Use Medicaid.gov's "Where Can People Get Help" page. Pick your state to get its website and phone numbers.

  2. Ask the right question

    Ask whether your state covers children under the TEFRA option, section 1902(e)(3), sometimes called Katie Beckett. If not, ask which 1915(c) waivers serve children like yours, and how their waiting lists work.

  3. Apply for Medicaid for your child

    In the states we checked, the path starts with a Medicaid application. Idaho asks families to write "Katie Beckett" at the top. Louisiana asks you to answer yes to the question about a health condition that limits activities.

  4. Disability determination

    Your child must meet the SSI childhood disability definition. If Social Security has not already decided, your state may review medical records and decide, as Louisiana describes.

  5. Level of care assessment

    A state team or contractor checks whether your child needs hospital, nursing facility, or intermediate care facility level care. In Tennessee a DDA case manager contacts you. In Idaho, after you apply for Medicaid and complete the Katie Beckett packet, the state contractor schedules a level of care determination if one is needed. Idaho says not all children need an appointment.

  6. Decision and renewal

    Timelines vary. DC says it decides within 60 calendar days of a completed packet. Louisiana reassesses level of care every year. Georgia says level of care determinations are authorized for no less than two years. Keep copies of everything.

Source: Medicaid.gov: Where Can People Get Help With Medicaid and CHIP?; Idaho Department of Health and Welfare: Apply for Katie Beckett; Louisiana Department of Health: Act 421 Children's Medicaid Option (TEFRA) FAQs, updated 7/21/2026; Tennessee Department of Disability and Aging: Katie Beckett Program; DC Department of Health Care Finance: TEFRA/Katie Beckett; Georgia Medicaid (Department of Community Health): TEFRA/Katie Beckett

The waiting list, honestly

Is there a line? It depends on the program.

1915(c) waivers can have a cap and a list. Federal rules require a state to say how many people it will serve in each year of a waiver, and that number becomes a limit on the program unless CMS approves more. Under a federal rule with a start date 3 years after July 9, 2024, states that cap a waiver and keep a waiting list must report to CMS each year on how they manage it, including whether they screen people on the list for eligibility, how many people are waiting, and the average time new enrollees spent on it.

Source: eCFR: 42 CFR 441.303, Supporting documentation required (1915(c) waivers); eCFR: 42 CFR 441.311, Reporting requirements (waiver waiting lists)

The TEFRA option is a state plan eligibility group, not a waiver. The federal cap rule above is written for waivers. Louisiana, for example, says in its official FAQ that its TEFRA program has no waiting list and no cap on how many children can enroll. Other states may differ, so ask.

Source: Medicaid.gov (CMS): Implementation Guide, Children under Age 19 with a Disability; Louisiana Department of Health: Act 421 Children's Medicaid Option (TEFRA) FAQs, updated 7/21/2026

Why get on a list now, even if you are unsure. A capped waiver can only serve the number of people the state set, so a waiting list is the line for the next open spot. We are not going to guess how long any list is. Ask your state how its list is ordered, whether it screens people before adding them, and how you will be contacted. If your child's needs change while you wait, tell the agency.

Do not wait to apply for what has no line

If your state offers the TEFRA option, you can apply for it and still ask about waivers for services. They answer different questions: one is about eligibility for Medicaid, the other about extra home and community services.

What to say when you call

A script, in your pocket.

A suggestion only. Use your own words. Write down the date, the name of the person you speak with, and what they tell you.

Suggested call script

"Hi, my name is ____. My child is ____ years old and has ____. They need a lot of care at home, including ____."

"Does our state cover children under the TEFRA option, section 1902(e)(3) of the Social Security Act, sometimes called Katie Beckett? If yes, how do I apply and what forms do I need?"

"If not, which home and community-based services waivers serve children like mine? Is there a waiting list, and can you add my child today?"

"How will I hear back, and who can I call with questions?"

Suggested documents to gather

  • Your child's diagnoses and recent medical records
  • Recent evaluations from therapists, schools, or early intervention
  • A plain list of daily care: feeding, breathing support, medications, supervision, nights
  • Names and contact details for your child's doctors and therapists
  • Any Social Security disability decision letters
  • Private insurance cards and plan details
  • Proof of your child's state residency and citizenship or immigration status
  • Any income or resources in your child's own name

Your state will tell you exactly what it needs. Some ask for household financial information too, even when parental income will not count.

Questions families ask

Answers, with sources.

What is the Katie Beckett program?

It is the common name for an optional Medicaid eligibility group created by Section 134 of the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA), now section 1902(e)(3) of the Social Security Act. It lets a state cover a child 18 or younger with a disability who needs the level of care given in a hospital, nursing facility, or intermediate care facility, but who can be cared for at home at no greater cost to Medicaid. CMS notes it is often called the Katie Beckett group because of her family's advocacy.

Source: GovInfo (U.S. Government Publishing Office): Public Law 97-248, 96 Stat. 324, Section 134; Medicaid.gov (CMS): Implementation Guide, Children under Age 19 with a Disability

Does my income as a parent count?

Under the federal TEFRA option, no. CMS explains that eligibility is judged as if the child were in an institution, and parents' income and resources are not deemed to a child in an institution. So the state looks at the child's own income and resources. Some states still ask for household financial information, for example to check first whether the child qualifies for another Medicaid program.

Source: Medicaid.gov (CMS): Implementation Guide, Children under Age 19 with a Disability; Louisiana Department of Health: Act 421 Children's Medicaid Option (TEFRA) FAQs, updated 7/21/2026

How old can my child be?

Federal law sets the TEFRA option at 18 years of age or younger, which state pages often describe as under 19. Some state programs that use the Katie Beckett name set different ages. Tennessee, for example, describes its Katie Beckett program as for children under 18. Confirm the age rule with your own state.

Source: GovInfo: 42 U.S.C. 1396a (Social Security Act section 1902), paragraph (e)(3); Wisconsin DHS: Katie Beckett Medicaid, Eligibility; Tennessee Department of Disability and Aging: Katie Beckett Program

Does my child need an SSI or Social Security disability decision first?

Your child must meet the SSI definition of disability for children, but does not have to receive SSI. For a child under 18, that definition is a medically determinable physical or mental impairment that causes marked and severe functional limitations and has lasted or is expected to last at least 12 months, or to result in death. Louisiana, for example, says its Medicaid team makes the disability decision when a child does not already have one from the Social Security Administration.

Source: GovInfo: 42 U.S.C. 1382c (Social Security Act section 1614), childhood disability definition; Louisiana Department of Health: Act 421 Children's Medicaid Option (TEFRA) FAQs, updated 7/21/2026

Does every state offer the Katie Beckett option?

No. CMS describes it as an optional eligibility group, so each state decides whether to cover it. Some states instead serve similar children through 1915(c) home and community-based services waivers or other arrangements. The quickest way to know is to ask your state Medicaid agency directly.

Source: Medicaid.gov (CMS): Implementation Guide, Children under Age 19 with a Disability; Medicaid.gov: Home and Community-Based Services 1915(c)

Is there a waiting list?

It depends on how your state built its program. Federal rules let a state cap the number of people in a 1915(c) waiver and keep a waiting list. A TEFRA state plan option works differently. Louisiana, for example, says its TEFRA program has no waiting list and no cap on enrollment. Ask your state which kind of program you are applying for.

Source: eCFR: 42 CFR 441.303, Supporting documentation required (1915(c) waivers); Louisiana Department of Health: Act 421 Children's Medicaid Option (TEFRA) FAQs, updated 7/21/2026

Does my child have to have been in a hospital or institution?

No. The child must need an institutional level of care, not live in an institution. South Carolina states that meeting a level of care does not mean a child must be institutionalized, and Louisiana says applicants do not have to show they are or have been institutionalized.

Source: South Carolina DHHS: Program Eligibility and Income Limits; Louisiana Department of Health: Act 421 Children's Medicaid Option (TEFRA) FAQs, updated 7/21/2026

Can we keep our private health insurance?

In many cases yes, and it can help. Louisiana, for example, says families are not required to keep private insurance, that private insurance pays first, and that Medicaid pays for covered services private insurance does not. Ask your state how it coordinates the two.

Source: Louisiana Department of Health: Act 421 Children's Medicaid Option (TEFRA) FAQs, updated 7/21/2026

Keep going

Guides for your child.

Condition guideCerebral palsy Condition guideAutism spectrum disorder Condition guideDown syndrome ToolMedicaid waiver finder by state ToolTherapy and equipment cost explorer LibraryAll family resources

Waiting on coverage and facing a bill now? Teagan's Crown helps families of children with special needs. Apply for family support.

Sources

Every fact on this page comes from these official pages. Program details change, so confirm with your state Medicaid agency before you act. This is general information, not medical or legal advice.

  1. Medicaid.gov (CMS): Implementation Guide, Children under Age 19 with a Disability. Accessed September 2026.
  2. eCFR: 42 CFR 435.225, Individuals under age 19 who would be eligible for Medicaid if they were in a medical institution. Accessed September 2026.
  3. eCFR: 42 CFR 435.217, Individuals receiving home and community-based services. Accessed September 2026.
  4. eCFR: 42 CFR 441.303, Supporting documentation required (1915(c) waivers). Accessed September 2026.
  5. eCFR: 42 CFR 441.311, Reporting requirements (waiver waiting lists). Accessed September 2026.
  6. GovInfo (U.S. Government Publishing Office): Public Law 97-248, 96 Stat. 324, Section 134. Accessed September 2026.
  7. GovInfo: 42 U.S.C. 1396a (Social Security Act section 1902), paragraph (e)(3). Accessed September 2026.
  8. GovInfo: 42 U.S.C. 1382c (Social Security Act section 1614), childhood disability definition. Accessed September 2026.
  9. Medicaid.gov: Home and Community-Based Services 1915(c). Accessed September 2026.
  10. Medicaid.gov: About Section 1115 Demonstrations. Accessed September 2026.
  11. Medicaid.gov: Where Can People Get Help With Medicaid and CHIP?. Accessed September 2026.
  12. Medicaid.gov: Medicaid State Plan Amendments (searchable). Accessed September 2026.
  13. Medicaid.gov: State Waivers List (searchable). Accessed September 2026.
  14. Ronald Reagan Presidential Library: The President's News Conference, November 10, 1981. Accessed September 2026.
  15. Minnesota Governor's Council on Developmental Disabilities: Katie Beckett (reprint of NPR, November 8, 2010). Accessed September 2026.
  16. Georgia Medicaid (Department of Community Health): TEFRA/Katie Beckett. Accessed September 2026.
  17. DC Department of Health Care Finance: TEFRA/Katie Beckett. Accessed September 2026.
  18. South Carolina DHHS: Program Eligibility and Income Limits. Accessed September 2026.
  19. Wisconsin DHS: Katie Beckett Medicaid, Eligibility. Accessed September 2026.
  20. Wisconsin DHS: Katie Beckett Medicaid, How to Apply. Accessed September 2026.
  21. Idaho Department of Health and Welfare: About the Katie Beckett Program. Accessed September 2026.
  22. Idaho Department of Health and Welfare: Apply for Katie Beckett. Accessed September 2026.
  23. Maine DHHS: Katie Beckett Program. Accessed September 2026.
  24. Louisiana Department of Health: Act 421 Children's Medicaid Option (TEFRA) FAQs, updated 7/21/2026. Accessed September 2026.
  25. Tennessee Department of Disability and Aging: Katie Beckett Program. Accessed September 2026.

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