The Katie Beckett Waiver and Autism: How to Apply

November 29, 2022 Apollo Behavior Team Comments Off

What is the Katie Beckett Waiver?

Almost 20 percent of American children are disabled or have unique healthcare requirements.

Unfortunately, the high level of care that children with more significant disabilities require has led some families to reluctantly turn away therapeutic services because of the cost involved. However, several states have begun providing exemptions that allow families to seek assistance for long-term healthcare and therapy for their kids, including Georgia.

Does the Katie Beckett Waiver Cover Autism?

The Katie Beckett Waiver, commonly known as TEFRA, brings hospital-level treatment to children and adolescents under the age of 19 who have significant conditions, including those with autism spectrum disorder (ASD) in some cases. One example is the services provided by outpatient clinics like Apollo Behavior, which employs Applied Behavior Analysis (ABA) and other evidence-based methods to help children on the autism spectrum.

Benefits of the Katie Beckett Waiver

The Katie Beckett waiver offers a wealth of advantages to its beneficiaries. The goal is to provide financial support for medical care and therapy for kids with physical or developmental disabilities. Since the Katie Beckett Waiver solely considers the child’s income and assets to determine eligibility, it can be a lifesaver for children who don’t qualify for Medicaid because of their parent’s finances. It helps to pay for the family’s existing private insurance by covering premiums and any deductibles or co-pays that may apply to their policy.

Who was Katie Beckett?

In the early 1980s, Katie Beckett’s parents battled a Medicaid rule that would have placed their daughter in a nursing home, resulting in the origins of the waiver. Her encephalitis kept her in the hospital for years, but eventually, with the right help, her medical team decided she could recover at home. Unfortunately, at that time, her parents’ private insurance had run out, and their income was too high for Medicaid to pay anything other than institutional care, even though the expense of the latter would be six times as high.

Legislative Change

Katie’s mother claimed this was a terrible policy and fought to bring it to the White House in 1981, where President Reagan relaxed the Medicaid restriction for her case. The Katie Beckett Waiver was later enacted by Congress, which allowed states to use Medicaid funding to provide in-home care for severely disabled children and young people regardless of family finances. After the success of the Katie Beckett waiver, Congress passed the Tax Equity and Fiscal Responsibility Act (TEFRA) in 1982, allowing states to implement their own healthcare reform programs.

Although many states have transitioned their Katie Beckett waivers into TEFRA programs, the name “Katie Beckett” is still often used to refer to any program. Children whose families earn more than the state’s Medicaid income eligibility limit may still be eligible for Medicaid coverage if their home state has implemented either the Katie Beckett waiver or the TEFRA state plan option.

How can the Katie Beckett Waiver help my child?

The Katie Beckett program offers several Medicaid-covered services for children who qualify. There is no delay in starting services, so your child can take advantage of them as soon as they are deemed eligible. Some services* that fall within the scope of this waiver are as follows:

  • FDA-approved pharmaceuticals
  • Hospitalizations
  • Lab tests
  • Medical checkups
  • Autism Therapy (ABA Therapy, CBT,)
  • Medical equipment and supplies
  • Multi-domain Rehabilitation (Physical, occupational, and speech therapy)
  • Therapeutic Services
  • Psychological and behavioral health screenings
  • Regular health screenings
  • Respite services (giving parents a break from caring for their child and leaving them in the capable hands of qualified staff)
  • X-rays

*The extent of coverage and availability of these services can vary.

Your child’s eligibility for the Katie Beckett Waiver will not be impacted by whether you have private health insurance. All medical expenses will first be sent to your private insurance company, and then Medicaid will pay for any remaining balance. Insurance does not often cover diapers, hygiene products, and transit between doctors’ appointments, but Medicaid can cover these costs and more.

How do I know if my child is eligible for the Katie Beckett Waiver?

In Georgia, children under 19 with disabilities or significant clinical needs are eligible for the Katie Beckett Waiver. If your child requires therapeutic services, but your private insurance won’t pay for them, this program can help. Katie Beckett programs don’t have waiting lists since states can’t restrict the number of participants like they may with Home and Community-Based Services (HCBS) waiver programs. For those interested in applying, here are the basic requirements:

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