TEFRA/Katie Beckett Program

TEFRA /Katie Beckett Program Applications for Katie Beckett may be filed online at

www.compass.gov or with the Centralized Katie Beckett Medicaid Team:

Right from the Start Medicaid Project Centralized TEFRA/Katie Beckett Medicaid Team

5815 Live Oak Parkway, Suite D-2

Norcross, GA 30093-1700

678-248-7449 (phone)

678-248-7459 (fax)

Katie Beckett Program Application Form

Overview

The Department of Community Health (DCH) provides Medicaid benefits to eligible children through the TEFRA/ Katie Beckett Medicaid program under §134 of the Tax Equity and Fiscal Responsibility Act (TEFRA) of 1982 (P.L. 97-248). States are allowed, at their option, to make these Medicaid benefits available to children age 18 or younger (living at home) who qualify as disabled individuals under §1614(a) of the Social Security Act as long as certain conditions are met, even though these children would not ordinarily be eligible for Supplemental Security Income (SSI) benefits because of parental income or resources. The specific statutory provisions establishing this option are contained in §1902(e) of the Social Security Act.

Who Is Eligible?

For Medicaid eligibility to be established under the TEFRA/Katie Beckett Program, it must be determined that the child:  Is 18 years old or younger, AND

 Meets federal criteria for disability, AND

 Is financially ineligible for SSI benefits, AND

 Requires a level of care provided in a hospital, skilled-nursing facility or intermediate-care facility (including an intermediatecare facility for people with intellectual disabilities); AND

 Can appropriately be cared for at home, AND

 Has an estimated cost of care outside of the institution that will not exceed the estimated cost of treating him/her within the institution.

How Are Level of Care and Eligibility Determined?

 Treating physicians, parents and others (school guidance counselors, therapists, etc.) complete the required clinical documents. The parents or legal guardians complete the Medicaid application.

 The Katie Beckett Medicaid Team (the Team) receives the Medicaid application and required clinical documents.

 The Team submits the clinical documents to Georgia Medical Care Foundation (GMCF) for determination of level of care and disability (if appropriate).

 GMCF, under the direction of a pediatrician, pediatric neurologist and nurse, performs the clinical review of the required documents for level of care determination and disability determination (if appropriate).

 If level of care, disability and all other eligibility criteria are met, the Team certifies Medicaid eligibility for the recipient.

Resources

 The Georgia Pediatric Program (GAPP) provides specialized medical services to Medicaid-eligible members who are medically fragile and under age 21 based on a medical necessity determination.

 The Champions for Children Program increases awareness throughout Georgia about non-profit services available to children who are medically fragile and children with special needs, increases access to health care and support services, and helps families continue to care at home for children with disabilities. For more information, visit its website at www.championsforchildrenga.org.

 Babies Can’t Wait (BCW) is Georgia’s statewide interagency service delivery system for families of infants and toddlers with developmental delays or disabilities. The Georgia Department of Public Health (DPH) is the lead agency for the Babies Can’t Wait Program. For more information about BCW, visit the web page at www.health.state.ga.us/programs/bcw.

 The Children’s Medical Services (CMS) Program provides a comprehensive system of health care for children and youth with eligible chronic medical conditions from birth to 21 years of age. Its program is intended to ensure specialty health care services to these children in Georgia who live in low-income households. The CMS program works to provide improved health outcomes for children with special health care needs by coordinating their access to affordable quality specialty health care in communities and by using resources in a responsible manner.For more information about the CMS program, visit the web page at www.health.state.ga.us/programs/cms/index.asp.

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Katie Beckett Program Application Form

For More Information To learn more about TEFRA/Katie Beckett, visit the DCH website at www.dch.georgia.gov/tefrakatie-beckett.

All information is courtesy of the Georgia Department of Community Health | 2 Peachtree Street NW, Atlanta, GA 30303 | www.dch.georgia.gov | 404-656-4507