Katie Beckett Medicaid Application (Form 94)
FamilyThe base Medicaid application (English/Spanish). Check the Katie Beckett block on page 1 and sign and date.
Official downloadGeorgia · How to apply
Georgia Katie Beckett application, step by step
Applying for Georgia Katie Beckett (TEFRA/Deeming Waiver) Medicaid means assembling a multi-form paper packet, timing a physician visit around a 90-day clock, and sending the right documents to two different places. Here is the whole process, with the official downloads.
The forms in the packet
Pediatric DMA-6(A) — Physician's Recommendation
PhysicianEvery item must be answered (N/A allowed). Valid only 90 days from the physician's signature.
Official downloadDMA-706 — Medical Necessity/Level of Care Statement
Physician + caregiverDiagnoses, level of care, skilled-nursing needs, therapies, hospitalizations. Physician and primary caregiver both sign.
Official downloadDMA-704 — Cost-Effectiveness Form
PhysicianThe child's physician estimates monthly in-home Medicaid service costs versus institutional care.
Official downloadThe seven steps
Step 1
Download the current packet from DCH
Always start from the official DCH Katie Beckett page so you have the current forms — the full packet with instructions runs about 41 pages. Do not reuse an old saved copy.
Step 2
Schedule the physician visit early
The DMA-6(A), DMA-706, and DMA-704 all need your child's physician. The DMA-6(A) is valid only 90 days from the physician's signature, so book the appointment before you do anything else and plan to mail promptly after signing. Bring the forms printed, with the identifying sections pre-filled.
Step 3
Complete Form 94 for the child
Check the Katie Beckett block, list household members, and answer every question. Remember: for Katie Beckett only the child's income and assets count — parent income is deemed unavailable — but the form still asks for household information.
Step 4
Assemble medical documentation for Alliant
Evaluations, current signed therapy notes, the most recent hospital discharge summary, and nursing notes support the level-of-care review. Medical documentation goes to Alliant Health Solutions, Attn: TEFRA/Katie Beckett, P.O. Box 105406, Atlanta, GA 30348.
Step 5
Submit the packet
Mail to the Centralized Katie Beckett Medicaid Team, 2211 Beaver Ruin Road, Suite 150, Norcross, GA 30071, or fax 678-248-7459. Since April 15, 2026 you can also upload documents through katiebeckettportal.dch.georgia.gov. The old P.O. Box has not been accepted since June 17, 2024. Keep a full copy of everything.
Step 6
Watch for a missing-information request
If anything is incomplete, families get 30 days to supply the missing information to Alliant. Log the request date immediately and respond well before the deadline.
Step 7
Follow up and track status
Use the portal's status tracking and secure messaging, or call the Katie Beckett team at 678-248-7449. A follow-up about three weeks after mailing is a reasonable rhythm. Once approved, level-of-care approvals run no less than 2 years.
Common mistakes to avoid
- • Letting the DMA-6(A) go stale — it expires 90 days after the physician signs, and a late mailing means a new doctor visit.
- • Leaving items blank on the DMA-6(A). Every item must be answered; write N/A rather than skipping.
- • Mailing to the old P.O. Box, which stopped being accepted June 17, 2024 — use the Beaver Ruin Road street address.
- • Sending medical records to Norcross instead of Alliant (or vice versa) — the application packet and the level-of-care documentation have different destinations.
- • Not keeping copies, so a 30-day missing-info request means rebuilding documents from scratch.
- • Missing physician signatures — the DMA-706 needs both the physician and the primary caregiver to sign and date.
Official sources
Last reviewed by WaiverPath: July 2, 2026.
Medicaid.gov Home & Community Based ServicesFederal HCBS overview describing home and community-based services for Medicaid beneficiaries.Georgia DCH TEFRA/Katie Beckett program pageOfficial DCH program page for Katie Beckett / TEFRA with the application packet, submission instructions, and contacts.Georgia DFCS PAMMS Manual Section 2133 (TEFRA/Katie Beckett)Georgia eligibility policy manual section covering TEFRA/Katie Beckett rules, deeming, and processing.Katie Beckett Portal (DCH)Official DCH Katie Beckett portal (launched April 15, 2026) for document upload, status tracking, and secure messaging.Katie Beckett Medicaid Application (Form 94)Official Form 94 Medicaid application download from medicaid.georgia.gov.Pediatric DMA-6(A) Physician's RecommendationPhysician-completed DMA-6(A); every item must be answered and it is valid only 90 days from the physician's signature.DMA-706 Medical Necessity/Level of Care StatementTEFRA/Katie Beckett Medical Necessity/Level of Care Statement completed by the physician with the primary caregiver.DMA-704 Cost-Effectiveness FormTEFRA/Katie Beckett Cost-Effectiveness Form; the child's physician estimates monthly in-home Medicaid service costs.Georgia DBHDD: How do I apply for DD services (NOW/COMP)Official DBHDD page for NOW/COMP waiver applications via the Individual IDD Connects portal or a DBHDD field office; intake 1-888-273-1414.
WaiverPath is not a government agency, law firm, Medicaid provider, or benefits advisor. We help you organize information, documents, and follow-up tasks. Always verify requirements with the official agency or a qualified professional.