Katie Beckett / TEFRA
The Katie Beckett waiver — formally the TEFRA Medicaid option — lets children with significant medical needs get Medicaid at home without counting their parents' income or assets. Here is how it works, who qualifies, and how to start in your state.
Katie Beckett was an Iowa child who needed ventilator care that Medicaid would cover in a hospital but not at home, because at home her parents' income counted against her. In 1981 the federal government created a pathway for children like her, made a formal state option by the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA) — which is why the program carries both her name and the TEFRA label.
States electing the TEFRA option treat a qualifying child as a household of one: parents' income and assets are "deemed" unavailable. The child must be under 18, meet an institutional level of care, and be cared for at home cost-effectively.
Unlike capped HCBS waivers with waitlists, TEFRA is a state-plan option: children who meet the criteria are entitled to coverage. If your child qualifies, there is no slot to wait for.
Not every state adopted TEFRA, and states that did use their own forms, physician paperwork, and review contractors. Always start from your own state Medicaid agency's current instructions.
The process varies by state, but these nine steps cover what most TEFRA programs require. Confirm with your state Medicaid agency before submitting — forms and timelines change.
Step 1
Not every state adopted the TEFRA Medicaid option. Call your state Medicaid agency or visit the agency website to confirm the program exists and whether applications are currently open. If your state does not have TEFRA, ask about the Medically Needy pathway or HCBS waivers for children.
Step 2
Three criteria must be met: (1) the child is under 18, (2) a physician can certify the child needs institutional-level care (nursing facility, ICF, or hospital level), and (3) providing care at home is cost-effective. Review these with your child's specialist before beginning paperwork.
Step 3
Application forms change. Contact your state Medicaid agency directly to get the current packet — do not rely on older forms downloaded from unofficial sites. In Georgia, the DCH portal (launched April 2026) accepts uploads and tracks status. Other states mail or fax packets.
Step 4
Most states require a physician-signed application form, a level-of-care certification form, and a cost-effectiveness form. In Georgia: DMA-6(A), DMA-706, and DMA-704. Physician signatures typically have 90-day validity — coordinate timing so nothing expires before submission.
Step 5
Fill in the state Medicaid application for your child only (parent information is collected but income/assets are not counted under TEFRA). Attach or upload required physician forms and any supporting medical records your state requests.
Step 6
The state's contracted review organization (not your child's physician) performs the formal level-of-care determination. In Georgia, Alliant Health Solutions conducts this review. Submit medical documentation to the review contractor per their instructions and keep copies of everything sent.
Step 7
Send your completed application and all attachments via your state's accepted method (portal upload, certified mail, fax). Get a submission confirmation number or delivery receipt. In Georgia, the intake team is in Norcross — call to confirm receipt if you do not get written acknowledgment within 5 business days.
Step 8
States may request additional documentation during review. Respond within the timeframe stated in their request — missing a deadline can result in denial. Log every call and correspondence with date, contact name, and what was said. Use the state portal or contact the intake office to check status.
Step 9
If approved: confirm the effective date, what services are covered, and whether any other Medicaid categories apply. If denied: the denial letter must state the reason and the appeal deadline. You have the right to a fair hearing — file an appeal if the denial seems incorrect.
Georgia's Katie Beckett program (locally, the "Deeming Waiver") is one of the best-known TEFRA programs — and one of the most paperwork-heavy. Families assemble a packet built around the Form 94 Medicaid application plus three physician forms (DMA-6(A), DMA-706 level of care, DMA-704 cost-effectiveness), mail or fax it to a centralized team in Norcross, and send medical documentation to Alliant Health Solutions for the level-of-care review. A physician-signed DMA-6(A) is valid only 90 days, and a new DCH portal launched April 15, 2026 for uploads and status tracking.
WaiverPath has state packs for families navigating Medicaid HCBS waivers and related programs. Each pack includes checklists, document requirements, and key agency contacts for that state.
Technically no. It is a TEFRA state-plan option, not an HCBS 1915(c) waiver. Because parents' income and assets are 'deemed' unavailable, many states — Georgia especially — call it the Deeming Waiver, and 'Katie Beckett waiver' stuck as the everyday name.
No. That is the defining feature: only the child's own income and assets are counted. A family can earn too much for regular child Medicaid and still qualify a medically complex child through Katie Beckett.
In general: a child under 18 who meets an institutional level of care (such as nursing facility or ICF level) and whose care at home is cost-effective compared with institutional care. Exact process and forms vary by state.
In states that adopted the TEFRA option, eligible children are entitled to coverage — there is no enrollment cap or waitlist like capped HCBS waivers. Georgia's Katie Beckett program, for example, has no waitlist.
Start with your state Medicaid agency. In Georgia, the Department of Community Health runs a mail/fax packet (Form 94 plus physician forms) with a new online portal launched in April 2026. Other states use different forms and intake routes — always get the current packet directly from your state agency.
Katie Beckett does not list specific diagnoses. A child qualifies if a physician certifies that they require an institutional level of care — typically a nursing facility, intermediate care facility (ICF), or hospital level — and that providing that care at home is cost-effective. Common conditions include ventilator dependence, severe cerebral palsy, complex congenital disorders, and other conditions requiring ongoing skilled nursing or intensive daily care. The level-of-care determination is made by the state's review contractor, not by the family or primary physician alone.
Many states adopted the TEFRA option, but not all. Georgia (Deeming Waiver), Florida (Medically Needy pathway and Katie Beckett option), and Iowa (the origin state) are well-known examples. Check directly with your state Medicaid agency — some states added the option recently and others have not. CMS does not maintain a public live list; your state agency is the authoritative source.
Katie Beckett establishes Medicaid eligibility; once enrolled, the child can generally access services covered under the state Medicaid plan. Coordination with other programs (like CHIP or an HCBS waiver) depends on the state. Some states allow Katie Beckett enrollment to run concurrently with an HCBS waiver waitlist position. Confirm with your state Medicaid agency and case manager what combination is permitted.
Last reviewed by WaiverPath: July 11, 2026.
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.
