Special Health Issues: TEFRA/Katie Beckett
TEFRA/Katie Beckett is an eligibility pathway for the Medicaid Program. It is for certain children who have long-term disabilities or complex medical needs and live at home. It allows children to receive services at home with additional supports, instead of in an institution. Under TEFRA/Katie Beckett, only the child’s income and resources are considered (not those of the parents). For more information on TEFRA/Katie Beckett, please read the TEFRA/Katie Beckett Fact Sheet and Frequently Asked Questions document.
- Be a resident of the District of Columbia;
- Be a US citizen or have eligible immigration status;
- Be eighteen (18) years old or younger;
- Have income less than 300% of Supplemental Security Income (SSI) and resources totaling less than $4000.
- Have a disability that is terminal or expected to last for more than (twelve) 12 months (or otherwise meet the definition of disabled under the Social Security Act);
- Require a level of care (LOC) that is typically provided in a hospital, skilled nursing facility, or intermediate care facility (including intermediate care facilities for people with intellectual disabilities);
- Be able to safely live at home; and
- Not be eligible for Medicaid under a different eligibility category.
Medicaid and Other Insurance
A child may have DC Medicaid (under TEFRA/Katie Beckett) and other health insurance. In those instances, the other insurance is billed first and then Medicaid provides “wrap-around” coverage for medically necessary services that a private insurance plan may not cover.
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The rest of this section contains information on the application process and answers to frequently asked questions.