Georgia Medicaid Katie Beckett (TEFRA) Pathway 2026: Eligibility Guide

Georgia administers the federal TEFRA option as the Katie Beckett Deeming Waiver. It lets a child with a significant disability qualify for Medicaid based only on the child's own income and resources, with parental income disregarded entirely. Families that earn far above standard Medicaid income limits can use it to bring a medically complex child home with full coverage. In Georgia the pathway is age-bounded: it does not extend past the month the child turns 19.

Key takeaways

Katie Beckett qualifies a child with a significant disability for Medicaid on the child's own income and resources, with parental income disregarded, so a family well above the usual income limit can still cover the child.
Georgia's Katie Beckett class of assistance is open to children 18 years of age and younger, and a child's age "does not extend past the month she or he turns age 19." Coverage stays open through the month the child turns 19 and closes the month after, with a Continuing Medicaid Determination considering every other Medicaid category first.
Eligibility turns on an institutional level-of-care determination: the child must need hospital, skilled nursing facility, or ICF/IID level of care, that care must be appropriate at home, and home care must cost no more than institutional care.
The federal authority is the TEFRA state-plan option at section 1902(e)(3) (42 USC 1396a(e)(3)), implemented by 42 CFR 435.225. It is an eligibility pathway, not a Section 1915(c) Home and Community-Based Services (HCBS) waiver.
Once enrolled, the child receives the full Georgia Medicaid benefit plus Early and Periodic Screening, Diagnostic, and Treatment (EPSDT), covering medically necessary services to correct or ameliorate a condition whether or not they are covered for adults.
Katie Beckett layers with Georgia's HCBS waivers and the Georgia Pediatric Program (GAPP) for private duty nursing, case management, and respite; Medicaid commonly acts as secondary coverage to private insurance.

Why the deeming disregard exists

For most children, Medicaid "deems" (attributes) the parents' income and resources to the child, so a child living at home is treated as if the whole family's finances were available to them. That rule is why, before the TEFRA option existed, a child could be covered by Medicaid while living in a hospital but lose eligibility the moment they came home, even when home care would cost far less. The TEFRA option waives that deeming for a qualifying child with a disability, so eligibility is decided on the child's own income and resources alone.

The pathway is widely known by the name of Katie Beckett, an Iowa child whose case in the early 1980s drew national attention to families trapped by the deeming rules. Congress responded in the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA), and the resulting option is codified at section 1902(e)(3) of the Social Security Act (42 USC 1396a(e)(3)) and implemented by the federal regulation 42 CFR 435.225. It gives every state the option to extend Medicaid to a child with a disability living at home using only the child's own resources.

Georgia offers this option as the Katie Beckett Medicaid Deeming Waiver, which provides Medicaid to Georgia children with significant disabilities whose families would otherwise be over income. It opens the door to Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) medically necessary services, supplements private insurance gaps, and works alongside Georgia's HCBS waivers to support medically complex children at home.

This guide is written for a parent or guardian of a Georgia child with a significant disability, a clinician supporting a family's application, or an advocate helping with an appeal. It covers the federal authority, the eligibility criteria, the institutional level-of-care determination, the Georgia application process, qualifying conditions, how Katie Beckett interacts with EPSDT and private insurance and the HCBS waivers, and common denials and appeal strategies.

What is the federal authority for Katie Beckett?

The implementing federal regulation, 42 CFR 435.225, lets a state cover children 18 and younger who qualify as disabled under the Supplemental Security Income (SSI) definition, who would be eligible for Medicaid if they were in a medical institution, and who are receiving at home the kind of medical care an institution would provide. When a state elects the option, it must determine in each case that the child requires the level of care provided in a hospital, skilled nursing facility (SNF), or ICF/IID; that it is appropriate to provide that level of care outside an institution; and that the estimated Medicaid cost of home care is no higher than the estimated Medicaid cost of appropriate institutional care. The state sets its own method for measuring that cost-effectiveness in its state plan.

The statutory authority is section 1902(e)(3) of the Social Security Act (42 USC 1396a(e)(3)), enacted in the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA). Its defining feature is that, for a qualifying child, the state disregards the parents' income and resources and decides eligibility on the child's own income and resources alone.

How Katie Beckett differs from an HCBS waiver

Katie Beckett is often confused with a Section 1915(c) Home and Community-Based Services (HCBS) waiver, but they are different instruments that families layer together. Katie Beckett is a state-plan eligibility pathway that opens Medicaid; it does not itself add waiver services. A Section 1915(c) waiver is authorized under 42 USC 1396n(c), rests on a cost-neutrality assurance and an individual institutional level-of-care evaluation, and, unlike a state-plan eligibility category, lets a state cap the number of people served, which is why waivers carry waitlists. The 200-participant figure families sometimes hear is a limit on the Secretary, not a guarantee to them: federal law forbids the Secretary from holding a waiver below 200 unduplicated participants, and it does not entitle any particular child to a slot.

Feature	Katie Beckett / TEFRA	Section 1915(c) HCBS waiver
Federal authority	42 USC 1396a(e)(3); 42 CFR 435.225	42 USC 1396n(c)
What it provides	Medicaid eligibility, disregarding parental income	Added home and community-based services
Level-of-care test	Hospital, SNF, or ICF/IID	Hospital, NF, or ICF/IID
Enrollment limit	A state-plan eligibility category	A state may cap the number served, so waitlists are common

A child eligible for both uses Katie Beckett for Medicaid eligibility and an HCBS waiver for the added services.

Other buy-in options

Some states offer alternative routes for families of children with disabilities whose income is above the usual limits, such as the Family Opportunity Act buy-in created by the Deficit Reduction Act of 2005. Whether Georgia offers any such buy-in changes with state policy, so confirm current options directly with the Georgia Department of Community Health (DCH) before assuming one is available.

What are the Georgia Katie Beckett eligibility criteria?

Georgia must find that the conditions below are met. Georgia's DFCS Medicaid policy manual lists five basic conditions (age, chronic impairment at an institutional level, financial ineligibility for SSI in a private living arrangement, the level-of-care criteria, and the other basic and financial eligibility criteria) and then applies the cost-effectiveness comparison as a separate step. The institutional level-of-care determination (Criterion 3) is the central technical test and the most common source of denials.

Criterion 1: age, through the month the child turns 19

Federal law lets a state cover a child 18 years of age or younger, and Georgia tracks that ceiling. Under the DFCS Medicaid policy manual, Katie Beckett is a class of assistance "available to children 18 years of age and younger," and the child's age "does not extend past the month she or he turns age 19."

Turning 18 does not end the case. In the month after the child turns 18, the child must be advised to apply for SSI, but regardless of whether proof of that application is provided, and regardless of whether Social Security approves SSI or finds the child not disabled, no action is taken to change eligibility: the Katie Beckett class of assistance stays open through the month the child turns 19 under continuous eligibility and closes the month after. Before it closes, Georgia must complete a Continuing Medicaid Determination that considers every Medicaid class of assistance, including Aged, Blind and Disabled Medically Needy (AMN). That determination is a safety net, not a plan, so start transition planning well before the 19th birthday and line up an adult pathway (SSI-Medicaid, ABD, the Medically Needy spend-down, or an HCBS waiver like NOW or COMP, with ICWP available only from age 21) before the Katie Beckett case closes.

Criterion 2: would be Medicaid-eligible if institutionalized

This requires that the child's OWN resources be within SSI resource limits for an individual and the child's OWN income meet SSI standards. For most children this is automatic. Children typically have no significant resources or income in their own name. If a child has a trust, an inheritance, or significant unearned income, that may affect eligibility.

Georgia states this criterion as the child being financially ineligible for SSI in a private living arrangement because of the child's own income or resources, or income or resources deemed from the parents. Two paperwork steps that used to sit on families have since been dropped: effective 7/1/2023, screening for SSI financial eligibility is no longer a requirement, and effective 3/12/2025, referrals to apply for SSI financially are no longer a requirement.

Criterion 3: institutional level of care

This is the central technical determination and the most common source of denials. The child must require the level of care provided in:

A hospital (typically inpatient acute or rehabilitation level)
A nursing facility (skilled or intermediate)
An ICF/IID (Intermediate Care Facility for Individuals with Intellectual Disabilities)

There is no single federal definition of institutional level of care: federal law requires each state to set its own assessment instrument, scoring rubric, and threshold, and across states the assessment looks at the same general categories: physical function and activities of daily living, skilled-nursing or medical needs, and cognitive or behavioral impairment. Georgia captures the determination on Form DMA 706, the TEFRA/Katie Beckett Medical Necessity/Level of Care Statement, and Georgia Medicaid states that qualification is not based on the medical diagnosis but on the institutional level of care the child requires. The documentation that carries a determination generally covers:

Activities of daily living (ADLs): bathing, dressing, eating, toileting, transferring, mobility
Cognitive functioning
Behavioral health needs
Medical complexity (ventilator, tracheostomy, G-tube, TPN, IV medications, complex seizure protocols)
Skilled nursing care needs (frequency and intensity)
Risk of harm without supervision

Children typically qualify under one of three patterns:

ICF/IID-level: severe intellectual disability with self-injury or aggression; severe autism with non-verbal status and significant behavioral issues; severe IDD with seizures or medical complications.

Hospital-level: ventilator-dependent; TPN-dependent; frequent acute hospitalizations; severe immunodeficiency requiring isolation; pediatric cancers on intensive treatment.

NF-level: severe physical disabilities requiring 24-hour skilled supervision; complex medication regimens; advanced chronic disease.

Criterion 4: home care is appropriate

The state must determine that home is a clinically appropriate setting. This is rarely a barrier in practice. Federal disability law and the Supreme Court's Olmstead v. L.C. decision strongly favor community-based care over institutional placement when appropriate. Issues that occasionally arise:

No suitable caregiver available
Home environment incompatible with medical needs (no reliable electricity for ventilator, etc.)
Severe behavioral risk requiring institutional containment (rare)

If a denial cites inappropriate setting, the appeal strategy is to document the family's caregiving capacity, the home environment's adequacy, and contingency planning for caregiver illness.

Criterion 5: cost-effectiveness

The estimated Medicaid cost of caring for the child at home must be no higher than the estimated Medicaid cost of the appropriate institutional alternative, and Georgia sets the method it uses to measure that cost-effectiveness in its state plan. Georgia runs that comparison as a separate step, working from Form DMA 704 (the TEFRA/Katie Beckett Cost-Effectiveness Form) and Form DMA 708 (the TEFRA/Katie Beckett Worksheet): the physician's estimated monthly cost of home care on the DMA 704 is subtracted from the monthly Medicaid billing rate of the institution, and the application is denied if in-home care is more costly, or proceeds if it is less costly or equal.

Because institutional care, especially a hospital or ICF/IID stay, is far more expensive than home care for most children, cost-effectiveness is rarely the reason for a denial. When it is cited, the appeal strategy is to provide a detailed home-care cost projection compared against the specific institutional alternative the child would otherwise require.

Which conditions qualify a child for Georgia Katie Beckett?

Below are the conditions that most commonly support a Georgia Katie Beckett approval. The diagnosis by itself does not guarantee approval; the documentation must show institutional-level functional impairment.

Severe physical disabilities

Cerebral palsy GMFCS IV or V (significant motor impairment)
Spina bifida with paralysis or significant motor impairment
Muscular dystrophy (Duchenne, Becker, and similar)
Spinal muscular atrophy (SMA Type I or II)
Severe traumatic brain injury
Severe burn injury with long-term care needs

Medical complexity

Ventilator dependence (continuous or nocturnal)
Tracheostomy with skilled nursing needs
G-tube or J-tube with complex feeding regimens
Total parenteral nutrition (TPN)
Complex seizure disorders requiring rescue medication protocols
Immunodeficiency requiring frequent IV immunoglobulin
Severe asthma with multiple ICU admissions
End-stage organ disease (liver, kidney, heart) on home-based care
Bone marrow transplant recipients during prolonged recovery

Severe intellectual and developmental disabilities

Severe autism with significant self-injurious behavior or aggression
Severe intellectual disability with aggression or elopement risk
Combined sensory and cognitive impairments (deaf-blind with cognitive impairment)

Genetic syndromes with major medical involvement

Down syndrome with complex congenital heart disease, severe sleep apnea, or major GI/seizure complications
Trisomy 18 (Edwards syndrome)
Cri-du-chat syndrome
Prader-Willi with severe behavioral issues
Rett syndrome
Williams syndrome with significant cardiac or cognitive needs
Angelman syndrome

Pediatric cancers in active treatment

Acute lymphoblastic leukemia (ALL) on intensive treatment
Brain tumors with significant neurological deficits
Solid tumors requiring complex surgical and chemotherapy treatment

Severe psychiatric conditions

Rarely qualifies because most psychiatric conditions do not require continuous hospital-level care. Some children qualify if they have multiple psychiatric hospitalizations per year with documented hospital-level functional impairment. For most psychiatric needs the better pathway is EPSDT-based behavioral health (Intensive Outpatient, Partial Hospitalization, Psychiatric Residential Treatment Facility) without TEFRA.

How to apply for Georgia Katie Beckett

Step 1

Start the application through a Katie Beckett intake channel

Georgia takes Katie Beckett applications through the Centralized Katie Beckett Medicaid Team at 678-248-7449, through any local Georgia Division of Family and Children Services (DFCS) office by mail, telephone, or fax, or online at Georgia Gateway. The Katie Beckett member portal that launched on April 15, 2026 is not an intake channel: DCH emails a family access to it only once an application or renewal has already been entered into the system.

Step 2

Have the pediatrician complete the medical and functional assessment forms

The packet is Form DMA 6A, the Physician's Recommendation for Pediatric Care, with its instructions for completion; Form DMA 706, the TEFRA/Katie Beckett Medical Necessity/Level of Care Statement; and Form DMA 704, the TEFRA/Katie Beckett Cost-Effectiveness Form, plus Form DMA 705, the level-of-care determination routing form. This is the most important step. The pediatrician (and ideally relevant subspecialists) complete forms documenting:

Specific medical diagnoses with ICD-10 codes
Functional limitations across ADLs
Medical complexity (equipment, medications, procedures, frequency)
Skilled nursing care needs (frequency, intensity, duration)
Behavioral and cognitive functioning
Cumulative impact on the child's ability to function safely without institutional supervision

Subspecialist letters are critical for many conditions:

Developmental pediatrician for autism, severe IDD, complex developmental delays
Pediatric neurologist for seizure disorders, cerebral palsy, TBI
Pediatric pulmonologist for vent-dependent, trach, severe asthma
Pediatric oncologist for cancers in active treatment
Pediatric cardiologist for complex congenital heart disease
Pediatric GI for TPN, complex feeding
Pediatric geneticist for genetic syndromes

Step 3

Send the level-of-care packet to Alliant Health Solutions

The level-of-care packet, including the DMA 705 routing form, is mailed to Alliant Health Solutions, Attention: TEFRA/Katie Beckett, P.O. Box 105406, Atlanta, GA 30348, which makes the level-of-care determination. Check the Georgia DCH Katie Beckett program page before mailing, since Georgia has been building out its Katie Beckett case-management system since the portal launched. Include:

Completed application form
Pediatrician's medical/functional assessment
All subspecialist letters
Recent hospitalization records if applicable
Therapy evaluations (PT, OT, ST)
Educational records (IEP if relevant)

Step 4

Alliant conducts the level-of-care review

The reviewer works from the medical chart and the DMA 706 statement to decide whether the child needs a hospital, nursing facility, or ICF/IID level of care, and the DMA 704 cost comparison is run alongside it.

Step 5

Receive the determination

Federal rules cap a disability-based Medicaid eligibility determination at 90 days from the date of application (45 days for applications not based on disability), except in the unusual circumstances the regulation lists: a delay caused by the applicant or by an examining physician, an administrative or other emergency beyond the agency's control, or the 30-calendar-day period a state must allow someone to respond to a community-engagement notice of noncompliance. If the child is approved, ask about retroactive coverage: federal law requires Medicaid to pay for covered services furnished as early as the third month before the month of application when the child would have been eligible then, and for applications made on or after January 1, 2027 that window shortens to two months for most enrollees. If denied, DCH provides a notice with the reasons and the right to appeal.

Step 6

Complete enrollment and keep the case current

Georgia delivers most Medicaid through Georgia Families, whose three current Care Management Organizations are Amerigroup Community Care, CareSource, and Peach State Health Plan. A previously separate fourth plan is no longer a Georgia Families CMO; a 2024 reprocurement that proposed a different slate was in a bid-protest phase with no announced go-live date as of mid-2026, and the three current contracts were reported as extended through roughly June 30, 2027. Not every Katie Beckett child is enrolled with a CMO, though: some are served in fee-for-service, so confirm which applies to your child (see fee-for-service versus managed care in Georgia). A level-of-care determination verified to meet the Katie Beckett standard is authorized for a period of no less than two years, while the Medicaid case itself renews on its own schedule, so keep the relationship with the pediatrician current.

How Katie Beckett interacts with other programs

EPSDT (the most powerful interaction)

Once enrolled, the child is entitled under EPSDT to the services needed to correct or ameliorate a condition found through screening, whether or not those services are otherwise covered for adults under the state plan. That is broader than adult Medicaid coverage and broader than typical private insurance, and it commonly reaches:

Medically necessary dental
Medically necessary vision, including eyeglasses
Hearing aids and cochlear implants
Applied behavior analysis (ABA) for autism at medically necessary hours
Behavioral health, including residential care in a Psychiatric Residential Treatment Facility (PRTF)
Home health and private duty nursing at medically necessary levels
Durable medical equipment, including communication devices, continuous glucose monitors, and insulin pumps
Physical, occupational, and speech therapy at medically necessary levels
Non-emergency medical transportation

See our companion guide on Georgia Medicaid children and EPSDT for the full EPSDT framework.

Private insurance

For most Katie Beckett families, parents have private health insurance through employment, and Medicaid serves as the secondary payer. This is valuable because private plans commonly cap therapy visits, carry high copays and deductibles, limit ABA hours, cap hearing aids and durable medical equipment, and exclude services a medically complex child needs. Medicaid as secondary picks up those gaps under EPSDT.

Independent Care Waiver Program (ICWP)

The Independent Care Waiver Program (ICWP) is a Section 1915(c) HCBS waiver for adults with severe physical disabilities or traumatic brain injury, and it serves a limited number of adults who apply between the ages of 21 and 64. Because of that age floor, ICWP is not a companion to Katie Beckett during childhood; it is the pathway a young adult with a condition such as cerebral palsy, spina bifida, or muscular dystrophy moves toward after aging out, adding services like case management, environmental modifications, family support, and respite.

New Options Waiver (NOW) and Comprehensive Supports Waiver (COMP)

The New Options Waiver (NOW) and the Comprehensive Supports Waiver (COMP) are Georgia's Section 1915(c) waivers for people with intellectual and developmental disabilities, and they carry long waitlists. A child can use Katie Beckett for immediate Medicaid eligibility while waiting for a NOW or COMP slot.

Georgia Pediatric Program (GAPP)

The Georgia Pediatric Program (GAPP) covers medically fragile children under 21 who require skilled nursing or personal care, paying enrolled provider agencies for private duty nursing, case management, family training, and respite. It is frequently combined with Katie Beckett.

SSI

Some Katie Beckett children also receive Supplemental Security Income (SSI) cash benefits based on disability. SSI automatically confers Medicaid eligibility in Georgia. Families with low family income use SSI for both cash and Medicaid; higher-income families use Katie Beckett because their family income disqualifies SSI (which uses parental income deeming for children).

Children's Medical Services (CMS) at GA DPH

Georgia's Children's Medical Services program (separate from federal Medicaid) provides specialty clinical care for children with special health care needs. It is income-tested and limited in scope compared to Medicaid. CMS often operates in parallel with Katie Beckett.

Foster care and youth aging out

A disabled child in Georgia foster care already has full Medicaid through their foster-care status, so Katie Beckett is most relevant for children in their family home. When a former foster youth ages out, a separate protection continues their Medicaid to age 26 regardless of income; see Georgia Medicaid for foster care and youth aging out.

Common mistakes families and providers make with Georgia Katie Beckett

The institutional level-of-care documentation is where most applications succeed or fail, so the errors below cluster around it.

Never applying. Many families assume their income disqualifies the child and never apply, not knowing the deeming disregard exists.
Applying only for standard children's Medicaid. Without explicitly requesting the Katie Beckett (TEFRA) pathway, DFCS evaluates only the standard MAGI children's category and denies based on family income. Ask for a Katie Beckett application by name.
Submitting a vague pediatrician letter. The application must address each eligibility criterion with detailed clinical findings; generic letters lead to denials or delays.
Not documenting institutional level of care. The record must show institutional-level functional impairment, not merely that the child has a disability.
Skipping subspecialist letters. For most conditions, a subspecialist letter materially strengthens the application.
Confusing Katie Beckett with an HCBS waiver. Katie Beckett is a state-plan eligibility pathway. Georgia's Section 1915(c) waivers are EDWP, ICWP, NOW, and COMP; the Georgia Pediatric Program (GAPP) is not one of them. Those programs add services on top of the eligibility Katie Beckett opens; they work together, not in place of each other.
Not appealing a denial. The common denial reasons are reversible with additional documentation, yet many families accept a denial that would be overturned on appeal.
Treating the 18th birthday as the cutoff. Georgia's current policy manual keeps the Katie Beckett case open through the month the child turns 19 and closes it the month after; the step at 18 is only an advisement to apply for SSI, and no action is taken on the case whether or not the family applies or SSA approves. The planning deadline is the 19th birthday, not the 18th, so line up SSI-Medicaid, ABD, the Medically Needy spend-down, or an HCBS waiver before then.

Frequently Asked Questions

What is Katie Beckett and how is it different from regular Medicaid?

Katie Beckett (the TEFRA option under 42 USC 1396a(e)(3)) is a Medicaid eligibility pathway for children with significant disabilities, which Georgia runs through the month the child turns 19. It is named for an Iowa child whose case in the early 1980s drew national attention to families whose income was too high for Medicaid at home even though Medicaid would cover the same child in an institution. Congress responded in the Tax Equity and Fiscal Responsibility Act of 1982, creating the option that lets states disregard parental income for children who meet an institutional level of care. Regular Medicaid for children uses Modified Adjusted Gross Income (MAGI) family-based income standards; Katie Beckett ignores parental income entirely and looks only at the child's own resources and the child's level of care.

Does parental income matter for Katie Beckett?

No. The defining feature of Katie Beckett is that parental income and resources are disregarded entirely, and there is no family income cap. A modest-earning family and a high-earning family qualify on the same terms if the child meets the criteria. What matters is: (1) the child's own resources are within SSI resource limits (automatic for most children, who have no significant resources in their own name), (2) the child meets an institutional level of care, (3) home care is appropriate, and (4) home care does not cost more than institutional care.

What are the five eligibility criteria?

The criteria come from 42 USC 1396a(e)(3) and 42 CFR 435.225: (1) the child is 18 years of age or younger, and in Georgia eligibility does not extend past the month the child turns 19; (2) the child would be Medicaid-eligible if institutionalized (the child's own resources are within SSI resource limits and own income meets SSI standards); (3) the child requires the level of care provided in a hospital, skilled nursing facility, or ICF/IID (Intermediate Care Facility for Individuals with Intellectual Disabilities); (4) it is appropriate to provide that care at home rather than in an institution; and (5) the estimated Medicaid cost of home care is no higher than the estimated Medicaid cost of appropriate institutional care.

What conditions qualify a child for Katie Beckett in Georgia?

Common ones include severe physical disabilities, medical complexity such as ventilator dependence or TPN, severe intellectual and developmental disabilities, genetic syndromes with major medical involvement, pediatric cancers in active treatment, and end-stage organ disease (see the section above for the full list). Georgia Medicaid states that qualification is not based on the diagnosis but on the institutional level of care the child requires.

How long does the application process take?

Federal rules cap a disability-based Medicaid eligibility determination at 90 days from the date of application, apart from the unusual circumstances the regulation lists (45 days applies to applications not based on disability). Steps: the family starts the application with the Centralized Katie Beckett Medicaid Team (678-248-7449), a local DFCS office, or Georgia Gateway; the pediatrician completes Form DMA 6A (Physician's Recommendation for Pediatric Care), Form DMA 706, and Form DMA 704; the level-of-care packet goes to Alliant Health Solutions, which makes the level-of-care determination. Incomplete applications get delayed or denied, so working with the pediatrician to ensure thorough documentation is essential.

Can Katie Beckett be combined with private health insurance?

Yes, and this is one of its most powerful features. Most Katie Beckett families have private insurance through employment, and Medicaid serves as the secondary payer, picking up under EPSDT the gaps private plans leave: capped therapy visits, high copays and deductibles, limited ABA hours, and caps on durable medical equipment and hearing aids.

Can my child have both Katie Beckett and an HCBS waiver?

Yes. Katie Beckett is an eligibility pathway (state plan option); HCBS waivers are service waivers. They are complementary, not duplicative. Common combinations in Georgia: Katie Beckett plus NOW or COMP for children with intellectual and developmental disabilities; Katie Beckett plus the Georgia Pediatric Program (GAPP), which is a separate pediatric program rather than one of Georgia's four 1915(c) waivers, for medically complex children needing private duty nursing. ICWP is not one of those combinations, because it serves adults who apply between the ages of 21 and 64. The waiver provides additional services like case management, respite, environmental modifications, and family caregiver supports on top of the Medicaid coverage Katie Beckett unlocks.

What happens when my child turns 18 or 19?

Turning 18 does not close the case. In the month after the child turns 18, Georgia must advise the child to apply for SSI, but regardless of whether proof of an application is provided, and regardless of whether Social Security approves SSI or finds the child not disabled, no action is taken to change eligibility. The Katie Beckett class of assistance stays open through the month the child turns 19 under continuous eligibility and closes the month after, and before it closes Georgia completes a Continuing Medicaid Determination considering every Medicaid class of assistance, including Aged, Blind and Disabled Medically Needy (AMN). Treat that determination as a safety net, not a destination, and start transition planning well before the 19th birthday. Most young adults with significant disabilities transition to SSI-related Medicaid (if they meet the Social Security Administration's adult disability standard and have low individual income and resources), the Aged, Blind, and Disabled (ABD) pathway, the Medically Needy spend-down (becoming eligible by incurring medical expenses equal to income above the limit, computed over a budget period of no more than six months), or an HCBS waiver (NOW or COMP, with ICWP available only from age 21)., Without planning, families risk a coverage gap. Work with DCH, DFCS, and case management well ahead of the 19th birthday to ensure continuity.

What if my child's Katie Beckett application is denied?

Appeal. The most common denial reasons (insufficient level-of-care documentation, inappropriate setting determination, cost-effectiveness concerns) are all reversible with additional documentation. Step 1: request internal reconsideration with DCH and submit additional documentation, including subspecialist letters that specifically address the five criteria. Step 2: if still denied, request a State Fair Hearing. Georgia DFCS policy directs that a hearing on an eligibility decision be requested within 30 days of the notice; federal law caps a state's request window at 90 days from the date the notice is mailed but lets the state set a shorter one, so the deadline printed on your own notice of action is the one that governs. Step 3: if denied at fair hearing, judicial review in superior court is available under Georgia administrative law. Atlanta Legal Aid Society (1-404-524-5811) and the Georgia Advocacy Office (1-404-885-1234) handle Katie Beckett denials.

How does Katie Beckett interact with EPSDT?

Katie Beckett is the eligibility pathway. EPSDT (Early and Periodic Screening, Diagnostic, and Treatment under 42 USC 1396d(r)) is the federal mandate that, once a child is enrolled, every Medicaid child under 21 is entitled to the services needed to correct or ameliorate a condition found through screening, whether or not those services are covered for adults under the state plan. See our companion guide on Georgia Medicaid children and EPSDT for the full framework and the service categories it commonly reaches.

What Brevy is tracking

We at brevy.com maintain a state-by-state map of Katie Beckett and TEFRA implementation, including the documentation patterns that succeed, the common denial reasons, and the community-integration principle of the Supreme Court's Olmstead decision that supports families fighting denials. Georgia's program is administratively reasonable but documentation-intensive. We update this guide as DCH policy changes and as federal CMS guidance evolves.

Katie Beckett is one of the most important and underused Medicaid pathways in the country. It continues to fulfill its original purpose: bringing medically complex and disabled children home from institutions and giving them the comprehensive Medicaid coverage they need to thrive.

Where to get help

Katie Beckett applications are paperwork-intensive, but the financial relief and service access are transformative for families of medically complex children. These resources can help with the application, documentation, and appeals.

DCH Member Services Georgia Medicaid member services and Katie Beckett questions. 1-866-211-0950 https://www.gabar.org/about-the-bar/contact-us

DFCS Eligibility Intake Division of Family and Children Services application and eligibility intake. 1-877-423-4746 https://dhs.georgia.gov/contact

Children's Medical Services (Department of Public Health) Specialty clinical care for children with special health care needs. dph.georgia.gov

Babies Can't Wait Early Intervention Early intervention services for children ages 0 to 3. 1-800-229-2038

Marcus Autism Center Autism evaluation, diagnosis, and treatment. 1-404-785-9444

Children's Healthcare of Atlanta Pediatric subspecialty care and application documentation support. 1-404-785-5437

Family Connection Partnership Local family support networks across Georgia. 1-404-527-7394

Parent to Parent of Georgia Peer support for families of children with disabilities. 1-800-229-2038

Atlanta Legal Aid Society Help with Medicaid denials and appeals. 1-404-524-5811 atlantalegalaid.org

Georgia Advocacy Office Disability rights advocacy. 1-404-885-1234 thegao.org

Georgia Council on Developmental Disabilities Policy, advocacy, and resources for developmental disabilities. 1-404-657-2126

Georgia Legal Services Program Civil legal help for families outside metropolitan Atlanta. 1-404-206-5175 www.glsp.org

Learn More

Find personalized help navigating the Georgia Katie Beckett pathway at brevy.com.

References

Cited in this article

Administration for Community Living. (n.d.). Veteran-Directed Care Program. acl.gov. https://acl.gov/programs/veteran-directed-home-and-community-based-services/veteran-directed-home-community-based
pamms.dhs.ga.gov. (n.d.). 2133 TEFRA/Katie Beckett. Retrieved Aug 7, 2026, from https://pamms.dhs.ga.gov/dfcs/medicaid/2133/
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