Tennessee Katie Beckett: Parts A, B, C Eligibility Guide

If your child has a significant disability and you have been told your family earns too much for Medicaid, Tennessee's Katie Beckett program may change that answer. It is the pathway for children under 18 with complex medical needs whose family income or assets would otherwise disqualify them from TennCare. Tennessee created it in 2019 to close a gap that had left families of medically fragile children an impossible choice: go without coverage, or place a child in an institution to qualify for it.

Tennessee's program looks different from the Katie Beckett coverage many families have read about. Instead of the federal state-plan option at §1902(e)(3) that CMS itself calls "the Katie Beckett group," Tennessee runs its version as a §1115 demonstration with a three-Part structure (A, B, and C). Under that demonstration, Tennessee may hold Part A and Part B enrollment to a set target, and Part A families with income above 150% of the federal poverty level pay premiums.1

Below: who qualifies, how the three Parts differ, what's covered, and how to apply in 2026.

A Brief History of Tennessee Katie Beckett

The "Katie Beckett" name traces back to Katie Beckett herself. In the early 1980s she was three years old and needed a respirator, and because Medicaid did not cover at-home respirator use, she was forced to live in a hospital even though her doctors said she could be cared for at home. Her family's advocacy produced a federal Medicaid eligibility group at §1902(e)(3) of the Social Security Act, a state option to cover children who live at home, who require the level of care provided in an institution, and who would be Medicaid eligible if they lived in one. CMS says that group "is often called the Katie Beckett group."1

Tennessee did not build a distinct Katie Beckett program of its own until 2019, with Public Chapter 494 (HB 498 / SB 476), enacted May 24, 2019 and codified at Tenn. Code Ann. §71-5-164. The statute gave the commissioner of finance and administration 120 days to submit a §1115 Social Security Act waiver to CMS "for the purpose of establishing a distinct Katie Beckett program," and set the two-part design still in use: Part A as a Medicaid-eligibility pathway plus wraparound, Part B as a Medicaid-diversion plan with a capped package of supports plus premium assistance. It authorized premiums on a sliding fee scale based on parent income, and a joint annual report from TennCare and DDA (then DIDD) beginning February 1, 2020 and by February 1 each year after.1

CMS approved the TennCare III §1115 demonstration (Project Number 11-W-00369/4) on January 8, 2021, effective through December 31, 2030, formally establishing the Katie Beckett (Part A), Medicaid Diversion (Part B), and Continued Eligibility (Part C) groups. It is that approval that carries the enrollment targets and, using MAGI rules, the Part A premium requirement above 150 percent of the federal poverty level. Applications opened in late November 2020; by February 1, 2021 TennCare reported more than 290 children enrolled.1

The Three Parts

Katie Beckett isn't one program; it's three different benefits with different rules.

How the caps got here: Part B's 4,700 slots were built from an original 2,700 plus $13 million in budget authority shifted from Part A in August 2023 (1,300 more slots) and another $7 million in October 2024 (700 more), while preserving funding for the 300 Part A slots.3

Part A: Full Medicaid + $15K Wraparound

Part A is for children who meet an institutional level of care but whose family wants to care for them at home instead. It delivers full TennCare Medicaid benefits, which can include home health, private duty nursing, durable medical equipment and supplies, and occupational, physical, and speech therapy, plus up to $15,000 per child per calendar year in HCBS wraparound services.2

The acuity-prioritized waiting list is what makes Part A distinctive: children are enrolled into an open Part A slot in numerical order by their level-of-care (LOC) prioritization score, and a child who is medically eligible when no slot is open stays on the Katie Beckett Group Part A Waiting List. Of the 300 Part A slots, 25 are reserved for Tier 1 children (the most complex medical needs and disabilities), down from 50 before the 2024 change that opened more room for Tier 2 children.2

Premium payments are required when family income exceeds 150% of the federal poverty level, on the terms set out in TennCare Rule Chapter 1200-13-20.2

The wraparound covers respite, supportive home care, and home and vehicle modifications. The rule is blunt about the ceiling: Part A HCBS "shall be limited to a maximum of $15,000 per child per calendar year. There are no exceptions to this limit."2 That $15,000 cap applies only to the wraparound benefit, not to the child's other Medicaid services, and every wraparound service counts against it, including minor home modifications.5 Individual services also carry their own sub-limits inside it, set by Tenn. Comp. R. & Regs. 1200-13-01-.32:

• Equipment and assistive technology, capped at $5,000 per calendar year2
• Family caregiver education and training, capped at $500 per calendar year, and requiring advance approval from your MCO2,5
• Minor home modifications, covered as medically necessary with limits of $6,000 per project, $10,000 per calendar year, and $20,000 per lifetime5
• Vehicle modifications, with limits of $10,000 per calendar year and $20,000 per lifetime5
• Community transportation, limited to $225 per month, and only for a child whose parent or legal guardian elects to receive this benefit through Consumer Direction5

Tennessee funded Part A at roughly $45 million to serve up to 300 children, a projected average of $150,000 per child. The state's January 2025 joint report to the General Assembly put the annualized cost of Part A children enrolled at that point at just over $22.3 million.2

Part B: Flexible $10K, No Medicaid Enrollment

Part B, the "Medicaid Diversion" group, is for children who do not qualify for an institutional level of care but are considered "at risk" of one unless they get services. It is unusual: it gives families up to $10,000 per child per year in flexible services, but the child is not enrolled in Medicaid. Part B is capped at 4,700 slots, far more than Part A's 300.3

Part B funds may be used for any combination of:

• Premium assistance for private or employer-sponsored health insurance
• A health-care savings-type account, which reimburses IRS-qualified health care expenses
• Reimbursement for services that would benefit the child but cannot be covered under that account
• Consumer-directed respite and supportive home care
• An array of services from a community-based provider

For a family who already has employer-sponsored health insurance but is drowning in out-of-pocket costs and respite gaps, Part B's $10,000 a year is often more useful than Part A's full Medicaid plus wraparound. Part B is also where every applicant starts: TennCare requires eligibility for Part B before considering Part A.3

Part C: Bridge Coverage

Part C ("Continued Eligibility Group") is for children who already have Medicaid but are losing it because their parents' income or resources increased. It lets the child keep Medicaid if they would qualify for Part A but no Part A slot is open.1

Part C is coverage continuity, not service expansion: the $15,000 HCBS wraparound is a Part A benefit, so Part C provides only the underlying TennCare state-plan benefit.1

Katie Beckett Eligibility: The Three Tests

Tennessee's rule, Tenn. Comp. R. & Regs. 1200-13-01-.32, sets three tests. Part A and Part B apply the same age and medical-needs tests; they differ on level of care.2

1. Age

The child must be under age 18. That is the rule's own limit and all it says on age, so Katie Beckett is not a pathway for adults. If your child is nearing 18, ask DDA how and when coverage transitions rather than assuming a birthday cutoff, and ask about the adult LTSS options at the same time.2

2. Functional / Medical

The child must have medical needs likely to last at least 12 months or result in death that produce severe functional limitations, and must meet TennCare's children's level-of-care criteria in Rule 1200-13-01-.11. For Part A that means qualifying for the level of care provided in a medical institution: a hospital, a nursing home, or an Intermediate Care Facility for individuals with Intellectual Disabilities (ICF/IID). For Part B it means qualifying for that level of care or being "at risk" of institutionalization. DDA makes the Part B level-of-care determination and refers the child on to Ascend, which makes the Part A determination.2

3. Financial

The financial test is about the parents' income and assets: the child must be not Medicaid eligible because of the parents' income or assets. That is the entire point of the program. For Part A, TennCare waives the deeming of the parents' income and assets to the child, so a family with income too high for regular Medicaid can still get coverage for a child with significant disabilities. Premium payments are owed for Part A if family income exceeds 150% FPL, calculated on a sliding scale based on monthly income and household size.2

If your child is already enrolled in another Tennessee disability program, ask DDA how that enrollment interacts with Katie Beckett before you apply. The published rule does not settle it.

How to Apply for Tennessee Katie Beckett

The lead agency is the Department of Disability and Aging (DDA), the cabinet-level agency formed by the merger of the Department of Intellectual and Developmental Disabilities (DIDD) and the Tennessee Commission on Aging and Disability (TCAD) under the Tennessee Disability and Aging Act, signed by Gov. Bill Lee on April 11, 2024 and effective July 1, 2024. Commissioner Brad Turner runs the merged agency. If you see older sources referring to "DIDD" or "TCAD," they're talking about what is now DDA.2,6

The standard sequence:2

For help at any step, DDA runs three regional intake offices and TennCare Connect has a support line:

Consumer Direction and Hiring Family

Katie Beckett allows Consumer Direction, meaning you self-direct certain home and community-based services and hire your own workers, under Tenn. Comp. R. & Regs. 1200-13-01-.32. Three restrictions in that rule trip families up:2

• A parent or legal guardian may hire family members, excluding spouses, to serve as workers.2
• "A family member shall not be reimbursed for a service that he would have otherwise provided without pay." This is the central restriction: parents cannot simply convert existing unpaid care into CD-paid hours.2
• A parent or legal guardian may not employ anyone who lives with the child to deliver Supportive Home Care or hourly Respite.2

Which specific services can be consumer-directed in your child's plan, and the worker-qualification and scheduling rules attached to them, come from TennCare and your DDA case manager. Ask them for the current list.

Public Chapter 182 of 2025: A New Agency-Employed Pathway

The Freedom for Family Caregiving Act (HB 712 / SB 1178), enacted as Public Chapter 182 of 2025 and effective July 1, 2025, applies across TennCare's LTSS waiver programs including Katie Beckett, and creates a pathway separate from Consumer Direction.2,4

Under PC 182, provider agencies may hire family members or other household members to perform HCBS services, and parents of minor children, through birth or adoption, are eligible to be a family caregiver without court approval.2

What PC 182 prohibits is TennCare and DDA blocking an agency from hiring a relative over things like the family relationship, a shared residence, the age of the person receiving care, parental or spousal status, or which TennCare program that person is enrolled in. It does not require any agency to hire you. Access still depends on finding a willing TennCare-contracted agency.4

Hard limits remain:

• Court-appointed legal guardians and conservators cannot be employed as a family caregiver unless the court order explicitly permits it.2
• Compensation is prohibited for care beyond the benefits available on the person-centered plan.2

So a parent of an enrolled minor can now be hired as a W-2 employee of a TennCare-contracted agency and paid for that child's authorized hours. That is a real shift away from the CD restriction on unpaid-care conversion, but one that runs through an agency rather than around it.4

For full guidance on the agency-employed pathway, see our companion guide on how to get paid as a family caregiver in Tennessee.

Appeals and Rights

A denial, reduction, or termination of Katie Beckett eligibility or services is appealable. TennCare runs two separate appeal tracks; which one you use depends on what was denied:7

Medical (service) appeals, for a denial, reduction, or termination of a service, go to TennCare Member Medical Appeals at 1-800-878-3192. You have 60 days after you find out there is a problem to file, and the appeal is usually decided within 90 days. An expedited appeal, decided in about one week, is available when you have an emergency and your health plan agrees that you do. The plan's agreement is part of the test, not an automatic right.7

Eligibility appeals, for a denial, a coverage ending, or an incorrect income or family-size determination, go through TennCare Connect at 855-259-0701 or tenncareconnect.tn.gov. You can also appeal when you have simply waited too long for a decision: more than 45 days on a standard application, or more than 90 days on a long-term-care application, at which point you can ask for a delayed hearing. TennCare states it will give a hearing within 45 days, or within 90 days for CHOICES applications, but Katie Beckett is not CHOICES, so do not assume the longer clock is yours. If you are past 45 days with no decision, ask.7

Free help with an appeal is available from the TennCare Advocacy Program at 800-758-1638, the Tennessee Justice Center, and Help4TN at 2-1-1.

Common Misconceptions

"Katie Beckett is the same as ECF CHOICES Group 4." No. ECF CHOICES Group 4 serves children under 21 with an intellectual or developmental disability who live at home and either meet nursing-facility level of care or are at risk of institutionalization, a different test from Katie Beckett's. The two sometimes serve overlapping families.2

"Part B enrolls my child in Medicaid." It doesn't. If you need Medicaid coverage itself, you need Part A or Part C.3

"Tennessee's Katie Beckett is a §1915(c) waiver." It isn't. Tennessee's program is authorized as benefit groups inside the TennCare III §1115 demonstration, not as the §1902(e)(3) state-plan option and not as an HCBS waiver.1

"Part A is first-come-first-served." No. Slots fill in numerical order by level-of-care prioritization score, and a medically eligible child with no slot available stays on the Part A waiting list.2

"PC 182 means parents can be CD workers now." No. It does not change CD rules; it creates a separate agency-employed pathway through provider agencies. Parents still cannot be CD workers if they would have provided the services unpaid.4

Related Terms

• HCBS waiver: The §1915(c) federal authority for home and community-based services. Tennessee's Katie Beckett program runs under §1115 demonstration authority instead.1
• Consumer Directed Services (CDS): The national term for what Tennessee calls Consumer Direction.
• Managed Care Organization (MCO): The health plans that administer TennCare benefits, including long-term services and supports, for enrolled members.2
• Activities of Daily Living (ADLs): The functional measures used in Level-of-Care assessments.
• Miller Trust / Qualified Income Trust: Tennessee's income-cap-state trust mechanism, relevant to adult LTSS pathways, not Katie Beckett.

Learn More

Find personalized help navigating Katie Beckett at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.