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

Tennessee's Katie Beckett program is the Medicaid pathway for children under 18 with significant disabilities or complex medical needs whose family income or assets would otherwise disqualify them from TennCare. It exists because Tennessee chose, late and after years of grassroots advocacy, to plug a longstanding gap that had pushed many medically-fragile children's families into impossible choices, surrender Medicaid coverage, or institutionalize a child to qualify for it.

Tennessee's program looks different from the Katie Beckett options in most other states. Rather than a §1915(c) HCBS waiver or the federal TEFRA state-plan option, Tennessee's program operates under a §1115 demonstration with a unique three-Part structure (A, B, and C). That structural choice lets Tennessee cap enrollment, charge premiums above 150% FPL, and offer a flexible cash-only Part B benefit that no §1915(c) waiver could provide.

This guide walks through who qualifies, how the three Parts differ, what's covered, and how to apply through the Department of Disability and Aging in 2026.

By Brevy Care Team · Last verified May 2, 2026

A Brief History of Tennessee Katie Beckett

The "Katie Beckett" name traces back to Mary Katherine Beckett, a ventilator-dependent Iowa child whose 1981 case prompted President Reagan to publicly call attention to a perverse Medicaid rule: parental income was deemed to a child living at home, but ignored after 30 days of inpatient hospitalization. Families had a financial incentive to institutionalize medically-fragile children rather than care for them at home. HHS waived the deeming rule for Katie shortly before Christmas 1981, and Congress codified the exception in the Tax Equity and Fiscal Responsibility Act (TEFRA) of 1982 as the optional Medicaid eligibility category at §1902(e)(3), commonly called the TEFRA option or 134(a) option.

Most states adopted some version of Katie Beckett relatively quickly: either through the TEFRA state-plan option directly, or through a §1915(c) HCBS waiver targeted to medically-fragile children. Tennessee did neither for nearly four decades. Families with severely disabled children whose income exceeded standard Medicaid thresholds had no Tennessee pathway at all, they were quoted institutional placement or out-of-state moves.

That changed with Public Chapter 494 of 2019 (HB 498 / SB 476), enacted May 24, 2019, codified at Tenn. Code Ann. §71-5-164. The statute required Tennessee's commissioner of finance and administration to submit a §1115 Social Security Act waiver to CMS within 120 days, explicitly choosing §1115 demonstration authority rather than the more common §1915(c) waiver path. CMS approved the TennCare III §1115 demonstration on January 8, 2021 with a 10-year period extending through December 31, 2030, formally establishing the Katie Beckett, Medicaid Diversion (Part B), and Continued Eligibility (Part C) groups. Operational enrollment began in late 2020; by February 1, 2021 TennCare reported "almost 300 children enrolled."

Why §1115 instead of TEFRA or §1915(c)? Three reasons:

• §1115 lets Tennessee cap enrollment. Part A's 300-child statewide cap and Part B's expandable slot count would not be possible under TEFRA (which is open-ended) or §1915(c) (which caps to a much higher annual ceiling).
• §1115 lets Tennessee charge premiums above 150% FPL, which TEFRA generally does not.
• §1115 lets Tennessee offer Part B's no-Medicaid flexible HCBS dollars, neither TEFRA nor §1915(c) authorizes a benefit-only-no-Medicaid option.

The statute also requires TennCare and DDA (then DIDD) to issue a joint annual report to the House Insurance Committee and Senate Health & Welfare Committee no later than February 1 each year.

The Three Parts

The single most important thing to understand is that Katie Beckett isn't one program, it's three different benefits with different rules.

A few important notes:

• Total Katie Beckett enrollment as of December 30, 2024 was 4,411 children, the vast majority (4,188) in Part B. Part A and Part C combined was approximately 223 children, with Part A below its 300 cap.
• Part A's Tier 1 reserved-slot count dropped from 50 to 25 in 2025 to allow more Tier 2 enrollments.
• Part B's cap was expanded to 4,700 slots, funded by $13M shifted from Part A in August 2023 and another $7M in October 2024.

Part A: Full Medicaid + $15K Wraparound

Part A delivers full TennCare Medicaid state-plan benefits (delivered through TennCare Select's Community component) plus up to $15,000/year in HCBS wraparound services.

The acuity-prioritized waitlist is what makes Part A distinctive. Each applicant gets a Level-of-Care prioritization score:

• Score 1: Ventilator-dependent (8+ hours daily)
• Score 2: Complex skilled medical interventions
• Score 3: Self-injurious AND aggressive behavioral needs
• Score 4: Self-injurious OR aggressive behavioral needs
• Scores 5–7: Tier 2 institutional Level of Care categories

A separate tie-breaker "other prioritization" score (0–100) is also applied. Of the 300 total Part A slots, 25 are reserved for Tier 1 (the most-medically-complex children); the remaining 275 are open to Tier 2.

Premium payments are required when family income exceeds 150% of the Federal Poverty Level. Part A members must also purchase and maintain minimum essential coverage through private or employer-sponsored insurance.

The $15,000/year wraparound covers (within the cap):

• Respite, 30 days OR 216 hours/year
• Supportive Home Care
• Assistive Technology / Equipment & Supplies, $5,000/year
• Minor Home Modifications, $6,000/project; $10,000/year; $20,000 lifetime
• Vehicle Modifications, $10,000/year; $20,000 lifetime
• Community Transportation, $225/month under Consumer Direction
• Community Integration Support, $500/year
• Family Caregiver Education, $500/year
• Decision-Making Supports, $500 one-time
• Family-to-Family Support, Community Support Development, Health Insurance Counseling (15 hours/year)
• Premium assistance on a hardship basis

Annualized Part A cost per child runs approximately $100,000/year, well below the original $150,000 projection, primarily because TennCare wraparound and case management hold per-child cost lower than the institutional benchmark the program is required to beat.

Part B: Flexible $10K, No Medicaid Card

Part B is unusual: it gives families up to $10,000/year in flexible HCBS dollars but does not include a TennCare Medicaid card. That tradeoff is why Part B can serve so many more children than Part A, current cap is 4,700 slots versus Part A's 300.

Part B funds may be used for any combination of:

• Premium assistance for private or employer-sponsored health insurance
• Healthcare reimbursement / HSA-style spending for IRS-qualified medical expenses
• Therapeutic Support for non-IRS-qualified items that benefit the child
• Self-directed Hourly Respite (not daily)
• Self-directed Supportive Home Care
• Community-based provider services (the same wraparound menu as Part A: home/vehicle modifications, AT/equipment, community transportation, community integration, family caregiver education, decision-making supports)

Part B operates a first-come, first-served waitlist rather than the acuity-prioritized method used for Part A. The administrative mechanics are also different: because Part B members aren't TennCare-enrolled, their Person-Centered Support Plans are authorized by DDA rather than an MCO. TASC is the HRA/billing vendor for Part B (took over from Inspira in July 2025). Consumer Direct Care Network of Tennessee (CDTN) handles payroll for any consumer-directed services.

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/year is often more useful than Part A's full Medicaid + $15K, and the line is shorter to get into.

Part C: Bridge Coverage

Part C ("Continued Eligibility Group") provides full TennCare state-plan benefits as a bridge for children who are losing Medicaid eligibility because of family income or asset increases when no Part A slot is available.

Part C is coverage continuity, not service expansion. The $15,000 HCBS wraparound is a Part A benefit; Part C provides only the underlying TennCare state-plan benefit, narrowly scoped to children bridging the gap until a Part A slot opens or until the family situation changes.

Eligibility: Five Tests

A Katie Beckett applicant must clear five tests to qualify for Part A. Part B applies the same disability and functional tests but uses different financial standards and lacks the institutional cost test.

1. Age

The child must be under age 18. Eligibility ends at the 18th birthday, there is no Katie Beckett pathway for adults. Transition planning to adult LTSS pathways (typically ECF CHOICES for I/DD-eligible young adults, or other waivers) is essential and should begin well before the 18th birthday.

2. Functional / Medical

Medical needs lasting 12+ months or expected to result in death; severe functional limitations; Institutional Level of Care (ICF/IID-equivalent for Part A). The Level-of-Care assessment is conducted by DDA staff, not the MCO.

3. Financial: The Child

The child's own income and resources must be under the child-specific SSI-related limits. The child must qualify for SSI "but for" parental deeming, meaning the child would qualify for SSI if parental income were ignored.

4. Financial: The Family

Family income must be above the regular Medicaid threshold. This is the entire point of the program: the deeming exception lets a family with income too high for regular Medicaid still get coverage for a child with significant disabilities. Premium payments are owed for Part A if family income exceeds 150% FPL.

5. Comparable Cost Test

The estimated home/community cost of caring for the child cannot exceed an institutional benchmark, pediatric inpatient medical hospitalization cost for medical Level of Care, pediatric inpatient psych for behavioral Level of Care, or private ICF/IID average for Tier 2.

Stacking Restriction

A child cannot simultaneously receive Family Support Program services AND Katie Beckett (or ECF CHOICES). Families currently enrolled in the Family Support Program will need to disenroll before Katie Beckett enrollment.

How to Apply for Tennessee Katie Beckett

Applications run through 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" in connection with Katie Beckett, they're talking about what is now DDA.

The standard sequence:

1. Apply for Part B first. TennCare guidance is explicit on this point: applicants must apply for and be determined eligible for Part B before being considered for Part A. Submit the application through TennCare Connect at tenncareconnect.tn.gov.
2. Submit medical documentation. Records must clearly identify the child's condition and/or proof of intellectual or developmental disability.
3. Parallel reviews. Financial eligibility (TennCare) and medical eligibility / Level of Care (DDA) are processed simultaneously.
4. DDA Level-of-Care assessment. A DDA assessor will collect functional, medical, and behavioral information. For Part A, the LOC determines the priority score that places the child on the acuity-prioritized waitlist.
5. Enrollment. Once eligibility is determined and a slot is available, the family receives an enrollment packet and (for Part A) is assigned to TennCare Select's Community component.

DDA regional intake numbers:

• West Tennessee: (866) 372-5709
• Middle Tennessee: (800) 654-4839
• East Tennessee: (888) 531-9876
• TennCare Connect support: (855) 259-0701

Consumer Direction and Hiring Family

Per Tenn. Comp. R. & Regs. 1200-13-01-.32, Consumer Direction in Katie Beckett covers three services: Supportive Home Care, Hourly Respite (not daily), and Community Transportation. Other services (modifications, equipment) cannot be consumer-directed. Consumer Direct Care Network of Tennessee (CDTN) handles payroll.

The CD restrictions trip up most families:

• Family members other than spouses MAY be paid as CD workers, BUT "a family member shall not be reimbursed for a service that he or she would have otherwise provided without pay." This is the central restriction: parents cannot simply convert existing unpaid care into CD-paid hours.
• Spouses cannot be CD workers. Rarely an issue for minors, but bars adult-spouse arrangements for older minors.
• Persons residing with the child cannot deliver Supportive Home Care or Hourly Respite under CD. Co-residents also cannot be reimbursed for Community Transportation.
• CD workers may not provide more than 40 hours/week without overtime approval (Part A only).
• Worker qualifications: 18+, criminal/abuse/sex-offender background check, no Medicare/Medicaid exclusion, training, signed Service Agreement, valid driver's license if transporting.

The family or legal representative is the legal employer of record.

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, explicitly applies to Katie Beckett Parts A and B and creates a new pathway separate from Consumer Direction.

Under PC 182, licensed provider agencies may now hire family members (including parents of minor children, no court approval required) and other household members as paid Direct Support Workers to deliver authorized services. The statute prohibits provider agencies from refusing to hire based on family relation, residence, age of member, parental/spousal relationship, waiver program, or concurrent unrelated caregivers.

Hard limits remain:

• Court-appointed legal guardians and conservators cannot be employed unless explicitly permitted in the order.
• Compensation cannot exceed PCSP-authorized benefits.

Practically, this means a parent of a Katie Beckett enrolled minor can now potentially be hired and paid by a TennCare-credentialed provider agency to deliver services like Supportive Home Care or aide hours, a meaningful shift from the historical CD restriction that "family members shall not be reimbursed for unpaid services." Note that PC 182 does not change the CD rules; it creates a parallel agency-employment route for relationships barred by CD.

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. Tennessee runs the same two appeal tracks for Katie Beckett as for CHOICES and ECF CHOICES:

Eligibility appeals, for denials, terminations, or LTSS application delays exceeding 90 days, go to TennCare Connect at 1-855-259-0701 or tenncareconnect.tn.gov. The hearing must be held within 90 days for LTSS applications.

Medical/service appeals, for any Adverse Benefit Determination on a Katie Beckett service, go to TennCare Member Medical Appeals at 1-800-878-3192. The filing deadline is 60 days from the date you find out about the problem; the standard decision is 90 days; expedited decisions (about a week) are available if waiting could endanger life or health.

The Grier Consent Decree provides additional procedural protections beyond the federal floor.

Free legal help is available through the Tennessee Justice Center, the TennCare Advocacy Program at 1-800-758-1638, and Help4TN at 2-1-1.

Common Misconceptions

"Katie Beckett is the same as ECF CHOICES Group 4." No. Katie Beckett serves children under 18 with significant medical OR behavioral disabilities whose family income disqualifies them from regular Medicaid. ECF CHOICES Group 4 serves children OR adults with intellectual or developmental disabilities living at home with family who meet ECF's I/DD criteria. The two programs sometimes serve overlapping families, but the eligibility, benefits, and application paths are different. A child cannot be enrolled in both.

"Part B includes a Medicaid card." It doesn't. Part B is $10,000/year in flexible HCBS dollars, useful for premium assistance, out-of-pocket costs, respite, and other supports, but it does NOT enroll the child in TennCare Medicaid. If you need Medicaid coverage, you need Part A or Part C.

"Tennessee's Katie Beckett is a §1915(c) waiver." Despite the colloquial name, Tennessee's program is a §1115 demonstration. That structural choice is why TN can cap enrollment at 300 (Part A) and 4,700 (Part B), charge premiums above 150% FPL, and offer Part B's no-Medicaid flexible cash.

"Part A is first-come-first-served." No. Part A uses an acuity-prioritized waitlist with Level-of-Care scores 1–7 and a tie-breaker score 0–100. A child without a Tier 1 LOC score may wait years or never receive a Part A slot. Part B is the program with a first-come-first-served waitlist.

"My child can age into adult Katie Beckett." No. Katie Beckett ends at the 18th birthday. Transition to adult LTSS pathways (typically ECF CHOICES if I/DD-eligible) should begin well before age 18.

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

Related Terms

• HCBS waiver: The federal authority most states use for HCBS. Tennessee uses §1115 instead.
• Consumer Directed Services (CDS): The national term for what Tennessee calls Consumer Direction.
• Managed Care Organization (MCO): Part A members are enrolled in TennCare Select, which administers the Community component.
• Activities of Daily Living (ADLs): The functional measures used in Level-of-Care assessments.
• Miller Trust / Qualified Income Trust: Tennessee's name for the income-cap-state trust mechanism (relevant for older transition pathways, not Katie Beckett directly).

Learn More

• What You Need to Know About TennCare CHOICES
• What You Need to Know About ECF CHOICES
• How to Get Paid as a Family Caregiver in Tennessee
• Tennessee Medicaid Programs for Seniors (Hub)
• How to Apply for Tennessee Medicaid

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. Katie Beckett eligibility, slot allocations, premium thresholds, and waitlist dynamics change. Always verify with TennCare, the Department of Disability and Aging, or an elder-law or disability-rights attorney. Brevy is not a law firm, financial advisor, or healthcare provider.