Katie Beckett - Healthcare Reimbursement Account (HRA) Guide

The Katie Beckett HealthCare Reimbursement Account (HRA) allows people to spend program dollars on IRS qualified HealthCare expenses. Payflex is the Katie Beckett Program’s HRA administrator. The HRA may be used with the Payflex card to cover out-of-pocket medical expenses or to reimburse claims from an itemized receipt.

Requesting HRA Service

The Katie Beckett Case Manager assists families with requesting the Katie Beckett HRA service. It is a one-time per year allocation and cannot be modified during the plan year. We strongly encourage families to review the types of expenditures listed below while considering how much of their Katie Beckett funds to allocate to the HRA.  DIDD cannot pay for claims submitted prior to the HRA authorization date on the plan. The $10,000 Katie Beckett budget expenditure cap may not exceed $10,000 across both the ISP year and calendar year and unspent funds cannot be rolled over into the next plan year. Once the services are authorized by the DIDD Case Manager on the child’s Katie Beckett support plan, Payflex will mail your HRA debit card to the address on file.

Helpful tips on using the HRA as well as understanding the calendar and ISP year budgeting may be found:

Payflex HRA Debit Card, Online Portal and Mobile App

Families may expect to receive the HRA debit card within 21 days of authorization. It will arrive in a plain white envelope in the parent or legal guardian’s name and contain instructions on how to set up the account. The card can be used for eligible medical expenses retroactive to the date of authorization on the child’s Katie Beckett support plan. You may log into the Payflex online portal at www.payflex.com or download the Payflex mobile app in order to review your HRA balance, submit claims and check claims status. Additional information regarding the Payflex online portal are located at PayFlex Reimbursement Quick Reference Guide. For information on the Payflex mobile app, click  PayFlex Mobile Application Flyer

Submitting Claims

You may submit HRA claims by logging into the Payflex online portal at www.payflex.com or into the mobile app and selecting “File A Claim” to upload all supporting documentation (including receipts and invoices) for the expense. Be sure the supporting documents include:

  • Child Name
  • Service Date
  • Merchant/Service Provider Name
  • Service Description
  • Total Cost of Patient Responsibility (EOB or final invoice once insurance is billed)
  • Letter of Medical Necessity

Payflex will send an alert should the expense require additional information for upload. Be sure to respond timely to any requests as to not delay the determination. For information on how to file a claim, select  Video: How to File a Claim with Payflex. For additional information on how to verify Payflex card purchases, click How to Verify PayFlex Card Purchases Online. To find helpful ways to submit claim documentation and prevent card suspension, please review Keep PayFlex Card Active Flyer.

Letter of Medical Necessity

Payflex requires a Letter of Medical Necessity (LOMN) Form from the healthcare provider confirming the expenses are needed to treat a specific diagnosis. It must be completed by child’s physician and multiple expenses may be itemized on one form. If the form is not available, a statement on letterhead from the medical provider detailing each diagnosis and expense is acceptable. To view the LOMN form, please click, PayFlex Letter of Medical Necessity Form


Once approved, reimbursement claims from itemized receipts are typically processed in 7-10 business days and paid by check or direct deposit.


If your HRA account has been frozen due to an overpayment of funds, you can remediate this by:

  • Paying it back in full online or by calling PayFlex.
  • Making payments to PayFlex via check. The check will need to be made out to PayFlex and the address to send the funds to are:

FSA Overpayments
PO BOX 4000
Richmond KY 40476

You must indicate you are part of the State of TN Katie Beckett HRA and the parent should indicate their full first and last name.


You may email Payflex at stateoftennessee@payflex.com or call (855) 689-8943 if you have any questions. Be sure to indicate the child’s legal name and date of birth when contacting Payflex. You may contact your Katie Beckett Case Manager with any questions regarding your support plan and budget authorizations.


DIDD has numerous resources for Katie Beckett families on their Katie Beckett webpage.  Previous recordings and presentations from Payflex webinars may be found including:


Eligible and Ineligible Items

Items deemed eligible by the IRS do not require a letter of medical necessity, however some items require the form. You may include multiple expenses on one LOMN form.