Katie Beckett Waiver

What is the Katie Beckett Waiver?

Tennessee’s Katie Beckett program is for children under the age of 18 with significant disabilities or complex medical needs. This program is for children who are not Medicaid eligible because of their parent’s income or assets.

This program has two parts, A and B, and will provide services and/or help paying for medical care that private insurance does not cover.

Katie Beckett Part A

Part A is for children who, based on their level of care needs, qualify for care in a medical institution- like a hospital, nursing home, or Intermediate Care Facility for individuals with Intellectual Disabilities (ICF/IID), but the family wants to care for their child at home instead.

  • Part A serves children with the most significant disabilities or complex medical needs.
  • Children receive full Medicaid benefits, which can include services like home health, private duty nursing, durable medical equipment and supplies, and occupational, physical and speech therapies, among other services.
  • Children in Part A also receive up to $15,000 a year in home and community- based services. These are non-medical services that help families care for children in their homes. Some of these services include respite, supportive home care, and home and vehicle modifications.

Katie Beckett Program Part B

Part B is for children who don’t qualify for care in an institution but based on their level of care needs, are considered “at risk” of going into one unless they can get services.

  • Part B serves children with disabilities or complex medical needs.
  • Children in Part B are not enrolled in Medicaid. They receive up to $10,000 a year in services.
  • Families have the flexibility to choose any or all of the following services within their budget: premium assistance, a health-care savings type account, reimbursement for services that will benefit the child but can’t be covered under a health-care savings account, self-directed respite and supportive home care services, or an array of services from a community-based provider.

Katie Beckett Program Part C

  • For children who have Medicaid, but their Medicaid is ending because their parents’ income or resources have increased.
  • Allows a child to keep Medicaid if they would qualify for Part A, but there isn’t a slot open.
  • Part C slots are only used when no openings remain in Part A.
  • If a child enrolls in Part C and then gets a Part A slot, they must move to Part A.

There is a limit on how many children can enroll in Part A and Part B. The limits are based on the amount of funding available for the program.

Applicants must apply for and be determined eligible for Part B before being able to be considered for Part A. There is a medical and a financial part of the application process. Both are started at the same time. The Department of Disability and Aging (DDA) is responsible for the medical eligibility and TennCare is responsible for the financial eligibility. Member services from TennCare gets the application and sends a referral to the Department of Disability and Aging (DDA).

It is important to be aware that all applications for Katie Beckett include applying for Medicaid, even if you know that you won’t qualify for Medicaid. A list of possible information that may be needed to complete the financial eligibility part of the application can be found in the Katie Beckett application items for financial eligibility.

To apply for Tennessee’s Katie Beckett Program, follow the steps below:

1. The application will start with a self-referral by creating a TennCare Connect account online.

Fill in the required information to complete the self-referral process.

2. Filling out the self-referral online is the fastest way to apply for the program. But if you don’t have a computer or would like assistance, a Department of Disability and Aging (DDA) case manager can help you complete the self-referral. To get help, call the Department of Disability and Aging (DDA) office in your region:

West Tennessee Regional Office: (866) 372-5709

Middle Tennessee Regional Office: (800) 654-4839

East Tennessee Regional Office: (888) 531-9876

3. Once you complete the self-referral, a Department of Disability and Aging (DDA) case manager will contact you to conduct an assessment. Be ready to provide medical documents that clearly identify your child’s condition and/or proof of intellectual disability at the time of the assessment. Please note: your child’s enrollment could be denied or delayed if you are unable to provide these supporting documents when you meet.

The Katie Beckett application is processed through a partnership between TennCare and the Department of Disability and Aging (DDA).

Step 1: Part B Application Process

TennCare Connect

After submission:

Once you submit your application, financial & medical eligibility reviews begin at the same time.*

Financial Eligibility Process (by TennCare)

  • Member Services receives the application and sends referral to DDA.
  • Member Services processes application. Case is held for medical eligibility determination and slot availability.
  • Once the medical determination is made (see Medical Eligibility Process), the financial eligibility determination is completed.

Medical Eligibility Process (by DDA)

  • Part B slot is held, if available, through the entire process.
  • DDA contacts family and schedules assessment.
  • DDA completes assessment and collects necessary documents.
  • DDA makes Level of Care (LOC) determination for Part B

Potential Outcomes

  • If your child meets the medical and financial requirements AND the evaluation doesn’t trigger, or you don’t request Part A, your child is enrolled in Part B, if a slot is available.
  • If Part B is approved and the evaluation triggers, or you request Part A, a Part B slot remains held, if available, and the referral is sent to Ascend (see Step 2: Part A Application Process).
  • If the application is denied, you have 30 days from the date of notice to appeal.

Notes:

  • The financial process cannot be completed until after the medical eligibility determination is completed. This is because your child can only be approved financially for Katie Beckett if they also qualify medically and there is a slot available.
  • Financial eligibility must be determined, even if you already know that you do not qualify for Medicaid.
  • You will receive separate communications regarding financial and medical eligibility, including potential requests for additional information and final determinations.

Step 2: Part A Application Process

The Part A application is either automatically triggered based on meeting a specific level of care (LOC) need found through the Part B application process or it can be requested for any child determined to be eligible for Part B.

Medical Eligibility Process

  • Ascend receives referral from DDA.
  • Ascend contacts your family and schedules an assessment.
  • Ascend completes assessment and collects necessary documents.
  • Ascend makes LOC determination for Part A. part A slot held upon approval, based on prioritization.

Potential Outcomes

  • If Part A LOC approved, Part A slot is held (if available). If financial eligibility is approved, you must pay a premium payment (if applicable) for your child to be enrolled in Part A. If not paid within 60 days, Part A enrollment will be denied and your child will be enrolled in Part B if slot was available at referral.
  • If Part A LOC approved and no Part A slot available, your child will be placed on the Waiting List for Part A and enrolled in Part B if a slot was available at referral. *If no Part B slot is available, your child will be placed on the waiting list for Part B.
  • If Part A LOC is denied, you have 30 days from date of notice to appeal the Part A determination. Your child will be enrolled in Part B, if slot was available at referral. *If no Part B slot is available, your child will be placed on waiting list for Part B.

Assistance & Contact Information

  • If you don’t have a computer or need assistance, a DDA care manager can help you complete the self-referral.
  • DDA office contacts by region:
    • West: (866) 372-5709
    • Middle: (800) 654-4839
    • East: (800) 654-4839

For questions about TennCare Connect: (855) 259-0701