Katie Beckett Medicaid and TEFRA for children with disabilities, by state

What Katie Beckett and TEFRA mean

Katie Beckett Medicaid, TEFRA Medicaid, and the Katie Beckett waiver all name the same coverage. It gives Medicaid to a child with a significant disability who lives at home, based on the child's own income and resources. Congress created it in section 134 of the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA). It sits in federal law at 42 U.S.C. 1396a(e)(3) and in regulation at 42 CFR 435.225. It carries the name of Katie Beckett, the child whose case inspired it.

The word waiver confuses families. Where a state adopts the TEFRA option, it is part of the Medicaid state plan, and federal law requires Medicaid to reach every eligible child "with reasonable promptness." That means no slots and no waitlist. Other states reach the same children through a 1915(c) waiver or a Section 1115 demonstration. Those also ignore parent income, but they cap enrollment. The state table shows which one your state uses.

Why parent income does not count

For a child who lives at home, SSI and most Medicaid categories treat part of the parents' income and assets as the child's. This is called deeming, and it is why a family with an ordinary paycheck gets turned down. Once a child lives in a hospital or nursing facility paid for by Medicaid, SSI stops deeming the parents' income (20 CFR 416.1165). TEFRA applies that institutional rule to a child who needs institutional-level care but lives at home. Only the child's own income and resources count.

Most children have no income of their own, so they pass this test easily. In 29 states and DC the child's limit is 300% of the SSI rate, which is $2,982 a month in 2026 (KFF, April 2026). SSA has set the 2027 SSI rate at $1,029 a month, which puts that limit at $3,087 starting January 2027. Most states cap the child's own resources at $2,000. New Hampshire uses $1,000, and Nebraska, Rhode Island, and DC use $4,000. Confirm the current figure with your state agency, because these limits change every January.

Who qualifies under the federal tests

Under 42 CFR 435.225, the state decides each case on the same core tests. States add residency and citizenship rules, and some set a lower age limit.

• The child must be 18 or younger. The federal option ends at 19. Michigan, Tennessee, and Massachusetts end coverage at the 18th birthday, and Connecticut lowered its waiver to 18 or younger in July 2025.
• The child needs a disability under the SSI childhood standard, meaning an impairment that causes "marked and severe functional limitations" and is expected to last at least 12 months (20 CFR 416.906). Your child does not need to receive SSI; the state makes this decision during the application.
• The child's needs must equal the care given in a hospital, a nursing facility, or an intermediate care facility for people with intellectual disabilities (ICF-IID). This institutional level-of-care test decides most applications. Georgia's Medicaid agency says qualification depends on the level of care a child requires, and a diagnosis alone does not decide it.
• Home care must be appropriate and cost Medicaid no more than care in the matching institution.
• Only the child's own income and resources count, and they must fall under the state limit.

Three ways states offer it

Every route below ignores parent income for eligibility. They differ on enrollment caps. A 1915(c) waiver must state how many children it will serve, and that number "will constitute a limit on the size of the waiver program" (42 CFR 441.303(f)(6)).

Katie Beckett and TEFRA by state (October 2026)

Each row comes from that state's own Medicaid agency, manual, regulation, or CMS record, checked October 17, 2026. Where a state has no Katie Beckett or TEFRA option, the row shows the closest program that counts only the child's income. "None stated" means the state's materials list no premium or waitlist; confirm with the agency before you rely on it. States with a full section below are linked.

FPL means the federal poverty level. "No option" means we found no Katie Beckett or TEFRA program in the state's own rules.

How to apply, step by step

Every state runs a financial review of the child's income and resources and a medical review of disability and level of care. Few children have income of their own, so the medical review is the harder test. Build the file around your child's daily needs.

1. 1
   Apply for Medicaid and name the program

   Most states start with a regular Medicaid application. Write or say Katie Beckett or TEFRA, and answer yes to every disability question. Idaho asks you to write Katie Beckett at the top of the form; DC sends the Katie Beckett packet after a regular Medicaid denial; Minnesota needs a county call to start the SMRT referral.

2. 2
   Gather proof of daily needs

   Diagnosis reports, the IEP or IFSP, therapy evaluations, hospital records, a physician's level-of-care form (Georgia's Pediatric DMA-6(A), Arkansas's DMS-2602), the child's own income and bank records, and any private insurance card.

3. 3
   Get the disability determination

   If your child does not already receive SSI, a state medical review team decides whether your child meets the SSI childhood standard. Arkansas allows up to 90 days when it has to make this decision.

4. 4
   Complete the level-of-care assessment

   A nurse or specialist reviews records and interviews you, in person or by video. Wisconsin's specialists meet at home or by video; Idaho uses Liberty Healthcare; Tennessee uses DDA and then Ascend for Part A; Nevada's coordinators visit the home.

5. 5
   Watch the deadlines

   Published decision deadlines: Arkansas 45 days (90 with a disability decision), Maine 45 days, DC 60 days, Rhode Island 90 days. Ask for retroactive coverage; Minnesota covers up to three months before the application month for applications filed through December 31, 2026, and up to two months for applications filed after that.

6. 6
   Renew and appeal on time

   Arkansas and Idaho renew every year; Georgia approves level of care for at least two years. Appeal in writing before the deadline: 30 days in Georgia and Tennessee, 45 days in Wisconsin. In Wisconsin, a current member who asks for a hearing before coverage ends keeps benefits during the appeal.

What Katie Beckett covers, including ABA

A child approved through a TEFRA option gets the same Medicaid benefits as any other child in the state. Georgia's manual says the child receives the same health coverage as other Medicaid members, and South Carolina's flyer lists all Medicaid-covered services. For children under 21, that includes EPSDT, Medicaid's child health benefit.

In its July 7, 2014 informational bulletin on autism services, CMS told states that EPSDT requires coverage of any Medicaid-coverable service that is medically necessary "to correct or ameliorate any physical or behavioral conditions." That is the legal path for ABA under Medicaid. Each state names the benefit differently. Georgia covers Adaptive Behavior Services for members under 21, Minnesota uses its EIDBI benefit, North Carolina uses Research-Based Behavioral Health Treatment, and Colorado uses Pediatric Behavioral Therapies. Each one requires a qualifying diagnosis, a Medicaid-enrolled provider, and prior authorization based on medical necessity.

• Keep your private plan. It pays first, and Medicaid pays after, so give your ABA provider both cards at intake.
• When your ABA provider is enrolled in Medicaid, it cannot bill you for the copays, coinsurance, or deductible your private plan leaves on a covered service. Medicaid pays its share as the second payer, and the most the provider can collect from you is your state's own Medicaid copay, if your state charges one (42 CFR 447.20).
• Tennessee Part B is a services budget of up to $10,000 a year. It is not Medicaid, so it does not carry the EPSDT benefit.
• In a capped waiver state, Medicaid begins when your child gets a waiver slot. Until then, ABA runs through private insurance or regular Medicaid if your family qualifies.

If your state has no Katie Beckett option

These states have no uncapped Katie Beckett or TEFRA program: Alabama, California, Colorado, Connecticut, Florida, Hawaii, Illinois, Indiana, Iowa, Kansas, Kentucky, Maryland, Missouri, Montana, New Mexico, New York, North Carolina, North Dakota, Ohio, Oregon, Pennsylvania, Texas, Utah, Virginia, Washington, and Wyoming. Arizona, Arkansas, New Jersey, and Tennessee use Section 1115 programs instead. Nearly all of these states have a waiver or category that ignores parent income, and the state table names it.

• Apply for the waiver list now, because most waiver lists run by application date. Connecticut reported about a 3.5-year wait for its Katie Beckett Waiver in March 2026, and Maryland had 172 children on its Model Waiver registry in February 2026.
• Waivers for medically fragile children include Maryland's Model Waiver, Illinois MFTD, Texas MDCP, North Carolina CAP/C, Utah MCCW, and Florida's Model Waiver for children leaving a nursing facility after 60 or more days. Developmental disability waivers include Colorado CES, Michigan's Children's Waiver (services on top of HCC/TEFRA), Missouri MOCDD, and Kentucky's CHILD waiver (high-intensity behavioral or developmental needs). Maryland also runs an Autism Waiver.
• Buy-in programs count family income but accept far higher incomes than regular Medicaid. They include Colorado's Buy-In for Children with Disabilities ($0 to $120 a month from April 1, 2026), Iowa's Medicaid for Kids with Special Needs (under 19, family income up to 300% FPL), Massachusetts CommonHealth, and North Dakota's Children with Disabilities coverage (5% of household income).
• Pennsylvania families can apply for PH-95, which has no level-of-care test and no premium.
• In the month after a child turns 18, SSI stops counting parent income (20 CFR 416.1165), so a young adult with a disability can apply for SSI and SSI-related Medicaid on their own income.

Related guides

Official sources

• 42 U.S.C. 1396a(e)(3): the TEFRA (Katie Beckett) option
• 42 CFR 435.225: children who would be eligible if in a medical institution
• 42 CFR 435.217: waiver groups that would be eligible if institutionalized
• 42 CFR 441.303(f)(6): 1915(c) waiver participant limits
• 20 CFR 416.906: SSI disability definition for children
• 20 CFR 416.1165: when SSI counts (deems) a parent's income
• SSA: SSI federal payment amounts (2026 and 2027)
• CMS Informational Bulletin, July 7, 2014: Medicaid coverage of services to children with autism
• CMS: Coordination of benefits and third party liability
• KFF: Medicaid eligibility for Katie Beckett children, 2026 (national overview)
• Georgia DCH: Katie Beckett Deeming Waiver Manual (April 2022)
• Georgia Medicaid: Autism Spectrum Disorder services
• Arkansas DHS: TEFRA premiums
• Arkansas DHS: TEFRA detailed fact sheet
• Idaho DHW: About the Katie Beckett Program
• Wisconsin DHS: Katie Beckett Medicaid eligibility
• Minnesota Statutes 256B.055, subd. 12: children with disabilities
• Minnesota DHS: parental fees ended for TEFRA (Oct 17, 2023)
• TennCare: Katie Beckett Program annual report (2025)
• Louisiana LDH: Act 421 Children's Medicaid Option FAQ
• Nevada Medicaid: Katie Beckett premium matrix (April 1, 2026)
• Maine 10-144 CMR ch. 332, sec. 7-5: Katie Beckett coverage group
• Connecticut DSS: notice of intent to renew the Katie Beckett Waiver
• Texas HHSC: Medicaid for the Elderly and People with Disabilities Handbook, waiver programs

The state table links to each state's own agency page. Figures checked October 17, 2026.