TEFRA/Katie Beckett Program for Georgia
The Department of Community Health (DCH) provides Medicaid
benefits to eligible children through the TEFRA/Katie Beckett
Medicaid program under §134 of the Tax Equity and Fiscal Responsibility Act (TEFRA) of 1982 (P.L. 97-248). States are allowed, at their option, to make these Medicaid benefits available to children (age 18 or under) at home who qualify as disabled individuals under §1614(a) of the Social Security Act as long as certain conditions are met, even though these children would not ordinarily be eligible for Supplemental Security Income (SSI) benefits because of parental income or resources. The specific statutory provisions establishing this option are contained in §1902(e) of the Social Security Act.
Who Is Eligible?
For Medicaid eligibility to be established under the TEFRA/Katie Beckett Program, it must be determined that:
The child is 18 years old or younger, AND
The child meets federal criteria for disability, AND
The child is financially ineligible for SSI benefits, AND
The child requires a level of care provided in a hospital, skilled-nursing facility or intermediate-care facility
(including an intermediate-care facility for the mentally retarded); AND
The child can appropriately be cared for at home, AND
The estimated cost of caring for the child outside of the institution will not exceed the estimated cost of
treating the child within the institution.
Applying for the TEFRA/Katie Beckett Program
Applications for Katie Beckett may be filed with the Centralized Katie Beckett Medicaid Team.
Right From the Start Medicaid Project
Centralized TEFRA/Katie Beckett Medicaid Team
5815 Live Oak Parkway
Norcross, GA 30093-1700
OR go to your local DFACS (Department of Family and Children Services) Office and ask for an application.
How are Level of Care and Eligibility Determined?
- Treating physicians, parents and others (school guidance counselors, therapists, etc.) complete the required
clinical documents. The parents or legal guardians complete the Medicaid application.
- The Katie Beckett Medicaid Team receives the Medicaid application and required clinical documents.
- The Katie Beckett Medicaid Team submits the clinical documents to Georgia Medical Care Foundation (GMCF) for determination of level of care and disability (if appropriate).
- GMCF, under the direction of a pediatrician, pediatric neurologist and nurse, performs the clinical review of the
required documents for level of care determination and disability determination (if appropriate).
- If level of care, disability and all other eligibility criteria are met, the Katie Beckett Medicaid Team certifies the
- The Georgia Pediatric Program (GAPP) provides specialized medical services to Medicaid-eligible recipients who
are medically fragile and under age 21, based on a medical necessity determination.
- The Champions for Children Program increases awareness throughout Georgia about non-profit services
available to medically fragile and special-needs children, increases access to health care and support services,
and helps families continue to care for children with disabilities at home. For more information, visit the
Champions for Children website at www.championsforchildrenga.org.
- Babies Can’t Wait (BCW) is Georgia’s statewide interagency service delivery system for families of infants and
toddlers with developmental delays or disabilities. The Georgia Department of Public Health is the lead agency
administering the Babies Can’t Wait Program in Georgia. For more information about BCW, visit the web page at
- The Children’s Medical Services (CMS) Program provides a comprehensive system of health care for children and youth with eligible chronic medical conditions from birth to 21 years of age. Their program is intended to ensure
specialty health care services to these children in Georgia who live in low-income households. CMS works to provide improved health outcomes for children with special health care needs by coordinating their access to affordable quality specialty health care in communities and by using resources in a responsible manner. For more information about CMS, visit the web page at www.health.state.ga.us/programs/cms/index.asp
For more information about Katie Beckett, visit the DCH website at www.dch.georgia.gov.