TEFRA/Katie Beckett Program

TEFRA/Katie Beckett Program

Overview
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 younger (living 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 Meets federal criteria for disability AND Is financially ineligible for SSI benefits AND Requires a level of care provided in a hospital skilled-
nursing facility or intermediate-care facility (including an intermediate-care facility for people with intellectual disabilities) AND Can appropriately be cared for at home AND Has an estimated cost of care outside of the institution that will not exceed the estimated cost of treating him/her within the institution.

TEFRA /Katie Beckett Program
Applications for Katie Beckett may be filed
online at www.gateway.ga.gov or with the
Centralized Katie Beckett Medicaid Team
Right from the Start Medicaid Project Centralized TEFRA/Katie Beckett Medicaid Team
5815 Live Oak Parkway Suite D-2 Norcross GA 30093-1700 678-248-7449 (phone) 678-248-7459 (fax)

How Are Level of Care and Eligibility Determined
There are two components to the Katie Beckett application and review process the eligibility review and the medical level of care review.
The eligibility review consists of basic demographic income resource and cost effectiveness information. This eligibility information is required annually and will be gathered on an annual basis by your Right from the Start (RSM) Medical Assistance Katie Beckett team (the Team). The parents or legal guardians complete the Medicaid application or review form.
The Medical level of care review consists of required clinical documents. Treating physicians parents and others (school guidance counselors therapists etc.) complete the required clinical documents.

G6e5o6rg-4ia5D0epartment of Community Health 2 Peachtree Street NW Atlanta GA 30303 www.dch.georgia.gov 404-656-4507

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The Team receives the Medicaid application or review and required clinical documents and 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 Team certifies Medicaid eligibility for the recipient. The Level of care component will be authorized for two years however the team will complete the required Medicaid eligibility review annually and parents must complete this information whether the level of care review is due or not. Failure to complete either the eligibility review or the LOC review will result in termination of coverage and may require a new application.
Resources
The Georgia Pediatric Program (GAPP) provides specialized medical services to Medicaid-eligible members 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 children who are medically fragile and children with special needs increases access to health care and support services and helps families continue to care at home for children with disabilities. For more information visit its 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 (DPH) is the lead agency for the Babies Can t Wait Program. For more information about BCW visit the web page at www.health.state.ga.us/programs/bcw.
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. Its program is intended to ensure specialty health care services to these children in Georgia who live in low-income households. The CMS program 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 the CMS program visit the web page at https //dph.georgia.gov/CMS.
For More Information
To learn more about TEFRA/Katie Beckett visit the DCH website at www.dch.georgia.gov/tefrakatie-beckett.

G6e5o6rg-4ia5D0epartment of Community Health 2 Peachtree Street NW Atlanta GA 30303 www.dch.georgia.gov 404-656-4507

September 2017

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