A snapshot of the Katie Beckett Program [Feb. 2008]

A Program of the Georgia Department of Community Health
A SNAPSHOT OF THE
Katie Beckett Program

Overview
Established in 1982 under the Tax Equity and Fiscal Responsibility Act (P.L. 97-248), the Katie Beckett Medicaid Program (KB), permits the state to ignore family income for certain disabled children. It provides benefits to certain children 18 years of age or less who qualify as disabled individuals under 1614 of the Social Security Act and who live at home, rather than in an institution. These children must meet specific criteria to be covered. Qualification is not based on medical diagnosis; it is based on the institutional level of care the child requires. Title 42 Code of Federal Regulations outlines the criteria used to determine eligibility.
Applying for the Katie Beckett Program
Applications must be filed at the local county Department of Family and Children Services (DFCS).

ENROLLMENT
Enrollment dramatically increased over five years from 2,694 to 6,299. Up 250 percent.
OTHER STATES
Other 20 States have opted to open the category
Only three other states in the Southeast have a KB program

Has Katie Beckett eligibility criteria changed?
To ensure that health care is delivered to the children who need services most, and to reduce abuse and fraud to the program, the Georgia Department of Community Health (DCH) began enforcing federal

ELIGIBILITY
18 years old or younger Meet federal criteria for
childhood disability Meet institutional level of care

guidelines for the program in November 2004. Reasons behind the

Can safely be served at home

current criteria are:

Cost does not exceed the

Enrollment dramatically increased over five years from 2,694 to 6,299

applicable institutional cost

DCH received numerous reports of children in the program that were

not eligible

The Centers for Medicaid and Medicare began auditing states' Medicaid and Medicare programs.

Portions of the audit focus on whether the evidence supports compliance with regulations and eligibility

determinations

Adult Activities of Daily Living (ADL) was being used to assess eligibility of children, rather than the

child specific criteria

In November 2004, physician specialists, advocates and parents helped develop pediatric criteria

How is level of care determined?
STEP 1 Families apply for the KB Wavier with a DCFS case manager
STEP 2 Treating physicians, parents and others (school guidance counselors, therapists, etc.) complete the required application packet
STEP 3 GMCF under the direction of a pediatrician, pediatric neurologist and nurses, perform the clinical review of the packet
STEP 4 If level of care is satisfied, DCFS does a cost neutrality assessment to determine whether the cost of home care is less than an institution

2 Peachtree Street, Atlanta, Ga 30303 www.dch.georgia.gov

February 2008

A Snapshot of Katie Beckett Program

Is there an appeals process? Yes. An initial (administrative) appeal can be made directly to GMCF. A second appeal can be made by requesting a hearing directly with DCH.
Alternatives to Katie Beckett During the 2006 legislative session, the General
Assembly directed the DHR to create a foundation to ease the transition of those children who are no longer eligible for the KB Wavier. The General Assembly appropriated $7.6 million in FY2006 Amended FY 2006 Budget to help these families. Contact DHR for more details about this foundation Babies Can't Wait (BCW) program Individualized Family Service Plan Local Education Agency Individualized Education Plans

TIMELINE
September - October 2003 DCH discovered proper federal criteria was not being applied. September - November 2003 A multi-disciplinary committee including, the medical director, found that the clinical criteria only addressed adults, not pediatrics; the clinical review and criteria was outdated, and did not follow the federally required criteria; and all of the determinations were based on diagnoses, rather than the three levels of care criteria in the CFR. The committee developed pediatric specific criteria; policies and forms; and continued reviewing the programs changes through January 2005.
September 2004 DCH Medicaid chief, medical director, and policy staff met with parents and advocates regarding the criteria. Meetings were held in Atlanta and Athens with the Developmental Disability Council coordinating the meetings. The DCH Policy staff also met with the DHR state staff of the BCW program. October 2004 The committee developed and refined the KB training tools and forms based on input from the parents, advocates and experts on the new KB criteria and a new Pediatric DMA-6A form exclusive for pediatric cases. KB letters were developed and reviewed by DCH's General Counsel. The appeal process for Parents' Right to a Hearing was also refined. November - December 2004 DCH phased in the updated KB criteria for renewal cases. After November 15, 2004, GMCF began applying the new KB criteria. If there was not enough information to review for a clinical determination, additional information was requested. DCH policy and General Counsel staff, and DFCS staff were trained on the KB forms and new criteria. January 2005 - present DCH has held several meetings with a number of stakeholders; continued to improve the criteria; and monitor the process.