When a child has complex medical needs, it impacts everyone in the family. Parents often end up feeling lonely and isolated as they juggle hospital stays, doctor visits and around-the-clock care. 

Thankfully, the internet has made it easier for these families to find one another, build support groups and share their experiences. Having common ground reassures these families that they are not alone. And one of the greatest tools they have within their reach is the Katie Beckett waiver. 

What is the Katie Beckett Medicaid Waiver? 

The Katie Beckett program is for children under age 19 who have disabilities or complex medical needs. It’s valuable for children who are not eligible for Medicaid because of their parents’ income or assets. This program helps pay for pediatric home care nursing that private insurance does not cover. 

Currently, the Katie Beckett Waiver is active in some form in 24 states. Rather than placing children with complex medical needs in an institutionalized setting, the waiver makes it possible for them to receive high-quality care in the home. This costs no more than a hospital or nursing home yet provides families with invaluable support. 

How the Waiver Came to Be

Mary Katherine Beckett was born in 1978 in Cedar Rapids, Iowa. At 4 months old, she contracted viral encephalitis that left her unable to breathe on her own. She was hospitalized to receive ventilator assistance until her case caught the attention of the Reagan administration. 

The administration used Katie’s story to deregulate and reduce the costs of Medicaid. And that’s how the Katie Beckett Waiver came to be. Prior to this, a child with complex medical needs had a harder time qualifying for Medicaid services because all of the financial resources of the parents were deemed as income.

The only way to get Medicaid benefits was to hospitalize a child for more than 30 days. As a result, children were placed into hospitals and institutions in order to meet the requirements. The Katie Beckett program allows Medicaid to cover private duty nursing for kids, regardless of the parents’ income and resources. 

Who is Eligible for the Katie Beckett Program? 

Katie Beckett allows children under the age of 19 who have complex medical needs or long-term disabilities to become eligible for Medicaid coverage. This enables children to receive care in a home setting rather than an institution. Only the child’s income and resources (NOT the parents’) are used to determine eligibility. 

Here are the eligibility requirements for Katie Beckett: 

• Under the age of 19
• U.S. citizen or eligible non-citizen
• Meet income and resource requirements 
• Meet the Social Security Administration’s disability requirement 
• Live at home 
• Require care typically offered in a hospital or nursing home 

There is no cost to the Katie Beckett Waiver. 

How Do I Apply for My Child? 

First, you need to find out if the Katie Beckett program is available in your state. If it is, you’ll need to speak with a Katie Beckett social worker to discuss what types of care and services are available and if you qualify for them. Your social worker can also walk you through the application process. 

The application process involves completing the application packet, which includes an application for medical assistance, a medical evaluation form and a parent questionnaire. Other documents to submit with your application include proof of citizenship, proof of identity and your child’s resources, as well as information about current health and dental insurance coverage. 

What are the Benefits? 

If your child qualifies for the Katie Beckett program, they are eligible for a full range of Medicaid covered services. Typically, an eligibility decision is made within 90 days. You can start using these services right away. There is no waiting period. 

Here are some examples of the types of care this waiver will cover: 

• Doctor visits
• Hospitalizations 
• X-rays
• Lab tests 
• Prescription drugs
• Dental and hearing screenings
• Behavioral health screenings
• Physical, occupational and speech therapy
• Medical equipment and supplies 

What if My Child Has Private Insurance? Am I Still Eligible? 

Having private insurance is actually a great thing! Not only are you still eligible for Katie Beckett, but also you may pay less out of pocket for pediatric services. Your private insurance gets the bill first, and Medicaid will pick up the costs your insurance won’t cover. Medicaid can pay for deductibles, copays, additional therapy visits and even non-covered services like diapers, personal care and transportation to doctor visits. 

Do I Have to Reapply Every Year? 

To keep your Medicaid coverage, your child has to be recertified every year. You will receive paperwork to fill out, and sometimes, a home visit is necessary to verify eligibility. We recommend keeping your recertification paperwork to make things easiest on you. 

Be sure to consult with your Katie Beckett social worker or your child’s long-term support service coordinator if you have questions. A complete and thorough application allows for faster decisions. 

What Happens after My Child’s 19th Birthday? 

The Katie Beckett Waiver covers children with complex medical needs up to their 19th birthday. Around age 18, it’s recommended that families apply for Supplemental Security Income (SSI). If approved, your child will receive a small cash benefit as well as full Medicaid benefits. 

You won’t see a difference in Medicaid benefits. They are the same benefits you receive with Katie Beckett. Your child can also apply for Medicaid at age 19. Only their income and resources are a factor, not yours. 

We Accept Medicaid. Contact Us Today. 

Continuum Pediatric Nursing has been providing pediatric home health care services since 1992. We accept Medicaid and private health insurance. We treat all patients and their families like part of our own family – the way it should be!

Our registered nurses and licensed practical nurses realize that having a medically complex child can be difficult at times, but we are here for you. You will always receive the understanding, compassion and support you deserve. Contact our team today to learn more about our pediatric services.