The Katie Beckett Medicaid Waiver is a state-specific program allowing children with a high level of care need to be included in Medicaid coverage. It's an incredibly helpful resource to those who are approved, but the approval process is not for the faint of heart. It has many convoluted steps, requires a high level of organization and detail, and is a very large learning curve. Having just been through the application process myself, I know from first-hand experience just how difficult it can be to find reliable resources for how to fill this application out. This page is my step by step guide to applying for Medicaid through the Katie Beckett waiver in Georgia. I'll provide links to additional pages on my site and in other locations where you can read more information on each step. To scroll down to a specific section, click on a box below.
An Introduction - What is Katie Beckett? Should I apply?
This program goes by several different names. You might hear folks refer to it as a TEFRA Waiver, Katie Beckett, Deeming Waiver, or just Medicaid. Started in the 80s, this government program allows children with a high level of care need to be considered for Medicaid coverage regardless of the amount of their parents' income. If you qualify for Medicaid based on your income, you do not need to apply for Medicaid through the Katie Beckett program. If your child has a high level of care need and you do not qualify for Medicaid based on your income, the Katie Beckett program could prove very helpful for you.
If you are approved, Medicaid will act as your secondary insurance, covering approved medical services and supplies where your primary insurance coverage may not. As an example, our primary insurance covers a limited number of occupational and physical therapies per year. Having Medicaid through the Katie Beckett program allows us to pursue additional therapies for our daughter beyond what our primary insurance will cover. That translates to an enormous cost savings for us as a family, allowing us to follow through with her prescribed therapies during her early years to maximize long-term success. This works best if you are NOT on an HMO plan, because in order for services to be covered under Medicaid, both the referring professional and the professional providing the service MUST be in-network with Medicaid. If you have an HMO primary insurance plan, the overlap of in-network requirements between your HMO and Medicaid will simply be too small a number of people to be effective.
Because Medicaid is administered at the state level, the process varies by state. Your application will be reviewed by a team in your state. Knowing what those reviewers are looking for is helpful as you consider whether or not you'd like to apply. The state summary of what their guidelines are for this program can be found here. In general terms, reviewers are looking for children with clear, documented medical needs. They are looking for a diagnosis and prescribed plan of care by medical professionals indicating that a high level of care is needed and will be effective for the child. Examples of a high level of care most commonly include in-home nurse support or traditional therapies (occupational, physical, and speech).
A couple of notes here that I've picked up on and can be helpful: an autism diagnosis alone is not enough to qualify for Katie Beckett. Unfortunately, the autism diagnosis has become a bit of a catch-all that has a very wide range of possible severity and need. The reviewers would need other diagnoses in addition to the autism diagnosis to get a fuller picture of the child's level of need. Additionally, if your child's main medical need is a high frequency of therapy (like us), they will need to have specific test scores on a psychological evaluation in order meet the criteria. Please read my detailed page on How to Qualify to help you decide if you should dive into all of this hard work!
If you apply for Medicaid through the Katie Beckett program but are denied, you can then qualify for other grants and services designed for folks who are denied Katie Beckett. To read more about the background of the Katie Beckett program and considering whether or not you should apply, read my post on the topic: Katie Beckett Basic Overview. If you're ready to dive in to the application process, keep scrolling and get started!
Katie Beckett Professionals in Georgia
If you want help from the pros as you work through your application, or just want to talk with someone to see if you should apply, these folks are all great places to reach out. They work on Katie Beckett applications all day, every day. They know this inside & out.
Cam & Madi's Promise
Sheila Carter was an invaluable resource to me as I walked through this application. Through her nonprofit, named after her two special needs kiddos, she receives donations so that she is able to help parents navigate this application without charging a fee.
Professional Advocate
Debbie Dobbs is a well-known Katie Beckett specialist who helps families complete their application for a fee. I have worked with her and she both thorough and experienced. She will save you a ton of time and headache.
Special Needs Attorney
DJ Jeyaram is a special needs attorney who specializes in helping folks who have had a Katie Beckett denial get approved. He's completed our Special Needs Trust documentation, and I would definitely use him for Katie Beckett if needed.
Disclaimers
I am not an attorney, medical professional, or professional advocate. I'm just a mom who has been through it and would like to help others have a smoother experience than I had. 🙂 I'm hopeful that these resources will be helpful to you and I will do my best to keep them updated and relevant, but please note that following my advice is no guarantee of approval. Also, please note that I live in Georgia, and Medicaid applications are state-specific. If you live in another state, find resources specific to your state to use as a guide.
Step 1 - Get Organized & Take a Deep Breath
As you are starting, know that you will need stamina and determination to get this application out the door. You will also need help. Communicate with your key support folks that you will need extra help over the coming weeks as you are filling out this application. This might be meals, errands, or help with childcare so you can make trips to doctor offices. For me, the application took me two months to complete. I'm told that is relatively quick. It could take longer depending on how many medical visits you need to have to include in your application (more details below). I would estimate my husband and I spent a combined total of 40-50 hours on this application. Hopefully, with this guide, I can spare you some portion of that time, or at least minimize some surprises along the way.
You'll need to have a plan for staying organized. Our application ended up being 280 pages, and I had to keep the documents meticulously organized so that I didn't get lost. Whether you have physical file folders or electronic ones, know that you'll need a system and backups. Don't just save it on your local computer! You'll also need a central place for your notes so you can keep track of conversations with doctor offices and getting questions answered as you go. I promise you, it's way too much to keep in your brain.
Note that there is an online application process on the GA Medicaid site, but apparently that will often route your application to the wrong place. As it stands currently, the best option is to do a paper application.
To read about the organizational setup that worked best for us, check out my post on getting started.
Step 2 - Schedule Appointments & Gather Doctor Reports
The one aspect of this application that will take the most number of days in your timeline is scheduling doctor appointments and obtaining the medical records from those appointments. Because this is the most time-intensive part, your first step is to find specialists and schedule appointments so that you can obtain ALL of the following documents:
- Any diagnostic tests applicable (i.e. genetic or blood test results)
- Reports from applicable diagnosing specialists for any of your child's diagnoses
- Developmental Assessment (for children ages 0-5) OR Psychological Evaluation (for children 6+) completed by a qualified professional within the past year IF you are applying for a ICF/ID Level of Care qualification
- Evaluations & plans of care within the past year from Physical, Occupational, Speech, and/or Behavior Therapists (as applicable)
- Notes from physical, occupational, speech, and/or behavior therapy sessions for the past 90 days
- Individualized Family Service Plan (IFSP) from Early Intervention (Babies Can't Wait in GA) less than a year old if your little one is under 3
- Individualized Education Plan (IEP) less than a year old from the school system if your child is 3 or over
- Request a full copy of your child's medical record from their primary care physician - you won't include all of this in your applicaiton, but there are many pieces of this that will be helpful to you, both for this application and for many other things in the future.
- Now is a good time to make sure you have your child's birth certificate and social security card available. You can go ahead and scan these if you have them ready, but if you need to make any kind of arrangements to get access to these documents, now is the time to initiate that process.
. Please read this information in detail as it can take multiple months to get on the schedule for these tests.
Obtaining reports from tests and evaluations will require appointments you may not have had yet. Scheduling each of these appointments will take some time and patience. Explain to your providers that you are working on a Medicaid application under the Katie Beckett waiver and ask them to schedule you as soon as possible. Get on the cancellation list and be willing to rearrange your schedule at a moment's notice to get in sooner. Before your visit, send them an email explaining that you are applying for Medicaid under Katie Beckett and let them know what you'd like to discuss or complete with them during your visit. During your office visits with them, remind them that you are applying for Katie Beckett and what kind of reports and test results you would like to obtain from your visits so that you can include them in your application. If you decide to have that specific provider help you with your Physician Forms (Step 3 below), discuss that with them at the visit.
As soon as they are available, request the reports/tests/notes. Every office has a slightly different procedure for allowing you to obtain those, so keep detailed notes on each one, respond to their directions quickly, and get the documents as soon as possible. Once you have them, make sure you make an electronic copy in a safe spot with a backup.
Keep in mind that you will end up requesting therapy notes twice in this process. The first time will be now, at the very beginning of the process, to gather notes from up to three months prior. The second time will be a request very close to the time you actually send in your application, where you will ask for notes from additional visits that happen in the meantime. When you do request these therapy notes, they must be signed. Verified electronic signatures are fine, but they must be signed.
To dig in a bit deeper on scheduling your appointments and gathering doctor reports, check out my post on Getting Started.
Step 3 - Physician Forms
Once you have appointments scheduled and requests in place for the documentation, it's time to start working on the actual application forms. This process is confusing. There are not clear directions provided by the state on how to fill them out. This is where the experience of others who have filled out these forms becomes absolutely necessary. I had no less than three sources I used for guidance on how to fill these forms out. You'll have the benefit of the answers to all of the questions of my very kind helpers.
The most recent versions of most of the forms are available from the Georgia Medicaid website. The Atlanta Speech Therapy website has become a go-to for snagging the forms, but there are several problems with that download that I explain here. In summary, I can't recommend AST's page as an accurate source. I downloaded each of the forms from the Medicaid website directly to make sure I had updated and clean versions, saved them in my electronic filing system, and filled them out using Adobe Acrobat Reader. The free version allows you to complete them electronically using the 'Fill & Sign' function. That way, you can save electronic versions of the form with everything but the signature & date ready to go so that you can make corrections, print new copies, or use them for renewals in future years.
Because you have to wait on the physician to complete and/or sign these forms, these will take some time and will need to be started before your Personal Forms (Step 4). Some doctors are familiar with these forms and very willing to help complete them. Some doctors have little to no experience and will fill them out with mistakes that will certainly result in a denial. Whether you have a physician offer to fill these out or they are only willing to review & sign them, you will need to be thoroughly informed on how they should be completed to ensure that they will be accurate.
Most folks ask their child's pediatrician to complete all of these forms. It can also be another key specialist: neurologist, geneticist, cardiologist, etc., as long as that physician (MUST be an MD, not a therapist) has a clear understanding of your child's condition and need. Your pediatrician has to be the one to complete a comprehensive prescription and diagnosis list (#4 in the list below), so it may be simplest to ask them to do the other three forms as well. You can coordinate gathering these signed forms with your Step 2 efforts by picking up medical records from whatever physician ends up filling out the forms, or maybe even with an appointment so you don't have to make multiple trips to the same office.
Here is a complete list of all of the Physician Forms that will be included in your application:
- Physicians Recommendation Pediatric Care Form (DMA6)
- Level of Care Statement (DMA-706)
- Cost Effectiveness Form (DMA-704)
- Prescription Order of Medical Necessity
For details on how to complete each form as well as a link to download each of the current blank forms, visit my detailed Physician Forms page.
Step 4 - Personal Forms
As you are waiting for provider appointments to happen, test results to come in, and doctor/therapy notes/forms to be provided to you from Steps 2 & 3, you can start working on your personal forms. Compared to the Physician Forms in Step 3, these are a breeze, so just work on them as you can. Always give priority to what is happening in Steps 2 & 3 so you can keep those moving as quickly as possible.
Here are the forms you'll be filling out (mostly) solo:
- Medicaid Application (Form 94)
- Third Party Liability Questionnaire (DMA-285)
- Voter Registration Declaration Statement
- HIPPAA Notice of Privacy Practices
- Supplemental Documentation
To dig in to each of these forms, download blank ones, and view examples, visit my Personal Forms page.
Step 5 - Pull It All Together & Submit!
Believe it or not, at some point, you'll start to see a light at the end of the tunnel with all of your reports, results, and physician forms coming in. When this happens, plan a tentative date when you'd like to submit your application. Of course you may have to adjust it by a day or two, but start looking at a submit date and planning accordingly.
Once you've selected a date, here are the final prep steps:
- Make a Table of Contents
- Number the pages
- Sign and Date
- Prep & Send the Package
After your package has been delivered, it's time to wait and see whether you've been approved. To view step-by-step suggestions on your final preparation steps, visit my detailed package prep page.
Updates in progress (April 2023)