There are two categories of qualification for Katie Beckett: Nursing Facility or ICF/ID level of care. There are also a couple of unique details to note if you are looking for Medicaid to cover ABA therapy. Read more about each category of guidelines below.
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.
Nursing Facility Levl of Care Qualification
Some children need the help of the Katie Beckett Medicaid waiver for medical needs only. In this scenario, Medicaid can be invaluable to cover blood transfusions, nursing care, medicines, medical supplies, etc. If you are looking to apply for Katie Beckett under this category, you do NOT need a Developmental Evaluation or Psychological Assessment.
In page 1 of the Level of Care Statement on the Georgia Katie Beckett website, it lists the following information about qualifying for this category. These individividuals are not required to be in hospital care, but regularly require "licensed nursing services, rehabilitation services, or other health-related services ordinarily provided in an institution." Again, this is referring to medical care, NOT developmental delay or intellectual disability.
To qualify for this category under Katie Beckett, the medical services must be ordered by a physician, furnished by licensed personnel, have to be performed by professional personnel (i.e. registered nurses, not mom & dad), and the person must require these skilled nursing services seven days per week or rehabilitation services (nursing, physical therapy, etc.) at least five days per week. Please read the Level of Care Statement provided by the state of Georgia to make sure you understand this category the qualifications necessary.
If your child is like mine, they may not have any severe medical needs, but require a high frequency of weekly therapies to address a devleopmental delay, cognitive impairment, or intellectual disability. For Medicaid application purposes, this is called an 'Intermediate Care Facility for Intellectual Disability' level of care, or ICF/ID. In everyday English, this means the patient requires a high frequency of therapies to address their developmental delay or intellectual disability, and the caregivers prefer to provide that level of care while the patient is living at home instead of a rehabilitative facility.
Most parents are applying for Medicaid for their child under this category. In order to qualify, your child must have at least one of the following test scores:
- IQ of 70 or below, OR
- A standard score of less than 70 on at least three of the five domains of function (cognitive, language, motor, social-emotional, and adaptive) on a standardized developmental assessment tool OR an overall standard score of less than 70, OR
- A standard score of less than 70 in at least three domains of function on a standardized adaptive functioning or an overall composite score of less than 70, OR
- A Childhood Autism Rating Scale (CARS) score of above 37, or the Gilliam Autism Rating Scale (GARS) score is 121 or greater.
If your child is 0-5 years of age, the test they will need to have completed is called a Developmental Evaluation. If your child is 6 or over, they will need to have a Psychological Evaluation completed. These tests need to be within the past 3 years. If your little one is turning 6 soon, a Psychological Evaluation is required immediately following their sixth birthday no matter how recently you have had a Developmental Evaluation, so plan ahead.
There is also a list of qualifications for the person who is able to complete this testing for your child. This person must sign and date the report and list their credentials.
- Developmental Pediatrician
- PhD Psychologists
- School/educational psychologists or diagnosticians with the following credentials: MEd, EdS, MA, MS, CAS, CAGS, PsyS, PsyD, SSP, or EDD.**
- An Individualized Family Service Plan (IFSP) from Early Intervention / Babies Can't Wait
Once you have determined which of the above options to proceed with, make sure you communicate with the professional the type of assessment you need (Developmental Evaluation for 0-5 and Psychological Evaluation for 6+) you need and that you are using it for a Katie Beckett Medicaid application. Communicate clearly with them that they must sign and date the report, list their credentials, and that you need the composite scores for all of the tests they complete, which is a very common missing piece. As noted above, the composite score can allow your child to qualify even if individual domains do not.
**Please note that, if you are looking to have help covering Applied Behavioral Analysis (ABA) therapy, a school evaluation will not be sufficient to qualify. You will need to use a different option from the list above.**
Keep in mind that many professionals who provide this testing are often busy months out, so this needs to be one of the first things you get on the calendar if you decide to proceed with your Medicaid application in this category.
Please read both the Manual and the Level of Care Statement on the Georgia Katie Beckett Medicaid Waiver website to make sure you understand all of the details. I also highly recommend Debbie Dobbs' most recent webinar on this topic (also linked below).
My original sources for pooling all of this information...
Parent to Parent has an hour-long archived webinar that walks you through the Katie Beckett application in detail, including each of these Physician Forms. You'll submit your email address in order to receive a link to the video, but their emails are worth getting anyway.
Sheila Carter has two special needs kiddos and knows her stuff inside & out. She founded a nonprofit, Cam & Madi's Promise, so she could help parents with this application at no cost. She was an invaluable resource to me and answered dozens of questions on these dizzying forms!
If you'd like a professional to help you complete these forms, consider engaging with a professional advocate that does this for a living. There is nobody more experienced than Debbie Dobbs. She does charge a fee but she will also save you a ton of time and headache.