Katie Beckett covers full Medicaid benefits for children under 19 with significant disabilities or complex medical needs, allowing them to receive care at home instead of in an institution. The coverage includes hospital care, physician visits, therapies, home health services, durable medical equipment, and in some states, additional home and community-based supports worth up to $15,000 per year. The key feature of the program is that it determines a child’s eligibility as if the child were living alone, meaning parental income and resources don’t count against the child’s ability to qualify.
How Katie Beckett Eligibility Works
Katie Beckett isn’t a single program with one set of rules. It’s a Medicaid pathway, sometimes called the Katie Beckett option or waiver, that individual states can choose to offer. The core idea is the same everywhere: a child who is disabled enough to qualify for care in a hospital, nursing home, or similar facility can instead receive Medicaid-funded care at home.
To qualify, a child must be under age 19, have a disability, and meet what’s called an “institutional level of care.” That means a medical evaluation determines the child’s needs are serious enough that they could appropriately be placed in a medical facility. The child must also be better served at home, and the cost of home care must not exceed what institutional care would cost. Medicaid evaluates the child’s financial eligibility using a hypothetical: it assumes the child is in an institution and living alone. That assumption strips away parental income and resources from the equation, which is the entire point. Many families with disabled children earn too much for their child to qualify for standard Medicaid but cannot remotely afford the level of care their child needs. Katie Beckett closes that gap.
Medical Services Covered
Once approved, a child receives a Medicaid card that works like any other insurance card. The coverage includes preventive health care, specialist visits, hospital inpatient and outpatient services, and personal care services. Children also get coverage for physical, occupational, and speech therapy, which are often central to managing developmental and physical disabilities.
Home health services, including private duty nursing, are covered as well. For children who need skilled nursing care around the clock or for extended hours, this is frequently the most valuable part of the benefit. Some services require prior authorization from Medicaid before they can begin, so your child’s provider may need to submit documentation showing medical necessity.
Equipment, Supplies, and Prescriptions
Durable medical equipment is a major category of Katie Beckett coverage. This includes wheelchairs and wheelchair accessories, hospital beds, respiratory care equipment, prosthetics, orthotics, and ostomy supplies. If your child needs home parenteral nutrition (IV nutrition delivered at home), that falls under this category too. Prescription medications are covered under the standard Medicaid benefit.
The specific brands, models, or quantities of equipment approved can vary by state Medicaid rules, and higher-cost items like powered wheelchairs typically require prior authorization and supporting documentation from a physician.
Home and Community-Based Services
In states that structure Katie Beckett as a waiver program, children can access additional non-medical services designed to keep them at home with their families. Tennessee’s program, for example, provides up to $15,000 per year in home and community-based services under its Part A. These include respite care (temporary relief for family caregivers), supportive home care, and modifications to the home or vehicle to accommodate the child’s disability.
Tennessee also offers a Part B option with a flexible budget families can direct toward premium assistance for private insurance, a health-care savings account, reimbursement for beneficial services not otherwise covered, or self-directed respite and supportive home care. This kind of flexibility is not universal. Each state designs its own version of the program, so the menu of home and community-based services varies significantly depending on where you live.
Case Management
Many state programs include dedicated case management as part of the benefit. A case manager, often through a home health agency, coordinates your child’s care across providers and services. They help ensure therapies, equipment, nursing, and medical appointments are aligned, and they can assist with navigating prior authorizations and service limits. Connecticut’s program, for instance, specifically includes case management by a home health agency alongside standard Medicaid-covered services.
What Families Pay
Cost sharing depends on where you live and your household income. Some states charge no premiums at all. Others use a sliding scale tied to the federal poverty level. Tennessee’s program charges monthly premiums for Part A families earning above 150% of the federal poverty level, starting at $25 per month for families in the 150% to 250% range and increasing to $350 per month for those between 500% and 600%. For every additional 100% above 500%, the premium rises by $70. These premiums are reduced by whatever the family already pays for employer-sponsored or private health insurance covering the child.
In Tennessee, the first two months of premiums must be paid before enrollment begins. Premium amounts may be adjusted annually as the federal poverty level changes. States without premium requirements may still have small copays for certain services, consistent with their broader Medicaid rules.
How Coverage Varies by State
Not every state offers a Katie Beckett option, and those that do structure it differently. Some states implement it as a Medicaid state plan amendment, which means the child simply receives the state’s full Medicaid benefit package. Others use a waiver, which allows the state to add services beyond standard Medicaid, like respite care or home modifications, but may also impose enrollment caps or waiting lists.
The core medical benefits (physician visits, hospital care, therapies, equipment, home health) are fairly consistent because they come from the standard Medicaid benefit. The biggest differences show up in the extras: whether respite care is included, how many hours of private duty nursing are authorized, whether home or vehicle modifications are covered, and whether case management is built in. If you’re exploring Katie Beckett for your child, your state Medicaid agency’s website will have the specific service list and any limits that apply in your state.