Tax Equity and Fiscal Responsibility Act (TEFRA)/Katie Beckett

TEFRA/Katie Beckett is an eligibility pathway for the Medicaid Program. It is for certain children who have long-term disabilities or complex medical needs and live at home. It allows children to receive services at home with additional supports, instead of in an institution. Under TEFRA/Katie Beckett, only the child’s income and resources are considered (not those of the parents). For more information on TEFRA/Katie Beckett, please read the TEFRA/Katie Beckett Fact Sheet and Frequently Asked Questions document.

Who is Eligible?

To be eligible for DC Medicaid under TEFRA/Katie Beckett, the child must:

Be a resident of the District of Columbia;
Be a US citizen or have eligible immigration status;
Be eighteen (18) years old or younger;
Have income less than 300% of Supplemental Security Income (SSI) and resources totaling less than $4000.
Have a disability that is terminal or expected to last for more than (twelve) 12 months (or otherwise meet the definition of disabled under the Social Security Act);
Require a level of care (LOC) that is typically provided in a hospital, skilled nursing facility, or intermediate care facility (including intermediate care facilities for people with intellectual disabilities);
Be able to safely live at home; and
Not be eligible for Medicaid under a different eligibility category.

Additionally, the estimated cost of providing care in the home cannot cost Medicaid more than if the child were served in an institution.

Medicaid and other insurance

A child may have DC Medicaid (under TEFRA/Katie Beckett) and other health insurance. In those instances, the other insurance is billed first and then Medicaid provides “wrap-around” coverage for medically necessary services that a private insurance plan may not cover.

TEFRA/Katie Beckett Application Process & Required Documentation

Step 1: Log in to dchealthlink.com to complete an application for financial assistance to apply for Medicaid or complete the application process by phone, mail or in person if needed. Once an application is submitted:

The applicant will be screened for MAGI Medicaid coverage and receive a decision within forty-five (45) calendar days.
If the applicant meets all non-financial and financial requirements, the applicant will be determined eligible for MAGI Medicaid and will receive an approval notice.
If applicant does not meet all non-financial and financial requirements, the Department will issue a notice to the applicant of their ineligibility for MAGI Medicaid and their opportunity to be evaluated for Medicaid through the TEFRA/Katie Beckett eligibility group.
In cases where an applicant is denied for over income and there is a child with a disability in the household, a TEFRA/ Katie Beckett Application Packet will be mailed to the applicant.

Step 2: Once an applicant receives a TEFRA/Katie Beckett Application Packet, the applicant can submit the TEFRA/Katie Beckett Application Form to the Economic Security Administration (ESA) in one of the following ways:

Fax the completed application to (202) 724-8963.
Send by postal mail to:
DC Economic Security Administration
Attn: Medicaid Branch
645 H St. NE
Washington, DC 20002
Submit by email by calling the ESA help desk for assistance at (202) 698-4220
Submit in person at an ESA Service Center. Look for the nearest service center at https://dhs.dc.gov/service/find-service-center-near-you or call (202) 724-5506.

Step 3: An applicant must submit the following completed Level of Care (LOC) Determination documents to the Division of Children’s Health Services (DCHS) at the Department of Health Care Finance (DHCF) via email at [email protected]:

Pediatric Level of Care Determination Form;
TEFRA/Katie Beckett Care Plan Form; and
Supporting documents, such as the Letter of Medical Necessity, the Individualized Education Program / Individualized Family Service Plan, therapy assessments, including diagnostic reports.

Step 4: The District will make an eligibility determination within sixty (60) calendar days of receipt of the completed TEFRA/Katie Beckett Application Packet.

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