Funding Guides
The Katie Beckett Waiver, Explained for Families
An old Medicaid rule lets children with significant disabilities get full health coverage, speech therapy included, no matter what their parents earn. Here is how it works, who it is really for, and how to apply in your state.
Verified August 2026Where This Rule Came From
In 1981, a three-year-old in Iowa named Katie Beckett was living in a hospital. She needed a ventilator, and Medicaid would pay for her care, but only in the hospital. If her parents brought her home, where care cost a fraction as much, their income would disqualify her.
Her parents fought. The story reached President Reagan, who called the rule absurd and changed it. Since then, states can cover a child with significant disabilities based on the child's own income, not the parents'. Katie went home, grew up, and lived to 34. The rule carries her name.
Is This Your Door?
Katie Beckett has one big gate: your child must need an institutional level of care. In plain words: without support at home, would your child qualify for care in a hospital or nursing facility? It is about significant disability or complex medical needs, not any one diagnosis.
Likely Worth Applying
Children with significant developmental disabilities, complex medical needs, autism with high support needs, genetic conditions, feeding tubes or medical technology, or several therapies and specialists at once. If your child sees a team, not just one therapist, apply.
If Your Child's Only Diagnosis Is a Speech Delay
Katie Beckett is probably not your door, and that is genuinely good news about your child's needs. Your doors are Early Intervention (free evaluations before age 3), school services, your state's education scholarship if it has one, and grants like Small Steps in Speech.
What Your Family Would Get
Full Medicaid for your child, working as secondary insurance behind your private plan. For speech therapy specifically, that means Medicaid's children's benefit (EPSDT) covers medically necessary therapy with no visit caps, and the copays and coinsurance your private plan leaves behind largely disappear. Families routinely describe this as the difference between rationing therapy and following the plan their SLP actually recommended.
How to Apply, in Five Moves
Find your state's version below.
About half the states run a true Katie Beckett/TEFRA option. Most others reach the same door through a Medicaid waiver with the same income rule and a waitlist.
Gather the medical picture.
Diagnoses, specialist letters, therapy evaluations, hospitalizations. The application is won on documentation of need, so ask every provider for records before you start.
Expect the SSI detour in some states.
Several states first want an SSI denial letter showing your income is too high. That denial is not a failure; it is a required ticket. Keep it.
Apply, and treat a denial as round one.
Level-of-care decisions get appealed and reversed all the time. Families who appeal with stronger documentation often win. Your state's Family-to-Family Health Information Center will help for free.
If your state uses a waitlist, join it this week.
Waiver lists move by application date. Every month you wait to apply is a month added to the end. Join even while you pursue everything else.
The one move families regret skipping: joining the waiver interest list early. In waiver states, the list is the door, and your place in line is set by the day you call, not the day your child needs it most.
Your State's Version
Verified August 2026. “Open” means no waitlist reported. Availability and rules change; each program's own site is the final word.
| State | What it's called | Status | Worth knowing |
|---|---|---|---|
| Alaska | TEFRA (Disabled Children at Home) | Open | No waitlist; periodic clinical re-review |
| Arkansas | TEFRA | Open | Sliding monthly premium above 150% FPL |
| Connecticut | Katie Beckett Waiver | Waitlist | 300 slots; historical waits of 6 to 7 years |
| Delaware | CCADP | Open | The state's only parental-income-disregard path |
| DC | TEFRA / Katie Beckett | Open | Decisions within 60 days |
| Georgia | Katie Beckett (Deeming Waiver) | Open | Paperwork-heavy; new application portal 2026 |
| Idaho | Katie Beckett Program | Open | Income-based premium; independent assessment |
| Louisiana | Act 421 Children's Medicaid Option | Open | Newer program (2022); annual level-of-care review |
| Maine | Katie Beckett Option (MaineCare) | Open | Monthly premium set by parental income |
| Massachusetts | Kaileigh Mulligan Program | Open | CommonHealth is the easier fallback (no care-level test) |
| Michigan | Home Care Children's (TEFRA) | Open | No waitlist |
| Minnesota | MA-TEFRA | Open | Apply through your county |
| Mississippi | Disabled Child Living at Home | Open | Needs 12 months of care documentation |
| Nebraska | Katie Beckett Program | Open | Expanded July 2024; speech pathology explicitly covered |
| Nevada | Katie Beckett Eligibility Option | Open | Standard institutional level-of-care bar |
| New Hampshire | Home Care for Children with Severe Disabilities | Open | Classic Katie Beckett rules |
| Oklahoma | TEFRA (SoonerCare) | Open | Requires an SSI denial letter first |
| Pennsylvania | Medical Assistance PH-95, "the loophole" | Open | The most generous version: disability standard, no care-level test |
| Rhode Island | Katie Beckett (TEFRA) | Open | Covers developmental and psychiatric disabilities too |
| South Carolina | TEFRA (Katie Beckett) | Open | SSI disability standard applies |
| South Dakota | Disabled Children's Program (TEFRA) | Open | Use this before the waitlisted waiver |
| Tennessee | TennCare Katie Beckett, Parts A and B | Waitlist | Part B ($10k/yr flexible funds) catches many who miss Part A |
| Vermont | Disabled Children's Home Care | Open | No premium, no waitlist |
| Wisconsin | Katie Beckett Program | Open | No waitlist, unlimited spots |
| No TEFRA option | AL, AZ, CO, HI, IL, IN, IA, KS, KY, MO, MT, NJ, NM, NY*, NC, ND, OH, OR, TX, UT, VA, WA, WV, WY | Waiver route | Same income rule via Medicaid waivers; waitlists range from none (WI-style) to 13+ years (TX). Join the list first, ask questions after. *Some states run near-equivalents; check each state's actual door. |
Waitlist honesty: in waiver-route states the wait ranges from months to many years. That is not a reason to skip it; it is the reason to apply this week and pursue your other doors in parallel.
Questions Families Actually Ask
Is parental income really ignored?
In true Katie Beckett states, yes: eligibility counts only your child's own income and assets. A few states (Arkansas, Idaho, Maine) charge a sliding premium based on your income, but the premium does not affect eligibility.
We have good private insurance. Is this still worth it?
Often, yes. Medicaid rides behind your plan as secondary coverage: it picks up copays and coinsurance and covers medically necessary therapy your plan caps or denies. Families with high-deductible plans usually feel the difference most.
Will this take services away from another child?
No. Katie Beckett state-plan options are entitlements: qualifying children are covered, full stop. Only the waiver-route states have fixed slots.
My child was denied. Is that the end?
Usually it is the beginning. Level-of-care denials are commonly overturned on appeal with better documentation. Every state has a free Family-to-Family Health Information Center that helps families do exactly this.
Does applying affect our taxes or our other benefits?
Applying does not. If approved, your child gains Medicaid; nothing about the program takes income or benefits away from your family.
The Right SLP Knows Your State's Doors
SLPs who work with families navigate these programs every week. Find one near you in our free directory, and bring this guide to your first conversation.
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