The Katie Beckett Program Explained: Medicaid for Autistic Kids No Matter What Parents Earn [2026]

You make too much for Medicaid. You have heard it from a caseworker, a website, or another parent, and for most families it ends the conversation. The Katie Beckett program exists to reopen it. Katie Beckett Medicaid, formally the TEFRA state plan option, covers a child with a significant disability based on the child's own income and assets, ignoring the parents' entirely. A family earning six figures can qualify, because the test was never about what you earn. It is about what your child needs.

Here is the fastest way to orient yourself, and the rest of this guide walks through each piece:

1. Check the three tests. Your child is under the age cap, needs an institutional level of care, and caring for them at home costs Medicaid no more than a facility would.
2. Find out what your state calls it. TEFRA, Katie Beckett, Deeming Waiver, or a lookalike under another name. About a third of states run the classic version; the state list below links to Spectrum Unlocked's guide for every state.
3. Apply this week, alongside everything else. Where it exists, Katie Beckett is an entitlement with no waitlist, so it can cover your child now while the state's waiver waitlist crawls.

Who Katie Beckett Was, and Why the Program Ignores Your Income

Katie Beckett was a toddler from Cedar Rapids, Iowa, left dependent on a ventilator after viral encephalitis. By 1981 she had spent most of her life in a hospital, paid for by Medicaid. Her doctors agreed she could be cared for at home for a fraction of the cost, but the rules of the time created an absurd trap: in the hospital, her parents' income did not count against her, but the moment she came home, it did, and she would lose the coverage that kept her alive.

Her parents fought, the case reached the Reagan administration, and in late 1981 the president ordered an exception so Katie could go home without losing Medicaid. Congress made the fix permanent in the Tax Equity and Fiscal Responsibility Act of 1982, which is why the program's formal name is the TEFRA option. The principle it established is the one your family can use today: a child who needs an institutional level of care should not have to live in an institution, or lose coverage, because their parents work.

That history explains the program's one hard edge. Katie Beckett was written for children whose needs are severe enough that Medicaid would otherwise be paying for facility care. It is not a general benefit for every disabled child, and the eligibility fight is almost always about whether your child's needs meet that bar.

The Three Eligibility Tests

Every version of the program applies some form of these three tests.

1. Age. The child must be under 18 in most states, under 19 in some, including Georgia. At the age cap the child transitions to adult pathways, where SSI rules change in the family's favor anyway because parental deeming ends. The federal programs guide covers that transition.

2. Institutional level of care. A physician and the state's medical reviewers must agree the child needs the kind of care Medicaid pays for in a hospital, nursing facility, or an intermediate care facility for individuals with intellectual disabilities. For autistic children this is the test that decides the application. An autism diagnosis by itself does not pass it; documented severe functional limitations do. Evaluations that spell out support needs for safety, elopement, communication, feeding, toileting, and behavior, hour by hour, are what reviewers can approve.

3. Cost neutrality. Caring for the child at home must cost Medicaid no more than institutional care would. Families almost never have to argue this one, because home care is nearly always cheaper. It exists in the statute, and it occasionally surfaces for children with extraordinary in-home nursing needs.

Pass all three and the financial test looks only at the child: their income, their assets. For most children that is nothing, which is why most children who clear the level-of-care bar clear the money bar automatically. The exception worth knowing: money in the child's own name, like a settlement or an inheritance, does count, which is one reason families use special needs trusts and ABLE accounts.

What Your Child Gets Once Enrolled

Full Medicaid, the same card every other Medicaid child carries. For autism families that typically means coverage for the services private insurance limits or refuses: ABA, speech, and occupational therapy, in-home supports, respite in some states, durable medical equipment, and incontinence supplies. If you have private insurance, you keep it, and Medicaid pays second, picking up copays, deductibles, and the therapy hours your plan caps.

Two practical notes. First, enrollment through Katie Beckett is the same Medicaid that unlocks other doors: many state programs and supports check for Medicaid enrollment rather than income. Second, where the classic TEFRA option exists it is an entitlement, not a lottery. There is no slot count and no waitlist. That is the single biggest difference between this pathway and the waiver system, and it is why the standing advice for every family is to apply for both at once.

Which States Have Katie Beckett

This is where the program gets confusing, because states run four different realities under similar names. Find your group below, then open your state's guide for the exact program names, phone numbers, and application steps.

Classic TEFRA / Katie Beckett states. The full or limited state plan option runs in Alaska, Arkansas, Delaware, Georgia, Idaho, Maine, Massachusetts (as the Kaileigh Mulligan program), Michigan, Minnesota, Mississippi, Nebraska, Nevada, Rhode Island, South Dakota, Vermont, Wisconsin, and West Virginia, plus the District of Columbia, with limited disability-only versions in New Hampshire and South Carolina. Georgia deserves a special mention: its Katie Beckett Deeming Waiver is one of the strongest and best-organized versions in the country, with a centralized application team.

Tennessee, the special case. Tennessee runs a program literally named the Katie Beckett Program, created by 2019 legislation, but it is not the classic uncapped TEFRA option. Part A provides full Medicaid for children with the most significant needs, prioritized by tier, with sliding-scale premiums above 150 percent of the federal poverty level. Part B is a capped package, up to $10,000 a year in services, without Medicaid enrollment. If you are in Tennessee, apply anyway. Just know the structure is tiered rather than an open entitlement, and TennCare requires a Part B determination first.

Lookalike states. California, Iowa, Kansas, Kentucky, Louisiana, Maryland, and New Jersey cover children through state plan amendments or 1915(i) options that behave like Katie Beckett, ignoring parental income, without using the TEFRA name.

No-pathway states. The rest, including Alabama, Texas, Utah, and Florida, offer no TEFRA or lookalike option. There, a middle-income family's route to Medicaid is a Home and Community-Based Services waiver with its waitlist, which is exactly why the get-on-every-list rule matters most in these states. The state comparison guide ranks how every state's system treats autism families.

How to Apply

The mechanics differ by state, and your state's guide has the specific office, forms, and phone numbers. The shape is the same everywhere:

1. Call your state Medicaid agency and ask for the TEFRA, Katie Beckett, or disability-based children's Medicaid application. Use all three names. Some front-line staff only know their state's label, and some will wrongly tell you the program does not exist. If you get a flat no, ask for the children's disability unit.
2. Get the physician forms started the same day. Every state requires a physician's certification of the level of care, and the forms usually have short validity windows, sometimes 90 days. This is the slowest link, so start it first.
3. Build the documentation file. Diagnostic reports, current therapy evaluations, school or IEP records, and a plain-language log of a typical day's support needs. Level-of-care reviewers approve specifics, not diagnoses.
4. Submit and calendar the response deadline. States must act on Medicaid applications within federal timeframes, generally 90 days for disability-based applications. Silence past the deadline is itself appealable.
5. If denied, appeal inside the window. Most denials are level-of-care denials, and many reverse when fuller documentation reaches a hearing. Your state's free protection and advocacy organization handles exactly these cases; every state guide names the one that covers you.

If your child is denied and the appeal fails, you are not out of options. The waiver system, SSI at 18, and state programs each have separate doors, and the IEP and school-services system runs on entirely different money.

The Bottom Line

The Katie Beckett program is the closest thing American Medicaid has to a simple promise for families like yours: if your child's needs are institutional in scope, your paycheck does not disqualify them from care. Whether your state honors that promise fully, partially, under another name, or not at all is an accident of geography, so the one action that is right everywhere is to find your state's version this week and apply, alongside every waiver list your state runs. You can always decline later. You cannot apply retroactively.