Katie Beckett Medicaid? - Mothering Forums

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#1 of 10 Old 11-25-2009, 05:49 PM - Thread Starter
 
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Is anyone familiar with this program? My daughter can't get SSDI Medicaid because we are over income. Someone told me about this but I can't get more info until next week because of the holiday.

Kim
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#2 of 10 Old 11-25-2009, 07:05 PM
 
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Its a medicaid program currently available in 20 states, including yours, that allows a child who would otherwise require an institution to receive medicaid based on their income and assets alone (instead of parents). We're planning to apply in the spring when we move to Georgia, since we'll lose SSI due to income.
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#3 of 10 Old 11-25-2009, 07:55 PM
 
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Also check into TEFRA. Its state medical insurance that allows kids with special needs to get insurance even if they are over income. The fees are based on parent income but they are very reasonable. I think it was about $48 a year for us when we first got it for my son. I keep seeing MN in my Google searches but i'm pretty sure this program or a similar one are available in more states, it might be called something else?

ETA: I actually think this is the MN version of the Katie Beckett Medicaid. They send the case file to a state review board to review and see if the child is eligible. Its a PITA but its worth it. While the rest of our family has had off and on insurance, my son has had great coverage the whole time. It pays for his PCA services and OT/PT/ST/ADAPT etc. Without it we wouldn't have any of that.

Mom to Joscelyne 14, Andrew 12, and Mackenzie 10 and wife to Nate.
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#4 of 10 Old 11-26-2009, 02:16 AM
 
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TEFRA was the act passed that allowed states to choose to have a Katie Beckett program. So yeah, same thing.
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#5 of 10 Old 11-26-2009, 01:54 PM - Thread Starter
 
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Unfortunately it looks like we have very little chance of getting it, all my DD disabilities are mental health related.

http://www.bazelon.org/issues/childr...EFRA/fact3.htm

TEFRA (Katie Beckett) Medicaid Option: State Policies

Issue
Families of children with serious mental or emotional disorders are often unable to obtain the specialized and intensive services their children need through their private insurance policy or by paying out-of-pocket. Medicaid provides the range of services children with disabilities require and can be a life-saving resource for these families. However, many such families have incomes too high to be covered under normal Medicaid rules.
more information

* Details on the TEFRA rules as they relate to children with mental disorders.

State Option
Under federal law, states have the option to cover children with physical and mental disabilities in the community if the child would be eligible for Medicaid institutional services but can be cared for at home. This option was authorized by the Tax Equity and Financial Responsibility Act of 1982 (TEFRA); it is sometimes called the Katie Beckett option after the child whose situation inspired it.

Children Who Are Not Covered
In half the 20 states that have the TEFRA option, no children with mental or emotional disorders have qualified for the program. While federal law does not permit states to exclude qualified children based on their disability, these states’ policies have effectively done just that. The states are: Connecticut, Georgia, Idaho, Massachusetts, Michigan, Nebraska, Nevada, Rhode Island, South Carolina and South Dakota.

State Policy Issues
State rules in these 10 states may be causing children with mental disorders to be in appropriately excluded under TEFRA. When states set policy for their TEFRA option they must do the following:

* clarify the definition of a medical institution that the child would need to be admitted to without the community services of TEFRA;
* define the level of care the state considers to be “normally provided” in these institutions;
* clarify how the state will decide that home care is appropriate for the child; and
* explain how the state will calculate that home care does not cost more than the alternative care in the medical institution.

In setting these policies, states can affect the degree to which children with mental disorders access the program. For example, state rules defining a medical institution and the level of care a child needs in order to be at risk of placement in such an institution can be problematic for children with mental and emotional disorders. A number of states include reference to “psychiatric hospitals” in their definition of medical institution. These states have children with mental disorders on TEFRA, while most of those that do not reference psychiatric hospitals do not.
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#6 of 10 Old 11-28-2009, 02:09 AM
 
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Hmmm, my child would not be placed in an institution but respite care (like once a month) was suggested several times by his ADAPT worker and other professionals and that was to help US as we were getting pretty burnt out (and his siblings) and I couldn't even work outside the house at the time because of it. It was never documented though, although I know he would have qualified for respite. Instead, after we got TEFRA, we got a PCA which allowed us to avoid respite care. It really sucks that they'd make it that hard to get and have such strict rules in some states. I mean, strict rules are good, but requiring the child to need to be institutionalized is unrealistic. It sounds pretty outdated, KWIM? Perhaps this way of looking at it would help if you could get some opinions from the professionals who work with your child and see what they say and what kind of documentation they can provide? Ours didn't require that, they just took the professional evaluations done by his various specialists along with his most current IEP and that all counted. His hours spent outside the mainstream classroom in the special ed classroom were considered as well.

Mom to Joscelyne 14, Andrew 12, and Mackenzie 10 and wife to Nate.
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#7 of 10 Old 11-28-2009, 09:07 AM
 
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There is something called a CAP waiver that is different from Katie Beckett Medicaid. It doesn't depend on your child otherwise needing institutionalization. A friend of mine with a child with cerebral palsy has a CAP waiver for him. Medicaid covers everything their private insurance doesn't cover. I looked into it for my son (autism) but the waiting list is years long and they prioritize it by need and his issues are mild so it seemed kind of hopeless, for us anyway.

In my state you have to get a case manager and apply for respite in order to get into some of the available services. I don't really understand the process, since we don't need respite. We need health care. But apparently that's what you have to do.
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#8 of 10 Old 11-28-2009, 02:55 PM
 
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Quote:
Originally Posted by Kristine233 View Post
Hmmm, my child would not be placed in an institution but respite care (like once a month) was suggested several times by his ADAPT worker and other professionals and that was to help US as we were getting pretty burnt out (and his siblings) and I couldn't even work outside the house at the time because of it. It was never documented though, although I know he would have qualified for respite. Instead, after we got TEFRA, we got a PCA which allowed us to avoid respite care. It really sucks that they'd make it that hard to get and have such strict rules in some states. I mean, strict rules are good, but requiring the child to need to be institutionalized is unrealistic. It sounds pretty outdated, KWIM? Perhaps this way of looking at it would help if you could get some opinions from the professionals who work with your child and see what they say and what kind of documentation they can provide? Ours didn't require that, they just took the professional evaluations done by his various specialists along with his most current IEP and that all counted. His hours spent outside the mainstream classroom in the special ed classroom were considered as well.
Institutionalized can mean many different things though. BY that, it can mean that the parents would be forced to give up care due to inability to fund necessary services. So DD would qualify based on the fact that her feeding tube supplies + medical bills are more than our monthly income. It was meant to provide for children who you can not financially meet the medical needs of (and autism services are viewed as a medical need, though not mental health in many of the states that have it). DD's medical needs would destroy us, but thankfully, we're still poor
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#9 of 10 Old 12-07-2009, 05:49 PM
 
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Each state sets its own eligiblity standards. Were you able to find the information you needed?
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#10 of 10 Old 12-08-2009, 12:16 PM - Thread Starter
 
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I have a preliminary appt this Thursday. But since I last posted about this DD has now been diagnosed Asperger's as opposed to PDD-NOS. This is great for our chances to get her the Katie Beckett Waiver. Now on to the waiting game

Kim
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