About the Program
The Katie Beckett Program is a special eligibility process that allows certain children with long-term disabilities or complex medical needs living at home with their families, to access Wisconsin Medicaid coverage. Eligibility for the Katie Beckett Program is based on the child’s disability and care needs rather than the family’s income. This program is for children who are living at home, but who need the kind of skilled health care or treatment that would be provided in a hospital or nursing home settings.
If your child is not eligible for Medicaid because your income or assets are too high, your child may be eligible for Medicaid through the special eligibility provisions of the Katie Beckett Program. All the following eligibility criteria must be met by your child.
- The child is under 19 years of age and determined to be disabled by standards in the Social Security Act;
- Requires a level of care at home that is typically provided in a hospital or nursing facility;
- Can be provided safe and appropriate care in the family home;
- As an individual, does not have income or assets in his or her name in excess of the current standards for a child living in an institution; and
- Does not incur a cost at home to the Medicaid Program that exceeds the cost Medicaid would pay if the child were in an institution.
This is a gateway to straight Medical Assistance, and does not provide any additional benefits to MA.
- Family calls regional Katie Beckett Consultant to request an application
- Consultant screens application request based on the following
- Age of child (under 19)
- WI residency
- US citizenship
- Eligibility for other sources of MA such as SSI
- Child living at home with family
- Assets/income of child (assets of under $2,000, income less than $1809/mo as of 2007)
- Child's diagnosis and level of functioning
- If appropriate, consultant will send the family an application packet, which includes application, releases of information, health insurance information, and asset/income information. A family always has the right to apply if they so desire.
- If application is not appropriate, consultant will try to refer family elsewhere when possible
- Family completes the application
- Family calls consultant to schedule a home visit
- Consultant visits with child and at least one parent in their home
- Consultant reviews completed application materials and signs
- Consultant verified citizenship via birth certificate or passport and identity via passport or photo ID
- Consultant verifies financial documentation
- Consultant provides family with information about the Katie Beckett Program
- Consultant answers family's questions and provides resources when possible
- Consultant takes application and medical/therapy/education records at the end of the home visit
Eligibility Determination (2-4 Month Process Unless Processed as a Presumptive)
- Consultant completes a CLTS Functional Screen on behalf of the child and then sends the application and accompanying documentation into the Katie Beckett Central Office
- Date of application is the date the Consultant does the home visit - this is stamped on last page of the application
- Central Office does initial processing, assigns a nurse, and sends the application to the Disability Determination Bureau for an eligibility determination
- DDB makes a disability determination based on information in application and medical/therapy/education records
- DDB may request further evaluations to be done at their cost
- If determined eligible at DDB, the application is returned to the Katie Beckett Program Central Office for second phase of eligibility determination
- If determined ineligible at DDB, DDB sends family and Katie Beckett Central Office a letter of denial. Application process stops here. Parents have the right to appeal.
- If eligible at DDB, nurses at Katie Beckett Program Central Office review the CLTS Functional Screen to determine if child meets KBP level of care criteria. If the child is ineligible based on the CLTS Functional Screen results, the nurse completes a comprehensive review of the application and accompanying paperwork.
- If determined eligible by the Katie Beckett Program, family receives an approval letter, and 1-2 weeks later, a plastic Medicaid (Forward) card
- Medicaid will be backdated to the date of application, and possibly up to 3 months prior to the date of application
- If child does not meet eligibility criteria, Katie Beckett Program Central Office sends family letter of denial. Parents can appeal this decision but must do so in writing within 45 calendar days of the date on the letter.
Recertification (Done Annually)
- Based on the month of initial eligibility
- Family must complete recertification materials yearly to determine if child continues to meet ALL eligibility requirements
- Home visit required approximately every 1-2 years
Dane County: (608) 265-4102 (Becky Burns and Michelle Schumacher)
Are only available via consultants and are not available on the internet.