Katie Beckett / TEFRA Guide for Tennessee

What Is Katie Beckett / TEFRA?

• Katie Beckett is named after a child whose family fought for Medicaid coverage when parental income made her ineligible.
• Under the TEFRA option (Tax Equity and Fiscal Responsibility Act), states can cover children who are medically complex — regardless of their parents' income.
• Only the child's own income and assets are counted. Since most children have little to no income, they typically qualify financially.
• The child must be under 18 and have a disability or medical condition that would normally require institutional care (hospital or nursing facility).
• This is a lifeline for middle-income and higher-income families who have a child with serious medical needs.

Why It Matters

• Regular TennCare eligibility counts the entire family's income — so families earning above the limit are shut out.
• Katie Beckett ignores parental income entirely. Only what the child earns matters (which is usually nothing).
• This means a family earning $80,000 or $150,000 a year can still get TennCare for their medically complex child.
• TennCare through Katie Beckett covers medical services that private insurance often limits or denies — like extensive therapy, nursing care, durable medical equipment, and home health services.
• It can also serve as secondary insurance alongside private coverage, picking up costs that the private plan does not cover.

Qualifying Conditions

• The child must be under 18 years old.
• The child must meet Social Security's definition of disability OR need an institutional level of care.
• Institutional level of care means the child's medical needs are serious enough that they would otherwise require care in a hospital, nursing home, or other facility.
• Examples include: severe cerebral palsy, complex congenital heart conditions, ventilator dependence, severe autism with high support needs, cancer requiring ongoing treatment, serious intellectual or developmental disabilities, and other conditions requiring extensive medical care.
• The child does not need to actually be in an institution — the point is that they COULD need one without the support services.

How to Apply

• Call TennCare Connect at 1-855-259-0701 and ask about Katie Beckett/TEFRA eligibility for your child.
• You can also apply through the Tennessee Department of Human Services (DHS) at your local office.
• Gather your child's medical records — diagnosis, treatment plans, therapy records, hospital stays, specialist reports.
• A disability determination will be made based on the child's medical documentation. This can go through SSI or TennCare's own process.
• If your child already receives SSI, they are automatically eligible for TennCare — you may not need the Katie Beckett pathway.
• The application process can take time, so apply as soon as you know your child may need this coverage.

ECF CHOICES for Intellectual/Developmental Disabilities

• Employment and Community First CHOICES (ECF CHOICES) is a separate TennCare program specifically for people with intellectual and developmental disabilities (IDD).
• ECF CHOICES provides: employment supports, independent living skills training, community participation, respite care, assistive technology, and more.
• If your child has an intellectual or developmental disability (such as Down syndrome, autism, or intellectual disability), ask about ECF CHOICES in addition to Katie Beckett.
• ECF CHOICES has a waiting list, so apply early.
• Contact the Tennessee Department of Intellectual and Developmental Disabilities (DIDD) at 1-615-532-6530 for more information.

Services Available Through TennCare

• Skilled nursing care — in-home or facility-based nursing services.
• Physical, occupational, and speech therapy — often with higher limits than private insurance.
• Durable medical equipment (DME) — wheelchairs, hospital beds, communication devices, orthotics.
• Prescription medications — covered through TennCare's pharmacy benefit.
• Home health services — nursing and aide visits in your home.
• Respite care — temporary relief for family caregivers.
• Medical supplies — feeding supplies, incontinence supplies, wound care, and more.
• Transportation to medical appointments.
• Mental health and behavioral health services.

Key Contacts

Documents You Will Need

Nursing home Medicaid requires extensive financial documentation. Gather these items before applying:

• Photo ID (driver's license, state ID, or passport)
• Social Security card or number for everyone on the application
• Proof of Tennessee residency (utility bill, lease, or mail with your address)
• Proof of U.S. citizenship or immigration status (birth certificate, passport, or immigration documents)
• Proof of income for everyone in the household (pay stubs, tax return, Social Security statement, employer letter)
• Bank statements (checking and savings) for the past 30 days
• Child's birth certificate
• Child's Social Security card or number
• Medical records documenting the child's disability or medical condition
• Doctor's reports, specialist evaluations, and treatment plans
• Hospital discharge summaries (if applicable)
• Therapy records (physical, occupational, speech)
• List of current medications and treating physicians
• Any SSI or Social Security disability determination letters for the child
• Child's own income documentation (if any — most children have none)
• Current health insurance information for the child
• School IEP or 504 plan (if applicable)
• Power of Attorney or guardianship documents (if applicable)