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The Katie Beckett waiver.

Q We own our own home, and our income puts us over the limit for Medicaid coverage. We have always raised our child at home, even though health care professionals have suggested institutionalization.

If our child was in an institution, the government would pay all the costs, including medical care. Since we have kept our child at home, however, the government will not pay for any of the costs. In fact, the government will not even pay for basic medical care. Is there anything we can do?

A Although the Medicaid regulations that apply to income limits seem quite rigid, there are some exceptions to those regulations. These exceptions are known as "waivers." Each waiver represents a situation in which specific states have applied for, and have been granted, exemptions from the standard Medicaid rules.

One of the most important of these Medicaid waivers is generally known as the "Katie Beckett waiver" or the "Katie Beckett provision." In the early 1980s, when the Katie Beckett waiver was first established, if a child with a disability lived at home, Medicaid generally considered parents, income in evaluating the child's eligibility. If the child was hospitalized or institutionalized for an extended period, however, the parents, income generally was not considered.

Katie Beckett, a young child who was on a ventilator, was unable to go home from the hospital, not because of medical reasons, but because she would no longer have been eligible for Medicaid. While Medicaid rules allowed for the continued payment of hospitalization costs, they did not allow Medicaid to pay for the cost of home care, even though home c are would have been far less expensive.

Eventually, a special Medicaid waiver was created so that Katie Beckett could return home. Since that time, the Katie Beckett waiver has helped an enormous number of children who would have been forced by Medicaid regulations to remain permanently in hospitals or institutions.

State regulations

Since Medicaid is administered at the state level, the Katie Beckett waiver is available only to residents of those states that have adopted it. Although almost every state has some form of the Katie Beckett waiver, regulations may differ drastically from state to state. Contact your state Medicaid office to learn the details of your state's waiver.

According to the National Health Law Program, a child with a disability does not need to be institutionalized to qualify for the Katie Beckett waiver. Thus, depending on the state you live in, and the specifics of your child s disability, the waiver may be applicable to your situation.

The specific rules are complex. In general, however, the waiver may apply to a situation involving a child with a disability under 18 years of age, for whom home care is appropriate, and in which the child requires a level of care equivalent to that provided by an institution. In addition, the cost of home care must be less than or equal to the cost of institutionalization. The waiver is available only to children who would qualify for Medicaid if institutionalized. There are other specific rules, as well.

In states that have not adopted the Katie Beckett waiver, Medicaid will consider paying the costs of long-term institutionalization for a child with a disability, regardless of the parents, income. However, even though the state would have to pay the full costs if the child were institutionalized, those state Medicaid programs generally will not pay any medical costs for a child with a disability if he or she is being cared for at home, unless the parents, income meets Medicaid eligibility requirements.

If denied

If your Medicaid application has been denied, and you think you qualify under a Katie Beckett waiver or under a different waiver program, contact your local Protection and Advocacy office or the local legal services office for advice. For your local offices, contact the National Legal Aid and Defense Association, 1625 K St., NW, Ste. 800, (202) 4520620 (voice), (202) 872-1031 (fax).
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Title Annotation:Medicaid coverage for institutionalized children
Author:Epstein, Richard
Publication:The Exceptional Parent
Article Type:Column
Date:Jun 1, 1995
Previous Article:Learning what families and physicians share.
Next Article:Taking charge: teenagers talk about life & disabilities.

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