This guide breaks down the three major parts of eligibility so you can prepare your application or renewal with confidence.
🎥 Watch the Eligibility Overview
Who Qualifies for Katie Beckett? (3-Part Eligibility)
Your child must meet all three categories: age/residency, medical criteria, and financial/cost-effectiveness.
1️⃣ Age & Residency
- Child is 18 years old or younger
- Child is a Georgia resident
- Child has a valid Social Security Number
2️⃣ Medical Criteria
This is the most important part of the application and the most common reason for denials. Your child must:
- Meet disability criteria under the Social Security Act
- Require a Level of Care typically provided in a:
- Hospital
- Skilled Nursing Facility (SNF)
- Intermediate Care Facility (ICF/IID)
- Be safe to care for at home with appropriate supports
- Have a condition requiring ongoing treatment or therapies (OT, PT, Speech, ABA, or medical specialists)
Diagnoses often seen in approved applications: autism, cerebral palsy, epilepsy, genetic or chromosomal disorders, neuromuscular disorders, and medically complex conditions.
3️⃣ Financial Criteria
Parents’ income is not counted. Instead, the state looks at:
- Whether the child is ineligible for SSI because of parental income
- Whether home care is cost-effective compared to institutional care
You do not need to calculate cost-effectiveness — the review team does this automatically.
What Does “Meet Federal Disability Criteria” Mean?
Under the Social Security Act, a child must have:
- A medically determinable physical or mental impairment
- Marked and severe functional limitations in day-to-day life (this is where psychological evaluations and the behavior section of the physician paperwork are essential)
- A condition expected to last 12 months or longer (or be terminal)
Understanding “Marked” and “Severe” Limitations (SSA’s Six Domains)
To meet disability criteria, a child must have:
- Marked limitations in at least two domains, or
- An extreme limitation in one
- Acquiring and Using Information
- Significant difficulty learning, understanding, or applying new concepts
- Cannot follow simple instructions or retain age-appropriate knowledge
- Requires specialized educational supports beyond typical special education
- Attending and Completing Tasks
- Cannot sustain focus long enough to complete age-appropriate tasks
- Needs constant redirection or supervision
- Struggles to transition between activities without support
- Interacting and Relating with Others
- Extreme difficulty communicating needs or forming relationships
- Aggressive, withdrawn, or unsafe behaviors
- Needs structured environments to maintain safety
- Moving About and Manipulating Objects
- Requires assistive devices for mobility
- Cannot perform age-appropriate fine motor tasks (feeding, dressing)
- Caring for Yourself
- Needs full assistance with basic self-care
- Engages in unsafe behaviors requiring constant supervision
- Cannot understand or respond to danger
- Health and Physical Well-Being
- Frequent hospitalizations or medical interventions
- Chronic conditions causing fatigue, pain, or instability
- Severe medication side effects impacting daily functioning
Understanding the Medical Level of Care (LOC)
This is where most families struggle. The state needs to understand:
- Why your child requires ongoing therapies or interventions
- What daily support your child needs (feeding, behavior, toileting, mobility, safety, communication)
- How the disability affects daily functioning at home and school
- What would happen without structured support
Documentation from OT, PT, Speech, developmental pediatricians, neurologists, psychologists, and teachers strengthens your case.
Under federal law (42 CFR), the child must need care similar to what would be provided in:
- Hospital level of care: frequent monitoring, interventions, or specialized equipment
- Nursing facility level of care: daily skilled nursing tasks (medication administration, suctioning, wound care)
- ICF/ID level of care: intensive support for communication, behavior, safety, or self-care
Plain-language examples:
- Feeding tube + daily skilled nursing → hospital/nursing level
- Severe autism + 24/7 supervision + dependence in self-care → ICF/ID
- Uncontrolled seizures requiring emergency monitoring → hospital/nursing level
Key takeaway: Your documentation must clearly show that without Medicaid-funded services, your child would require hospital, nursing facility, or residential-level care.
What Disabilities Qualify?
Katie Beckett is not diagnosis-based, but some diagnoses commonly meet criteria when functional limitations are documented:
- Autism spectrum disorder
- ADHD with severe functional impairments
- Cerebral palsy
- Epilepsy/seizure disorders
- Genetic or chromosomal conditions
- Significant developmental delays
- Medically complex conditions
Reviewers focus on functional limitations, safety concerns, and medical necessity — not the diagnosis name alone.
Documents That Strengthen Eligibility
- Psychological evaluation
- OT, PT, and Speech evaluations
- ABA progress notes
- Neurology or developmental pediatrician reports
- School/IEP documentation
- Behavior logs
- Feeding therapy notes
- Safety plans
You’ll also include these in your “What to Gather Before You Apply” checklist.
Where to Apply or Ask Questions
Applications and renewals are processed through the Centralized Katie Beckett Medicaid Team:
- Address: 2211 Beaver Ruin Road, Suite 150, Norcross, GA 30091
- Phone: 678-248-7449
- Website: Georgia Medicaid Katie Beckett Program
Next Steps
Now that you understand eligibility, you’re ready for the next step:
Or return to the Katie Beckett Georgia Parent Guide.
Leave a Reply