The Katie Beckett Program is a special eligibility process that allows certain children with disabilities, mental health challenges and complex medical conditions to get health insurance coverage from Wisconsin Medicaid.
Children who may not be eligible for Medicaid, because their parents’ assets or income is too high, may qualify for Medicaid and receive a ForwardHealth card through the Katie Beckett Program. The program is disability based, rather than income based.
How Can the Katie Beckett Program Help My Child?
The Katie Beckett Program allows your child to get comprehensive health care coverage from Wisconsin Medicaid. Medicaid can pay for many services and supplies important to children with special needs like: doctor and dentist visits; physical, occupational and speech therapy; prescriptions; and, medically necessary supplies and equipment.
This is one of the doorways into Medicaid and provides the same coverage as other Medicaid programs like BadgerCare Plus or Medicaid-SSI. Note: your child will not be required to sign up with a Medicaid HMO.
How Do I Know if My Child is Eligible?
To be eligible your child must be:
- Under age 19,
- A U.S. citizen and a Wisconsin resident,
- Live at home,
- Be determined disabled by the Wisconsin Disability Determination Bureau,
- Not have an income of more than $2,205 per month (this includes child support),
- And, require a level of care typically provided in a hospital or nursing facility.
A Katie Beckett Consultant can answer questions about these requirements.
What If We Already Have Private Insurance?
Having both private insurance and Medicaid can be very helpful! While your private insurance will be billed first, Medicaid can pay for services, supplies and costs that your private insurance may not cover. For example, Medicaid can pay for: deductibles; co-pays; additional therapy visits; and, non-covered services like personal care, diapers and transportation to medical appointments.
How Do I Apply?
Contact the Katie Beckett consultant in your area. Visit Wisconsin Compass or go to dhs.wisconsin.gov/kbp/consultants.htm for a list by county.
If you and the consultant decide that the program is right for your family, you will be mailed paperwork to complete and a home visit will be scheduled so the consultant can meet your child and learn about his or her needs.
The consultant will use a Functional Screen, a tool that collects information on your child’s health, need for supports and how he/she plays and interacts with others. Your input can be critically important in helping the worker fully understand your child’s limitations, care needs and challenges. (See the Family Voices Fact Sheet, Completing a Functional Screen.)
A Two-Step Process is Needed to Decide if Your Child is Eligible:
1. The DHS Disability Determination Bureau reviews medical records and other paperwork and decided if your child meets Social Security standards for being disabled.
2. Katie Beckett Program nurses review records and all other criteria.
You will receive a letter from the Department of Health Services letting you know if your child is eligible. KEEP THIS LETTER IN A SAFE PLACE! A ForwardHealth card will be mailed to you separately.
Is There a Waiting List for the Program?
No. If you child qualifies, he or she can immediately start using Medicaid to cover the cost of medical care and other services. Remember to show your child’s providers your FowardHealth card so they know to bill Medicaid in addition to other insurance you may have.
Do We Have to Re-Apply?
To keep Medicaid coverage your child must be “recertified” each year. This is called an annual recertification. You (or your Children’s Long-Term Support service coordinator) will receive paperwork to complete. Sometimes a home visit is required to review your child’s level of care needs. It may be helpful to keep each year’s recertification paperwork so you can refer back to it. If you need help, contact your Katie Beckett consultant, your service coordinator or a Regional Center.