Roy Can Help

A field guide from a dad who's been in the waiting room

Too Much Income for SSI? Meet the Medicaid Door Called Katie Beckett

In short: A state may choose to give Medicaid to a child with a disability who lives at home by counting only the child's income, not the family's. It is a state option, so ask your state Medicaid office whether it has one.

If your family makes too much for SSI, there may still be a door. It is called TEFRA or Katie Beckett, it lives in the federal law, and a lot of parents never hear about it because it is a state choice, not a guarantee. Here is exactly what the law says and how to ask.

The Short Version

Federal law lets a state choose to give Medicaid to certain children with disabilities who live at home. The way it works is the state treats the child as if they were getting SSI. That means the family's income stops being the gate. The program is named for the Tax Equity and Fiscal Responsibility Act of 1982, also called TEFRA. Roy's Wisdom page has the short version of why it matters for families who make too much for SSI.

What the Law Requires

The rule is in section 1902(e)(3) of the Social Security Act. A child qualifies if all of these are true:

  1. The child is 18 years of age or younger and qualifies as disabled under Social Security's definition.
  2. The state determines that the child requires the level of care that would be provided in a hospital, nursing facility, or intermediate care facility for people with intellectual disabilities.
  3. The state determines that it makes sense to provide that care outside an institution.
  4. The estimated Medicaid cost of care outside an institution is not greater than the estimated cost inside an institution.
  5. The child would be eligible for Medicaid if they were in an institution.

A child who meets all of that is treated, for Medicaid purposes only, as if they were receiving SSI. The family's income no longer decides eligibility.

It Is a State Option

The law starts with "at the option of the State." Not every state offers it, and states call it different names. Call or write your state Medicaid agency and ask whether it has a TEFRA or Katie Beckett option, what the program is called in your state, and what the application looks like.

How It Connects to SSI

This is the same "state home care plan" that shows up in the exception on the SSI Deeming page. Once a child qualifies, the Medicaid benefits available to children, including EPSDT, are explained on the Paying for It page.

How To Ask

  • Call or write your state Medicaid agency and ask whether it offers a TEFRA or Katie Beckett option.
  • Ask what documents it needs to show your child's level of care.
  • Keep every date, name and copy. Ask for the decision in writing.

If the answer is no, you are entitled to an explanation and usually a fair hearing. The disagree-in-writing guide shows how to ask, including the federal 90-day window for requesting a Medicaid hearing.

See also: Paying for It, SSI Deeming, Do You Qualify?, How to Disagree, All Explainers.

Sources: www.ssa.gov.

Last checked: October 2026. The eligibility conditions were checked against the text of section 1902(e)(3) of the Social Security Act as published by the Social Security Administration. This is not legal advice; see the full disclaimer.