NASHVILLE, Tenn. (AP) — Tennessee would no longer be the only state in the country that does not have a program offering coverage for children with significant disabilities living at home under a proposal currently being reviewed by the federal government.
Commissioner Brad Turner, who oversees the Department of Intellectual and Developmental Disabilities, said Tuesday the state submitted a waiver in September asking the federal government for approval to allow disabled children to get Medicaid assistance whose families wouldn't otherwise qualify in the state.
"We're moving forward building this under the assumption this is going to be approved by January 2020," Turner said. "We are building that apparatus right now so as soon as they give us the green light we can start having those conversations about intake."
Known as a Katie Beckett program, the initiative was named for an Iowa girl whose health plight led then-President Ronald Reagan to change Medicaid's rules in 1981. It allows states to extend services to children even if their parents aren't poor enough to qualify for Medicaid.
That's because under federal law, when a child is in a medical institution for at least 30 days, the parents' income does not count while determining the child's eligibility for Medicaid. However, that provision goes away when the child leaves the institution. The Katie Beckett program is an option for states to help families pay for therapy and medical equipment to maintain kids at home.
Currently, Tennessee only covers "medically eligible" children in households with income 200% below the federal poverty level, disqualifying many families because they have too high of incomes or assets under the state's Medicaid program.
However, if the state's waiver is approved by the Centers for Medicare and Medicaid Services, Tennessee would launch a two-part program that would serve children with disabilities and complex medical needs.
The first part would apply to an estimated 300 children with severe disabilities or complex medical needs are expected to qualify for care that offers full Medicaid benefits, as well as case management and other wraparound services. The children must qualify for care in a medical institution, such as a hospital or nursing facility, but receive the services at home.
The second part would apply to a bigger group of 2,700 children — also with disabilities or complex medical needs — who would be funneled into a Medicaid diversion program rather than become Medicaid recipients. It would offer a capped package of services that include up to $10,000 per year in private medical insurance premium assistance and other things their insurance may not cover.
Earlier this year, state lawmakers budgeted $27 million to help cover the costs of the Katie Beckett waiver and will spend another $4.8 million to hire 78 case managers.