Federal, exists in every state
A Medicaid option you may hear called Katie Beckett
MaineCare for a child with a disability living at home. Your income and savings do not decide eligibility.
What it is
MaineCare for a child with a disability living at home. Your income and savings do not decide eligibility.
Katie Beckett can help when your family earns too much for ordinary MaineCare. Your child must meet separate disability and care-level tests. Your income affects a premium, even though it does not decide financial eligibility.
Eligibility rules
- Your child must be under 19 and live at home in Maine.
- In 2026, the child’s own gross countable income must be no more than $2,982 monthly, with countable assets below $2,000.
- The disability must meet Social Security standards and be expected to last at least 12 months or result in death.
- A separate assessment checks institutional-level care. The annual cost at home cannot exceed the institutional alternative.
- The institutional-care comparison can include inpatient hospital care, not only psychiatric or intellectual-disability facilities. MaineCare’s assessment must find that your child meets the relevant care level and the other disability, financial and home-care cost rules. A cancer diagnosis or an earlier hospital stay does not decide that assessment.
What you get
- Full MaineCare when your child meets the financial, disability, care-level and cost tests.
Premium and other insurance
- A monthly premium based on parent income is billed every three months.
- The monthly family premium depends on parent income and private insurance. At 150%–200% of poverty it is $11 with private insurance or $30 without it. Above 2,500% it is $263 or $750. The guide describes quarterly billing. Tribal exemptions and good-cause rules can matter. OFI confirms the charge below the first listed band and how nonpayment affects current continuous coverage.
- The monthly premium schedule is effective January 1, 2020 and remains in the chart amended April 29, 2025. Amounts are per family, not per child; the pairs below mean with private insurance / without private insurance.
- 150–200% of poverty: $11 / $30 monthly; 201–250% of poverty: $14 / $40 monthly; 251–300% of poverty: $18 / $50 monthly; 301–350% of poverty: $21 / $60 monthly; 351–400% of poverty: $25 / $70 monthly.
- 401–450% of poverty: $30 / $85 monthly; 451–500% of poverty: $35 / $100 monthly; 501–550% of poverty: $40 / $115 monthly; 551–600% of poverty: $46 / $130 monthly; 601–700% of poverty: $51 / $145 monthly.
- 701–800% of poverty: $61 / $175 monthly; 801–900% of poverty: $72 / $205 monthly; 901–1000% of poverty: $84 / $240 monthly; 1001–1200% of poverty: $96 / $275 monthly; 1201–1400% of poverty: $117 / $335 monthly.
- 1401–1600% of poverty: $138 / $395 monthly; 1601–1800% of poverty: $159 / $455 monthly; 1801–2000% of poverty: $182 / $520 monthly; 2001–2500% of poverty: $207 / $590 monthly; 2501+% of poverty: $263 / $750 monthly.
If you decide to apply
- Ask the hospital enrollment specialist about the MaineCare application and Disability Determination packet.
- Have ready: your child’s financial records, medical records and a description of care needed at home.
Acentra assessment questions: 1-866-521-0027, option 2 · Official page ↗
Assessment
- The University of Massachusetts conducts the disability review under contract. Acentra assesses the care level.
Good to know
A diagnosis alone does not establish the required care level. Ordinary child MaineCare may be simpler and has no premium.
Official sources
“Could Katie Beckett fit our child’s care needs, what premium could we owe, and could you help us decide whether to apply?”
Why I’m asking: We want to understand coverage that checks our child’s finances separately from ours.
More background and detailed requirements
Additional program information and published rules
Who does what
The three parts, side by side. The agency decides; nobody on this page does.
You
Ask for the application paperwork this week, gather the child's own account balances, and get it filed within two weeks with fresh signatures.
Your social worker
Gets the application paperwork, sends the level-of-care form to the right clinician, and checks the signatures are current when it goes in.
The care team
Writes the level-of-care description: every daily task, how often, and what happens without it.
- Who decides
- The state Medicaid agency's disability review
- Ask your social worker
- “Can you help me apply for Katie Beckett (TEFRA)? Who on the team writes the level-of-care application paperwork, and how soon can it go in?”
How to apply
First step: Ask the social worker for the state's Katie Beckett application paperwork this week and who on the team writes the level-of-care section.
- Get the state packet this week.
- Have the clinician describe every daily task and what happens without it.
- File in the first two weeks. Coverage reaches back to the application month.
Where it starts: State TEFRA/Katie Beckett application
What to gather
- Pathology report and oncologist's letter with diagnosis and relapse dates
- The doctor's and nurse's description of daily skilled care (line care, medicines, monitoring)
- The child's own accounts (the child's money is tested, usually at $2,000)
How long: Up to 90 days by federal rule for a disability application. File in the first two weeks so coverage reaches back to the application month.
What a yes looks like
Medicaid on the child's own record, no premium in most states, with a level-of-care end date on the letter.
What a no looks like, and the next move
“Level of care not met”: the doctor's description of daily care decides it. Ask what was missing, add the log, and appeal within the notice's period.
Watch out
- Not every state has it. TEFRA states: AK, DC, DE, GA, ID, LA, ME, MA, MI, MN, MS, NE, NV, NH, OK, RI, SC, SD, WV, WI. Texas and California use other options. The state item explains.
- The application paperwork expires: signatures usually have to be recent when it reaches the reviewer. Do not let it sit at the clinic.
- A child on maintenance can be re-reviewed at the next level-of-care date. Ask when that date is.
The numbers and the rules
The arcane layer, kept on purpose. Checked September 7, 2026.
What it is worth
Full Medicaid on the child's own record, usually with no premium, regardless of parents' income.
Covers: Full state Medicaid benefits · EPSDT home nursing and equipment once enrolled
Legal protection: The test is disjunctive: hospital, nursing facility or ICF level of care. Any one suffices
What it costs the family: No premium in most states. Nevada charges by income.
The eligibility facts, as published
- State option required
- yes
- Child at home
- yes
- Parental income
- not counted
- Child resource limit
- usually $2,000
- Level of care
- hospital, nursing facility or ICF/IID; any one
- Disability
- SSI medical standard where applicable: documented acute leukemia meets listing 113.06A for at least 24 months from diagnosis or relapse, or at least 12 months after transplant, whichever is later; the agency still verifies evidence
Decisions this site cannot make: Disability · Institutional level of care · Cost-effectiveness (some states)
Expect friction on: Detailed medical packet with recent signatures · Re-review at the level-of-care date
The trap: The level-of-care test is separate from the disability test: the child must need the care of a hospital, a nursing facility, or an intermediate-care facility, any one of them. The doctor's description of daily care decides it, not the diagnosis.
What changes by state: Whether it exists, the name (Georgia calls it the Deeming Waiver), the premium (none in most. Nevada charges), the level-of-care form and how long a letter is valid.
Where I read this
- Medicaid Program — Centers for Medicare & Medicaid Services, read August 27, 2026
- Full List of Medicaid Waivers and Programs — Kids’ Waivers, read August 27, 2026
- 42 CFR 435.912: Timely determination of eligibility — Cornell LII (eCFR mirror), read September 7, 2026