Frequently Asked Questions

Developmental and Intellectual disabilities are typically present at birth, and are life-long, incurable disabilities impacting individuals’ language, cognitive and behavioral development. Sometimes, Developmental Disabilities can affect fine/gross motor, executive functioning and other adaptive functions, at times, having negative effects on other body parts, too. Typically, individuals with developmental or intellectual disabilities need long-term support in the areas of life skills, self-care, self-direction, health, safety, mobility and many other areas.  The support services individuals require are in the form of nursing assistance, medical and therapeutic services (services that are covered by Medicaid). 

Autism Spectrum Disorder, Behavioral disorders, Apraxia of Speech, Brain Injuries, Cerebral Palsy, Craniofacial Abnormalities, Down Syndrome, Epilepsy, Hearing Loss, Intellectual Disability, Muscular Dystrophy, Spina Bifida, Swallowing Abnormalities, Vision Impairment and many others.  Individuals that do not have a developmental disability, but are deemed medically fragile, also require long-term services and may be eligible for either Katie Beckett, or the NOW/COMP waiver programs.  You are considered medically fragile if you are quadriplegic, paraplegic, require a PICC line, suffer from a spinal cord injury, had a massive stroke, require ostomy care, tube fed or are ventilator dependent.  As a result of the complexity of their medical conditions, many medically fragile pediatric patients are eligible for the Georgia Pediatric Program for Children (GAPP) Medicaid waiver which families can apply for with the assistance of many in home nursing support providers.  

No.  It is not the individual's disability that makes them eligible for a waiver.  Having Autism Spectrum Disorder or Downs Syndrome, for example, is not enough to be eligible for a Medicaid waiver.  It is whether the individual's disability rises to an institutional level of care that makes them eligible for a waiver.  This means that the care and treatment your child would receive in the community must be comparable to that provided in a hospital, nursing home or intermediate skilled nursing facility. Individuals eligible for the Katie Beckett and NOW/COMP waivers must have been diagnosed with a developmental or intellectual disability by qualified medical professionals before the ages of 18 and 22, respectively.  

If an individual is approved for a waiver which allows them to remain in the comfort and security of their home while receiving medical and therapeutic support in their community, they must receive a minimum amount of care equivalent to what they would receive, if they were in fact institutionalized in a hospital, nursing home or skilled intermediate nursing facility.  If your child receives services in school such as speech, occupational or physical therapy, school-based therapy counts toward your child's minimum of 5 weekly sessions, as long as your Pediatrician requests school-based therapy in their order (script) for total weekly sessions.  In some circumstances a child may not be required to participate in 5 weekly therapy sessions based on the results from a Psychological Evaluation using intelligence and behavioral testing.

A Pediatrician is the primary provider responsible for managing the overall medical care your child receives.  Depending on your insurance provider, your Pediatrician is often required to make referrals to other healthcare providers to insure any additional services may be covered.   But, in areas where a child's development, or behavior is a concern, it may be necessary that you and your child's Pediatrician work together to seek the services of a more specialized physician such as a Developmental Pediatrician. Developmental Pediatricians have attained more advanced training in all areas of child development.  Depending on your child's disability, you may also need the services of even more specialized physicians, clinicians or researchers such as an Endocrinologist, Neurologist, Cardiologist, Physiatrist, Geneticist, Psychometrist or Gastroenterologist.  Regardless of your child's healthcare needs, it is always best to consult first with their Primary Pediatrician, regarding any medical services performed by other providers.  This ensures that continuity of care is properly managed, and that you, along with the counsel of your child's doctor, will make the best informed decisions regarding your child's care.  Additionally, your child's pediatrician will be necessary in attesting to  their level of care when  applying, or reapplying for a Medicaid disability waiver.  

Yes! Easterseals of Nort h Georgia's Champion for Children Program is an excellent option for children who are medically fragile, have developmental disabilities and are not eligible for Katie Beckett.  The program provides financial assistance and support to families needing medical or therapeutic services for their children.  The United Healthcare Children's Foundation offers grants for healthcare services for children covered under a commercial health plan but are limited to care due to high cost or fewer services.   United Healthcare Children's Foundation - UHCCF 

If your child is approved for a waiver, Medicaid will go back 90 days from the date of the application to pay medical bills.  The way that works is you have to let those providers know to bill Medicaid for those costs.  If you've paid out of pocket for those predated medical expenses, the providers will reimburse you after their claims have been paid by Medicaid.  Medicaid does not reimburse individuals. Medicaid only pays providers that accept Medicaid.  Medicaid can serve as a child's secondary form of insurance while their parents' insurance can remain as primary coverage.  Medicaid could also serve as a child's primary insurance if there is no other form of primary insurance.  

Absolutely!  Depending on your loved ones' medical condition, there may be other waiver programs offering more specialized services suitable to their healthcare needs.  To find the right Medicaid waiver for your disabled loved one, please click below.  

Shortly before your chlld turns 18, you'll receive notification from the Katie Beckett Centralized Office that their Medicaid will terminate on  the last day of the month they turn 18.  It is critical that you contact the Centralized office to request that your child's Katie Beckett Medicaid is changed to Transitional Adult Medicaid to prevent a gap, or loss in coverage.  By this time, your child should have also been placed on the Long Term Planning List for the NOW/COMP Waiver, which we recommend families immediately apply for upon your child's initial approval for Katie Beckett.  You would then need to apply for SSI for your child as an adult as early as the day after they turn 18.  In order to maintain your child's Transitional Adult Medicaid. you will have to provide evidence to the Katie Beckett Centralized office that you've applied for SSI for your child.  This evidence is what is referred to as the Summary of Application that you'll received after you've completed your child's SSI application.  Simply provide this Summary to your child's Katie Beckett Case Manager to maintain their Medicaid coverage until after an SSI decision has been made, which could take up to 1 year.   After an interview by a representative from your local Social Security office, you will receive a determination letter if benefits are approved.  If benefits are not approved, you may need to seek the services of an experienced Social Security Disability attorney, who will assist you in the appeals & adjudication processes to have your case reconsidered after an unfavorable determination.  You can also seek assistance through the Bobby Dodd Institute for appeals, as well.  To apply for SSI for your adult child, click  Adult Disability Starter Kit (ssa.gov).  You can check on the status of your child's SSI application at How to check your application status (ssa.gov) 

Like Hospital In-Patient and Marketplace Exchanges, Medicaid has a Drug Formulary of approved drugs it may cover the cost for patients whose medical providers prescribe for them.