TERFA/Katie Beckett Waiver in DC for ASD?

[Anonymous]

I saw another poster mention they have used TERFA/Katie Beckett in DC to cover ABA co-pays.
Previously, I had done a lot of my own research trying to figure out if our child would qualify but determined that it was unlikely as it seems to be for children who would otherwise require institutionalized care?

Am I misunderstanding the eligibility requirements for the waiver?Or perhaps it something which is restricted to only the highest support needs (level 3?) Our child is diagnosed at level 2.
We are currently paying our ST/OT and ABA copays out of pocket, and the costs are really becoming overwhelming, but we do not qualify for traditional Medicaid. I was curious if anyone has had experience in DC with the waiver program for a child with ASD.

Thanks!

[Anonymous]

I work in a pediatricians office and complete these on a regular basis - many who have ASD.

Your child should qualify.

1. Apply for Medicaid for your entire family (even though you are over income.) Answer the question that you have a child with special healthcare needs (can't remember what #question it is.)

2. You will be denied, but they will send you the Katie Beckett application.

3. Have your pediatrician complete it in it's entirety also with a letter of medical necessity. Have them sent all of that + the clinical documentation to you (you have to submit everything.)

4. Submit it to DC Health Check

If the application is done correctly, you should be approved quickly and that will get your child HSCSN.

There are folks out there who try and scam parents by charging them to complete the forms (though they aren't able to actually sign them.) You do not need to pay to have these completed (unless your doctor's office charges a typical fee for forms.)

Hope this helps.

[Anonymous]

OP here - thank you this is really helpful! I think I read the physician form really literally to mean that our child had to have a disability which would otherwise require them to be in an institutionalized care setting, and was not sure that would be a qualifying factor or not.

But I really appreciate it and will give the application process a try - the copays for ABA +OT +Speech on top of summer care are really giving us financial strain right now.

[Anonymous]

PP here - No problem. I think it is a much under utilized resource that many parents don't know is available to them.

Your child will retain private insurance as the primary insurance and Medicaid (HSCSN) will cover anything that private insurance doesn't cover including co-pays, deductibles, nursing, equipment.
Good luck!

[Anonymous]

Anonymous wrote:PP here - No problem. I think it is a much under utilized resource that many parents don't know is available to them.

Your child will retain private insurance as the primary insurance and Medicaid (HSCSN) will cover anything that private insurance doesn't cover including co-pays, deductibles, nursing, equipment.
Good luck!

Parent with HSCSN as a secondary chiming in to say that it covers some but not all of what private insurance does not cover. For anything that primary insurance outright denies, HSCSN preauthorization is required in order for the cost to be covered. Also the rates that are covered are determined by Medicaid so you might not necessarily get reimbursed for the entire amount. I still recommend applying because it certainly helps in most instances.