Welcome to the Itsy Bitsy Toddler & Co. State Resource Page!

I'm so happy you're here. As a pediatric nurse and a mom to two amazing boys with autism, I truly understand how overwhelming it can be to figure out Medicaid waivers, the Katie Beckett program, and other Medicaid options for children with special needs. That’s why I’ve created this space—to provide support and guidance, just like a big sister would, to help you make sense of these important resources.

On this page, you’ll find a curated collection of details on various programs designed for children with disabilities or medical needs. These include Medicaid waivers, Katie Beckett (TEFRA), and other state-specific assistance programs. After years of research and personal experience, I’ve gathered this information to help you connect with the right services for your child.

While I’m here to guide you, please remember that I don’t operate or have control over these programs, so I can’t check the status of your child’s application or guarantee placement. My goal is to provide you with clear information and offer support as you navigate the application process. If you ever have questions, don’t hesitate to reach out through our secure chat or contact me privately.

I’ll keep this resource updated quarterly, though it’s important to note that state and federal changes can sometimes occur between updates. You can always see the date of the most recent update at the bottom of the page.

We’re in this together, and I’m here to help you every step of the way!

LETTER OF
MEDICAL NECESSITY

I am providing this Letter of Medical Necessity template as a helpful guide that you can share with your child’s doctor when requesting documentation. In most states, families are required to submit either a medical necessity letter or an official prescription in order to move forward, and regardless of which is used, there are specific details that must be included for it to be accepted. This template is meant to make that process easier by outlining the information typically required, but your doctor may adjust it as they see fit based on your child’s needs. If you have any questions or need additional support along the way, please don’t hesitate to reach out, I’m happy to help.

Letter of Medical Necessity Free Download

Alabama

Alabama currently has five waivers that are open to children. This includes a new Community Care Waiver for people with intellectual disabilities in certain counties. All programs are HCBS 1915(c) Medicaid waivers, though one is concurrent with an 1115 demonstration program. Three of these programs waive parental income; we do not know the status of the others. View Alabama’s HCBS waiver page, which includes a chart comparing waivers.

Alaska

Alaska currently has four waivers that are open to children. Three are HCBS 1915(c) Medicaid waivers and one is a TEFRA program. While the TEFRA program waives parental income, we do not know whether the other waivers count parent income or not. See this brochure for an overview of Alaska’s waiver programs or this page on HCBS waivers. Alaska also has a Community First Choice Program that may allow some children with disabilities to access additional personal care services.

Arizona

Arizona currently operates one 1115 demonstration waiver and serves all children with disabilities through this program. View Arizona’s Health Care Cost Containment System Page. Because Arizona operates its program through a demonstration waiver, some federal rules are waived.

Arkansas

Arkansas currently has three programs that are open to children. Two are HCBS 1915(c) Medicaid waivers and one is a TEFRA-like program. While the TEFRA-like program and Autism waiver waive parental income, we do not know whether the Community and Employment Support (formerly ACS) waiver counts parent income or not. See this older Guide to Services for Children with Disabilities for general information or this page on services for children.

California

California currently has four waivers that are open to children, including a newer waiver for developmental disabilities. All waivers are HCBS 1915(c) Medicaid waivers, and these programs waive parental income. For general information on California’s waivers, see this list of waivers.

California also offers a range of home and community based services to those already enrolled in Medicaid through a state plan 1915(i) program, including respite, environmental accessibility, vehicle modification, day programs, and therapies. It also has a Community First Choice program, allowing those already enrolled in Medicaid to receive personal care services.

Colorado

Colorado currently has five waivers that are open to children. All are HCBS 1915(c) Medicaid waivers. Four of these programs waive parental income; we do not know the status of the other. For general information on Colorado’s waivers, see this overview. See also these charts comparing waivers.

In addition to waivers, Colorado has a Medicaid buy-in program for children with disabilities whose families earn less than 300% of the federal poverty line.

Connecticut

Connecticut currently has five waivers that are open to children, as the Early Childhood Autism Waiver has now expired. All are HCBS 1915(c) Medicaid waivers. Three of these programs waive parental income; we do not know the status of the others. For general information on Connecticut’s waivers for people with developmental disabilities, see this overview. Information on other waivers can be found here.

Connecticut has recently begun offering the Community First Choice Option for individuals already on Medicaid, who can receive personal care services regardless of age.

Delaware

Delaware currently has two programs that are open to children. One is an HCBS 1915(c) Medicaid waiver, and one is a TEFRA or TEFRA-like program. Delaware also provides community-based services through an 1115 waiver program, DSHP-Plus. While most of these services are for adults, the program recently added pediatric respite and self-directed personal care services for children, including those provided by parents and guardians. The program also provides access to Medicaid for children at a slightly lower level of care than those eligible for TEFRA.

Delaware also offers some employment related and personal care home and community based services to those already enrolled in Medicaid, ages 14-25, through a 1915(i) program.

Florida

Florida currently has three waivers that are open to children. All are HCBS 1915(c) Medicaid waivers, and all waive parental income. For an overview of the programs, see this page. Two of these waivers are extremely small programs specifically for Familial Dysautonomia and Degenerative Spinocerebellar Disease. With the exception of these programs, Florida has no programs for children with physical disabilities or medical technology. These children may, however, qualify for the iBudget waiver, which targets people with developmental disabilities. Note that this waiver historically has a very long waiting list.

Georgia

Georgia currently has four waivers or programs that are open to children. Georgia has a TEFRA program and three HCBS 1915(c) Medicaid waivers. All programs waive parent income. For an overview of the programs, see this waiver program page, this page from Community Health, or view this guide.

Georgia’s GAPP program previously functioned as a waiver to provide medical daycare services in addition to in-home nursing. This program now only provides in-home nursing through the regular Medicaid state plan for children under 21. It can be accessed by families already in Medicaid or via the TEFRA/Katie Beckett program.

Hawaii

Hawaii serves most children through a managed care demonstration waiver program, but does have one 1915(c) HCBS waiver. The HCBS waiver waives parental income. Hawaii provides home and community based services to most children who require at least an institutional level of care through their Medicaid demonstration program. For an overview of Hawaii Medicaid, see Quest Hawaii.

Idaho

Idaho currently has one program that serves children, a TEFRA/Katie Beckett program. It waives parent income and is open to children of all incomes. For children already in Medicaid, Idaho’s enhanced plan includes home and community based services through the regular state plan without the need to enroll in a waiver. The two previous children’s waivers have been terminated. General information about developmental disabilities in Idaho can be be found on the Children’s DD Services page.

Illinois

Illinois currently has six waivers that are open to children. All are HCBS 1915(c) Medicaid waivers. Three of these programs waive parental income; three do not. View Illinois’ HCBS waiver page.

Indiana

Indiana currently has four waiver programs that serve children. All are 1915(c) HCBS waivers, and all waive parent income and are open to children of all incomes. General information about waivers in Indiana can be found on the state’s HCBS Waiver Page. Indiana Family to Family also has fact sheets available on these programs.

Indiana also has a 1915(i) program for children with mental or behavioral health challenges that provides additional home and community based services to children already eligible for Medicaid.

Iowa

Iowa currently has five waiver programs that serve children. All are 1915(c) HCBS waivers. We are not sure if they waive parental income or not. General information about waivers in Iowa can be found on the Iowa Home and Community Based Services page. A chart comparing waivers is also available. Waiting list information for Iowa waivers can be found here. Iowa is planning on combining several of its waivers in 2024, and this information will be updated when it becomes available.

Kansas

Kansas currently has six waivers that are open to children. All are HCBS 1915(c) Medicaid waivers and all waive parental income. See this HCBS Waiver Page for information about Kansas’ programs or this Access Guide. Kansas also aligns its waivers with its privatized KanCare 1115 waiver, placing waiver participants in managed care.

In the past, Kansas charged a parent fee to waiver participant families who were not low income. It appears that Kansas is now only charging a client obligation fee, meaning only the child’s income would be counted in assessing or not assessing a client obligation fee. If the child has no income or minimal income, the client obligation is $0.

Kentucky

Kentucky currently has four waivers that are open to children. All are HCBS 1915(c) Medicaid waivers. Three of these programs waive parental income; we have not been able to obtain information about the other. For information on Kentucky’s programs, visit their Division of Long Term Services and Supports page.

Louisiana

Louisiana currently has four waivers and a new TEFRA program that are open to children. Three of these programs waive parental income; we have not been able to obtain complete information about the other two. For general information on most of Louisiana’s programs, see their Programs or Waiver Services page.

Maine

Maine currently has one waiver that is open to children, a TEFRA program, that waives parental income.

Maryland

Maryland currently has four waivers that are open to children. All are HCBS 1915(c) Medicaid waivers. Three waive parental income but one does not. Previously, the Community Pathways and Community Supports Waivers accepted children; however, the most recent federal documents specifies these programs are for those over age 18, though those under age 18 currently in these programs can remain in the programs. For an overview of Maryland’s programs, see Maryland’s Home and Community Based Services page or this booklet on home and community based programs.

Maryland also participates in the Community First Option, which allows states to provide assistant services through Medicaid without a waiver, and has a state-based waiver program (1915(i)) for children with behavioral issues. The latter replaced a 1915(c) waiver that previously served the same population.

Massachusetts

Massachusetts currently has three programs waivers that are open to children. One is a TEFRA program, another is an HCBS 1915(c) Medicaid waiver for autism, and a state-based program, MassHealth CommonHealth, is part of an 1115 demonstration waiver. While the TEFRA program and state program waive parental income, the 1915(c) waiver counts parent income under most circumstances. See this page for an overview of health care in Massachusetts and this page for home and community based options.

Michigan

Michigan currently has four waivers that are open to children. One is a TEFRA program and the others are HCBS 1915(c) Medicaid waivers. While the TEFRA program and two of the HCBS 1915(c) waivers waive parental income, one HCBS waiver does not. For more information on Michigan Medicaid, see its Health Care Programs page.

Michigan also has a 1915(i)/1115 program that provides home and community based services to children with severe behavioral or mental health conditions.

Minnesota

Minnesota currently has a TEFRA program and four HCBS 1915(c) waivers that serve children. All programs waive parent income. See this Home and Community-Based Service Waivers overview for general information. Minnesota also has a 1915(k) Community First Services and Supports (CFSS) program that provides in-home services. Minnesota plans to expand this program to include both personal care and state-plan home and community based services.

Minnesota has charged a “parent fee” for its programs, including its TEFRA program, for decades. These parent fees ended effective 6/30/23.

Mississippi

Mississippi currently has a TEFRA program and three HCBS 1915(c) waivers that serve children. All programs waive parent income. See their Long Term Care page for an overview of Home and Community Based Services.

Missouri

Missouri currently has four HCBS 1915(c) waivers that serve children. Only the waiver for children with developmental disabilities waives parent income. For a general overview of programs, see their Home and Community Based Waivers page.

Montana

Montana currently has two HCBS 1915(c) waivers that serve children and waive parent income. See Montana’s Long Term Care page for more information on Montana’s programs. Montana also has a Community First Choice program that allows anyone enrolled in Medicaid to receive personal care services.

Nebraska

Nebraska currently has a TEFRA program and two HCBS 1915(c) waivers that serve children. All programs waive parent income. See this overview of Nebraska programs or see this summary document for more detailed information.

Nebraska plans to add a Family Support Waiver for children 0-21 who have developmental disabilities beginning in 2024. More information will be provided when it becomes available.

Nevada

Nevada currently has a TEFRA program and two HCBS 1915(c) waivers that serve children. Only the Katie Beckett TEFRA program waives parent income. For a list of Nevada’s methods of accessing Medicaid for people who are disabled, see this overview.

Nevada previously charged a family fee or “parental reimbursement” for families who earn more than 200% of the federal poverty level. See this Parental Reimbursement Questionnaire. As of 2019, there was a moratorium on collection of these fees, so fees are not currently being collected.

Nevada also has a state-based program through a 1915(i) authority to provide intensive in-home services for children with behavioral or developmental disabilities already in Medicaid.

New Hampshire

New Hampshire currently has a TEFRA-like program and two HCBS 1915(c) waivers that serve children. All three programs waive parent income. An overview of New Hampshire’s programs can be found on its Children’s Medicaid page and Waivers.

New Hampshire also has a behavioral health program, including home and community based services, through a 1915(i) program. This program provides care coordination, respite, and other wraparound services.

New Jersey

In 2014, New Jersey transitioned its waivers to a single, comprehensive Medicaid waiver that is an 1115 demonstration program. Children who meet a nursing home level of care can qualify for the Medicaid Managed Long Term Services and Supports (MLTSS) program, which is based only on the child’s income. General Information on New Jersey’s FamilyCare Comprehensive Waiver can be found on the Office of Home and Community Services page.

Some limited home and community based services for children with behavioral or developmental disabilities are provided as part of the Comprehensive Waiver through PerformCare or New Jersey Children’s System of Care, including in-home care, ABA, and respite. Through the Children’s Support Services Program, children receive services through three tiers. Low income children receiving Medicaid receive additional targeted HCBS services. Middle income children (up to 300%) receive both Medicaid state plan services and targeted HCBS services. Families over the income level only receive targeted HCBS services.

New Mexico

New Mexico has rolled many of its waiver programs for those with physical and medical disabilities into a comprehensive 1115 demonstration waiver called Centennial Care. New Mexico will retain three 1915(c) HCBS waivers for people with developmental disabilities and one for individuals who are medically fragile. The DD waiver and Medically Fragile waiver do not count parent income; we are unsure whether the Mi Via and Supports waivers count parent income or not. See the Centennial Care page for information on Centennial Care, and the Division of Developmental Disabilities for information on continuing 1915(c) waivers.

New York

New York currently has two Medicaid waivers that accept children. Both waivers are HCBS 1915(c) waivers and waive parent income. For general information on children’s waiver programs in New York, see this brochure on Children’s HCBS or access the Front Door, New York’s gateway to services for people with developmental disabilities.

In 2019, New York combined several waivers to form a new Children’s Waiver. The terminated waivers include the three Bridges waivers for children in foster care, OMH SED (mental health), and the Care at Home waivers.

North Carolina

North Carolina currently has two home and community based 1915(c) waivers that serve children. One serves children only, while the other serves people of all ages. Both waive parent income. See North Carolina’s services by population page for general information.

North Dakota

North Dakota currently has four home and community based 1915(c) waivers that serve children. Three serve children only, while the other serves people of all ages. All waive parent income. See North Dakota’s page on waivers for general information.

North Dakota also has a 1915(i) Program for those with Behavioral Health Diagnoses that provides care coordination, training and support, respite, transportation, and several other services for children and adults.

Ohio

Ohio currently has five home and community based 1915(c) waivers that serve children. Four serve both children and adults, and the new OhioRISE waiver is only for children. Three waive parent income for eligibility, but the parental deeming is unknown for the other programs. See Ohio’s HCBS Waivers page for more information. Ohio also has additional information on waivers for people with developmental disabilities, including this page comparing programs.

Oklahoma

Oklahoma currently has three waivers/programs that serve children, including a TEFRA program and two home and community based 1915(c) waivers. The TEFRA program waives parent income, the Community waiver does not, and we are unsure of the deeming status of the In-Home Supports waiver. See Oklahoma’s HCBS Waivers page for general information.

Oregon

Oregon currently has five waivers that serve children, all of which are home and community based 1915(c) waivers. Three of these waivers waive parent income; we are uncertain of the how parent income is considered for the Children’s HCBS waiver. See this CIIS page for an overview Oregon’s intensive in-home programs for children, or this page on Developmental Disability services. As of 7/2024, Oregon has received approval for a new 1915(c) waiver, Children’s Extraordinary Needs Waiver, which will allow for paid parent caregivers for children with high medical and behavioral needs.

Oregon uses a 1915(k) waiver or Community Choice Program to provide many children and adults already in Medicaid with in-home services. For more information on this program, see K Plan Information. These services are available to all children who meet eligibility standards without a waiting list.

Pennsylvania

Pennsylvania currently has four waivers that serve children, all of which are home and community based 1915(c) waivers. All waive parent income when determining eligibility. See Pennsylvania’s Medicaid Waiver page for more information. Pennsylvania also has a state-based program that is much like a TEFRA program and provides coverage to any child in the state with a disability.

Rhode Island

Rhode Island currently has only one Medicaid program for children, which is a TEFRA program that waives parental income. Rhode Island recently replaced its Medicaid program with an 1115 demonstration program. Once children gain eligibility to Medicaid through the Katie Beckett TEFRA program or standard criteria, they may access other home and community based services through the 1115 demonstration program. See this page on general information for children with special needs in Rhode Island.

South Carolina

South Carolina currently has seven Medicaid waivers/programs that can serve children, including a TEFRA program and six additional home and community based 1915(c) waivers. A new waiver for children with serious emotional disturbance was approved in 2020. All programs are based only on the child’s income, waiving parental income for eligibility. For more information about waivers in South Carolina that serve individuals with developmental or intellectual disabilities, see Medicaid HCBS Waiver Services from the Department of Disabilities and Special Needs. See also South Carolina Medicaid’s page on waivers.

South Dakota

South Dakota currently has three Medicaid programs that can serve children, including a TEFRA program and two additional home and community based 1915(c) waivers. The TEFRA program and Family Supports Waiver are based only on the child’s income, waiving parental income for eligibility, but we are unsure how parent income is considered in the CHOICES waiver. See South Dakota’s Medical Eligibility page for information about its various programs.

Tennessee

Tennessee has a “Katie Beckett”-like program as part of its TennCare Demonstration Waiver, which grants Medicaid coverage and additional services to a small number of children who do not otherwise qualify for Medicaid based on income. This program also provides home and community based services only (without Medicaid) to a second group of lower acuity children. These programs may require a parent fee and insurance coverage and unfortunately are not available to low-income or foster children who qualify for Medicaid categorically.

Tennessee also has a unified program for people of all ages with intellectual or developmental disabilities, the Employment and Community First CHOICES program, which is part of its 1115 demonstration waiver, TennCare.

Tennessee previously had three HCBS waivers that stopped enrolling participants in 2016. However, some individuals still remain in these programs, though they expect to be transitioned by 2024. These include: Comprehensive Aggregate Cap Home and Community Based Services, Self-Determination Waiver Program, and Statewide Home and Community Based Services Waiver.

Texas

Texas currently has six Medicaid waivers that can serve children, and all of them are home and community based 1915(c) waivers. Five of these six waivers are based only on child income without regard to parent income. See this information on Long Term Care or this page comparing the various programs. An independent site, Texas Medicaid Waivers Explained, also gives general information about the waiver process in Texas. Texas also has a Medicaid Buy-In Program for children.

Texas has shifted children in most waiver programs into managed care through an 1115 demonstration program called STAR Kids. In addition, Texas began implementing the Community First Choice Option in 2015, which means it can no longer have waiting lists for attendant care for individuals who qualify for Medicaid. It appears that Texas is allowing some individuals on waiting lists for waivers to access this benefit.

Utah

Utah currently has five Medicaid waivers that can serve children, and all of them are home and community based 1915(c) waivers. The autism waiver was recently terminated, but a new Limited Supports Waiver was added. All waivers are based only on child income without regard to parent income. See Utah’s Medicaid for Long-Term Care page or HCBS Waivers page for general information about programs in Utah.

Vermont

Vermont currently has only one Medicaid program for children, which is a TEFRA program that waives parental income. Vermont replaced its Medicaid program with an 1115 demonstration program, and once children gain eligibility to Medicaid through the Katie Beckett TEFRA program or standard criteria, they may access other home and community based services through the 1115 demonstration program.

Virginia

Virginia currently has three Medicaid waivers that can serve children, and all of them are home and community based 1915(c) waivers. All waivers are based only on child income without regard to parent income. For more information, see Virginia’s Long Term Care and Waivers Service page. For Developmental Disability waivers, see this information.

Virginia merged previous waivers, including the Technology Assisted Waiver and the Elderly or Disabled Waiver, together into Commonwealth Coordinated Care Plus. This waiver also includes a managed care component.

Washington

Washington state currently has four Medicaid waivers that can serve children, and all of them are home and community based 1915(c) waivers. All waivers are based only on child income without regard to parent income. For more information, see this general overview of Washington’s Medicaid waivers. See also the Informing Families website for services available throughout the lifespan.

For those already eligible for Medicaid, the Community First Choice option allows for additional services. Similarly, those who access Medicaid based on income or through waivers can receive home nursing care through the Medically Intensive Children’s Program.

West Virginia

West Virginia currently has four Medicaid waivers/programs that can serve children, including a TEFRA program and three home and community based 1915(c) waivers. This includes a newer program for children with Serious Emotions Disorder that was started in 2020. The TEFRA program is based only on child income without regard to parent income, while the DD and TBI waivers do count parent income. For more information, see West Virginia’s Medicaid Waivers page.

Wisconsin

Wisconsin currently has two Medicaid waivers/programs that can serve children, including a TEFRA program and a home and community based 1915(c) waiver. All programs are based only on child income without regard to parent income. For more information, see Wisconsin’s page on Services for Children with Delays or Disabilities.

Wisconsin charges a Parental Payment for children who participate in the Children’s Long Term Support waiver. This payment is only charged for families with children between 0 and 18 years of age. The payment is a percentage of the costs of the program, ranging from 0-41%, depending on family income. Children in the TEFRA Katie Beckett program have no parental payments. More information on Parental Payments can be found on the What Does It Cost? page.

Wyoming

Wyoming currently has three Medicaid waivers that can serve children, all of which are home and community based 1915(c) waivers. All three are based only on the child’s income, waiving parental income for eligibility. See Wyoming’s Medicaid Eligibility page for links to the various different available programs or this page on developmental disability programs.