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TEFRA PROGRAM (TAX EQUITY AND FISCAL RESPONSIBILITY ACT) — RHODE ISLAND

  • Writer: Fatumata Kaba
    Fatumata Kaba
  • Oct 9
  • 3 min read

ENABLING CHILDREN WITH DISABILITIES TO RECEIVE MEDICAID SUPPORT WHILE LIVING AT HOME — REGARDLESS OF PARENTAL INCOME

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The TEFRA-like Program in Rhode Island (also known as Katie Beckett eligibility) allows children with significant disabilities or complex medical needs to qualify for Medicaid based solely on the child’s income and assets—not the parents’. This program enables families to access necessary medical and support services at home, rather than requiring institutional placement for Medicaid eligibility. Administered through the Executive Office of Health and Human Services (EOHHS), TEFRA aligns with federal provisions outlined in Section 134 of the Tax Equity and Fiscal Responsibility Act of 1982.

 

1. GOVERNING AGENCIES

Agency: Rhode Island Executive Office of Health and Human Services (EOHHS)

Role: Determines eligibility, manages applications, and authorizes Medicaid services under the Katie Beckett provision.

Agency: Centers for Medicare & Medicaid Services (CMS)**

Role: Oversees federal Medicaid policies including TEFRA-related eligibility standards.

Agency: Rhode Island Department of Human Services (DHS)**

Role: May assist in outreach, enrollment support, and coordination of wraparound services.

 

2. TEFRA PROGRAM OVERVIEW

The TEFRA/Katie Beckett option is designed for children under age 19 who:

  • Have a qualifying disability or complex medical condition (as determined by SSI standards)

  • Require institutional-level care but can be safely supported at home

  • Would not otherwise qualify for Medicaid due to family income

  • Live in Rhode Island and are U.S. citizens or eligible non-citizens

Once approved, the child becomes Medicaid-eligible, unlocking access to:

  • Home Health Nursing

  • Personal Care Assistance (PCA)

  • Durable Medical Equipment (DME)

  • Physical, Occupational, and Speech Therapy

  • Assistive Technology and Behavioral Health Services

  • Case Management and Respite Care

 

3. PROVIDER SERVICES UNDER TEFRA

Approved Medicaid providers can deliver the following services to TEFRA-eligible children:

  • Skilled Nursing: In-home care for medically fragile children

  • Therapies: PT, OT, ST with age-appropriate, goal-based plans

  • Home-Based Behavioral Services: ABA therapy or behavioral supports

  • Care Coordination: Integration with school services and specialists

  • Equipment and Supplies: Wheelchairs, adaptive seating, communication aids

  • Transportation: Non-medical and medical rides to waiver-authorized services

 

4. ENROLLMENT & APPROVAL PROCESS (FOR FAMILIES)

Step 1: Family contacts EOHHS or accesses the online Katie Beckett application.

Step 2: Submit documentation, including medical records, SSI evaluations, and financial statements (for the child only).

Step 3: A clinical review team evaluates the child’s medical needs and functional limitations.

Step 4: If approved, the child receives full Medicaid coverage through the Katie Beckett pathway.

Step 5: A case manager may be assigned to coordinate HCBS and manage the plan of care.

 

5. DOCUMENTATION REQUIRED (FOR PROVIDERS WORKING WITH TEFRA CLIENTS)

  • Provider Medicaid enrollment confirmation

  • NPI and licensure for clinical/therapy staff

  • Service Authorization from Medicaid or care coordinator

  • Plan of Care aligned with medical necessity and HCBS standards

  • Daily service notes, treatment goals, and family engagement logs

  • HIPAA documentation and consent forms

 

6. STAFFING REQUIREMENTS FOR PROVIDERS

Depending on services rendered, providers may need:

Role: RN or LPN

Requirements: Rhode Island licensure, experience with pediatric and home-based care

Role: Speech/OT/PT Therapist

Requirements: RI license, Medicaid credentialed, child-focused treatment planning

Role: Behavioral Health Provider or ABA Technician

Requirements: Credentialed in behavior analysis, experience with neurodiverse youth

Role: Care Coordinator or Case Manager

Requirements: Knowledge of Medicaid, IEPs, and wraparound supports

Training:

  • Pediatric safety and abuse prevention

  • Communication with families and guardians

  • Person-centered planning

  • Documentation and billing protocols

 

7. FUNDING & SERVICE DELIVERY FRAMEWORK

TEFRA-based services are funded under Rhode Island’s Medicaid State Plan. Services must meet:

  • Medical Necessity criteria

  • Least Restrictive Environment preference (home/community over institutions)

  • Provider Scope of Practice and Licensure rules

  • HCBS Settings Rule for community integration

 

8. TIMELINE FOR PROVIDER ENGAGEMENT

Phase: Medicaid Enrollment and Credentialing

Timeline: 30–90 days

Phase: Service Authorization and Care Planning

Timeline: Begins immediately after child approval

Phase: Service Delivery and Documentation

Ongoing: Real-time notes, quarterly reports, and Medicaid billing

 

9. CONTACT INFORMATION

Rhode Island Executive Office of Health and Human Services (EOHHS)

Katie Beckett Program Info: https://eohhs.ri.gov

Rhode Island Medicaid Provider Portal

Katie Beckett Parent Guide and Application

Centers for Medicare & Medicaid Services (CMS)

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RHODE ISLAND TEFRA SERVICE PROVIDERS

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — RHODE ISLAND TEFRA SERVICE PROVIDERS

WCG equips providers to support TEFRA/Katie Beckett families with quality, Medicaid-approved pediatric services.

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Scope of Work:

  • Provider enrollment and credentialing with Medicaid

  • Pediatric-focused Policy & Procedure Manual development

  • Staff training and licensure tracking

  • Plan of Care templates, family communication logs, and service note formats

  • Compliance assistance with HCBS rules and state audits

  • Katie Beckett referral coordination guidance



Our Client Portal offers a wealth of resources that you can explore related to various programs and state requirements. 

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