Your Child is Ineligible: What are Your Options?

Not every child will meet the required eligibility criteria. Here are some very important things for you to think about if you’ve received a letter telling you that your child is not eligible:

If you’ve applied for the Children’s Long-Term Support Medicaid Waiver or the Children’s Community Options Program, your child must meet all eligibility criteria that you were asked to provide documentation for at the time of application and the institutional level of care.

  • If your child does not meet the eligibility criteria, the Bureau of Children’s Services at the Department of Health Services will send you a letter explaining in detail, why your child did not meet eligibility for the program you applied for. That letter will also include your right to appeal, and it’s very important that you do so within the timeframe noted in the letter.
    • Some good reasons to appeal include:
      • New testing or health results that you’ve received for your child.
      • A change in your child’s age which may have an impact on level of care.
      • Information in the eligibility letter that does not appear to reflect the needs or capabilities of your child. While CWT tries very hard to ensure we receive from you all the information necessary to give us a complete picture of your child, there may have been important pieces of information about your child that we’ve missed.
      • Any other changes that have an impact on your child’s eligibility.

If you’ve applied for the Katie Beckett Medicaid program, your child must meet eligibility for the disability determination (as determined by criteria set by the Social Security Administration), institutional level of care (as determined through the Children’s Long-Term Support Functional Screen), and all other eligibility criteria, including citizenship, age, living circumstances and child’s income.

  • If the Disability Determination Bureau (DDB) finds that your child does not meet the criteria for the disability determination, DDB will send you a letter telling you that. The letter will include your right to appeal, and it’s very important that you do so within the timeframe noted in the letter.
  • If you decide to not appeal, the DDB decision will stand and your child will not meet the eligibility criteria for Katie Beckett Medicaid.

If your child is approved for a disability determination, he or she will be reviewed next for meeting the institutional level of care and the remaining eligibility criteria for Katie Beckett Medicaid.

  • If he or she does not meet the institutional level of care or the remaining eligibility criteria, the Bureau of Children’s Services at the Department of Health Services will send you a letter explaining, in detail, why your child did not meet eligibility. That letter will also include your right to appeal, and it’s very important that you do so within the timeframe noted in the letter.
  • Some good reasons to appeal include:
    • New testing or health results that you’ve received for your child.
    • A change in your child’s age which may have an impact on level of care.
    • Information in the eligibility letter that does not appear to reflect the needs or capabilities of your child. While CWT tries very hard to ensure we receive from you all the information necessary to give us a complete picture of your child, there may have been important pieces of information about your child that we’ve missed.