BTHE BARATELLI INSTITUTE · Mentoring at Scale
FOR FAMILIES SCREENING SSI + MEDICAID OPTIONS FOR A CHILD WITH SIGNIFICANT MEDICAL NEEDS

Two paths most families don't know exist — and the income rules that decide between them.

Path A is traditional SSI: means-tested cash assistance for low-income families with a disabled child, with Medicaid attaching automatically. Path B is the Medicaid waiver — TEFRA, Katie Beckett, or your state's equivalent — which DISREGARDS parental income for medically-fragile children. Many middle and upper-middle income families assume they're disqualified from Medicaid; they often aren't, under the waiver path. This tool screens both and explains the secondary-payer coordination with private insurance.

Two paths
Screened separately
Monthly $
Expected benefit
Waiver list
By state
Coordination
With private insurance
YOUR SCREEN
1
Child & medical
2
Income & assets
3
State & waiver
4
Private insurance
5
Eligibility & plan
STAGE 1 OF 5

Child and medical situation

Defaults reflect a 7-year-old with a moderate-to-severe condition requiring complex care.

SSA uses functional equivalence to listings. "Marked" or "extreme" limitations in 2+ functional domains is the standard. Hospital social work can help characterize.
SSI requires the condition to last at least 12 months or be expected to result in death. Acute conditions resolving in 6 months don't qualify.
Critical for TEFRA / Katie Beckett — the test is whether the child would qualify for institutional-level care (nursing facility, hospital, ICF/IID) if not at home.
SSA has childhood "Listings of Impairments" by body system. Listing-level match qualifies medically without functional analysis.
STAGE 2 OF 5

Family income and assets

SSI deems parental income to the child until age 18. Medicaid waivers (TEFRA / Katie Beckett) DISREGARD parental income for medically-fragile children. This is the single most important distinction.

Both parents combined, before tax. Drives the SSI deeming math and confirms whether the waiver path is the relevant one (it almost always is for middle-income families).
$
Drives SSI deeming allocations and the federal-poverty-line tests in some waiver paths.
SSI looks at parental assets, deeming most to the child. The household resource limit for a two-parent family is ~$5,000 (varies). Most middle-income families fail this test — which is why the waiver path matters.
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Cash, custodial accounts, savings titled to child. SSI's child resource limit is $2,000. Above this WITHOUT an SNT triggers disqualification.
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SSI deeming allocates ~$472/mo per non-applicant child to remove from parental countable income before deeming.
Affects the deeming math — SSI allocates a higher exclusion when a parent is disabled.
STAGE 3 OF 5

State of residence and waiver landscape

Medicaid waivers vary dramatically by state. Some have generous TEFRA / Katie Beckett options; others have long waitlists; a few effectively don't offer the path.

Eligibility, waiver names, waiting periods, and benefit levels are state-specific. Examples: TX is Medically Dependent Children Program (MDCP). NY is Care at Home (CAH I/II). MA is Kaileigh Mulligan. PA is PH95.
Many waiver programs have waiting lists. TEFRA states (true TEFRA option under federal law) cannot have waiting lists; HCBS-waiver states often do.
TEFRA is the federal authority; states implement under different names. Katie Beckett, MDCP, CAH, Kaileigh Mulligan, PH95, MFC are common names. Some states use HCBS waivers (1915c) for the same population — functionally similar but with different rules.
STAGE 4 OF 5

Private insurance and coordination

Medicaid is the payer of last resort. Private insurance pays first. The coordination is where families save (or lose) tens of thousands a year.

Premium share + deductible + copays + coinsurance + uncovered services. For a complex pediatric case on a typical employer plan: $8K-$25K is common.
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Common gaps in private plans that Medicaid often covers: ABA therapy, in-home nursing, durable medical equipment, respite care, communication devices, behavior support. Each can be $20K-$100K+/year.
Complex pediatric cases routinely hit the OOP max. Once hit, marginal private-insurance value drops; Medicaid secondary value rises.
STAGE 5 OF 5

Eligibility paths and the coordination plan

Path A (traditional SSI) and Path B (Medicaid waiver). The action sequence and the secondary-payer playbook.

WANT THE METHODOLOGY BEHIND THIS TOOL?
Read more in the Family Office Reference.
The tool gives you the answer. The guide gives you the argument — the case law, the worked examples, the negotiation playbook, the cross-check tables, the exception cases.
The methodology behind this calculator is in Public benefit coordination of the reference guide.
Read more in the Family Office Reference → Browse all 22 guides
Educational references and tools — not legal, tax, accounting, or investment advice, and not a recommendation to buy or sell any security. Consult a qualified professional about your specific situation. © 2026 The Baratelli Institute.