In 2026, Belgium operates two parallel care assessment systems — not one. The traditional KATZ scale is still used by RIZIV/INAMI for home nursing reimbursements, while the new BelRAI Screener has replaced the Medico-Social scale for Flemish care budgets as of March 1, 2026. As a family, you may face both assessments. This guide explains how each works, what they trigger financially, and how to navigate the process.
The Dual Assessment Reality: KATZ and BelRAI in 2026
The question "has BelRAI replaced KATZ?" has a nuanced answer in 2026: yes for regional care budgets; no for home nursing. Home nurses still use the 6-item KATZ scale to bill RIZIV/INAMI for daily home care. Meanwhile, social workers and care advisors use the BelRAI Screener to determine eligibility for Flemish care budgets (ZBO and ZZZ). A single patient in 2026 routinely undergoes both assessments.
KATZ in Home Nursing: The RIZIV/INAMI Scale
For home nursing reimbursements, KATZ scores each of the 6 ADL items on a 1–4 scale: 1 = fully independent, 4 = fully dependent. The combined scores determine which nursing "Forfait" applies — a daily lump-sum payment from health insurance.
| KATZ Item | Level 1 (Independent) | Level 4 (Fully Dependent) |
|---|---|---|
| Washing | Can wash self entirely without help | Must be completely helped above and below the waist |
| Dressing | Can dress and undress entirely without help | Needs help dressing both above and below waist |
| Mobility | Moves in/out of bed or chair unassisted | Bedridden or wheelchair-bound, fully dependent |
| Toileting | Can go to toilet, dress, and clean self alone | Needs help with all three: moving, dressing, cleaning |
| Continence | Continent for urine and feces | Incontinent for both urine and feces |
| Eating | Can eat and drink alone | Fully dependent for eating and drinking |
| Forfait | KATZ Score Requirements (2026 RIZIV) |
|---|---|
| Forfait A | Score 3 or 4 for mobility/transfer AND/OR toileting |
| Forfait B | Score 3 or 4 for mobility AND toileting, plus 3 or 4 for incontinence or eating |
| Forfait C | Score 4 for all items; minimum score 3 for incontinence or eating (highest daily rate) |
The BelRAI Screener: 27 Items Across 5 Modules
From March 1, 2026, the BelRAI Screener officially replaced the Medico-Social scale for the Flemish Zorgbudget voor Ouderen (ZBO). It consists of 27 items organized in five modules — a significant expansion beyond KATZ's 6 items, capturing cognitive, psychological, and behavioral dimensions that KATZ misses entirely.
| Module | What It Covers | Why It Matters vs. KATZ |
|---|---|---|
| 1 — IADL | Housework, meal prep, medication management, finances, transport | Captures "grey zone" independence: can cook but not safely |
| 2 — ADL | Hygiene, bathing, dressing (upper/lower separately), toilet use, mobility, eating | More granular than KATZ — splits "washing" into hygiene vs. full bath |
| 3 — Cognition | Memory, daily decision-making, communication | Identifies dementia cases KATZ misses entirely |
| 4 — Psychical | Mood, anxiety, depressive symptoms | Links mental health to functional care burden |
| 5 — Behavior | Aggression, agitation, social withdrawal | Assesses caregiver burden in dementia/psychiatric cases |
Financial Impact: ZBO and ZZZ Budgets
The BelRAI Screener score is a financial trigger. Two main Flemish care budgets are determined by BelRAI:
- ZZZ (Zorgbudget voor Zwaar Zorgbehoevenden) — €140/month in 2026, non-means-tested. Triggered when BelRAI scores indicate significant care needs (high total score or combined ADL+IADL score above threshold).
- ZBO (Zorgbudget voor Ouderen met een Zorgnood) — Means-tested, for those 66+. Six categories (0–5); Category 5 triggers up to €725/month. Category 0 receives no budget but may get service discounts.
Key point: Category 5 specifically requires a high "CPG Sum" (cognitive/psychical/behavior score) — effectively channeling maximum support to families managing dementia or psychiatric care needs. A single category jump from B to C level can unlock more than €32,000 in additional annual funding.
The Assessment Process: 5 Steps for Families
- Request: Contact your Zorgkas (Care Insurance Fund) or the Dienst Maatschappelijk Werk (DMW) of your health insurer. If already receiving home care, the provider will automatically initiate a BelRAI Screener as part of their mandatory social inquiry.
- Assessment Visit: A certified assessor (indicatiesteller) visits the home — typically a social worker from the DMW, OCMW, or home care organization. The interview covers all 27 BelRAI items plus an 80-item Social Supplement mapping the informal care network. Allow 45–90 minutes.
- Processing: The assessor submits the digital form via the Flemish IT Platform BelRAI to the Zorgkas. Financial decisions are usually communicated within 3–4 months; first payment follows the month after the decision.
- MyBelRAI Portal: Log in at Mijngezondheid via itsme or e-ID to view your full BelRAI profile in plain language. If the assessor doesn't share results immediately, they become visible to you automatically after 7 days.
- Appeals: Disagree with your category? File an administrative appeal. From March 1, 2026, a dossiertaks (filing fee) of €75 applies (€30 for low-income households). The fee is refunded if the appeal succeeds.
Why BelRAI Is More Accurate Than KATZ Alone
The legacy KATZ-6 was designed primarily for nursing home placement, not home care assessment. It consistently failed people with dementia who could physically wash themselves but lacked the executive function to remember when to wash, or how to safely use kitchen appliances. BelRAI's Module 3 (Cognition) and Module 5 (Behavior) capture this care burden accurately — and translate it into real financial support.
The BelRAI transition also introduces the Digital Circle of Trust: only professionals with a documented care relationship can access or complete a BelRAI assessment, protecting privacy while requiring families to engage their care providers proactively.
The Bottom Line
The KATZ scale and BelRAI are not interchangeable — they serve different systems and trigger different financial rights. In 2026, a well-informed family engages both: KATZ for home nursing reimbursements, BelRAI for regional care budgets. Understanding which module covers your situation — and arguing it holistically rather than task-by-task — is what separates families who receive full entitlements from those who don't.
Action: Request your BelRAI assessment today, even if care is years away. Know your score. It will shape the next decade of your life.