Medical Assistance for children with disabilities – TEFRA option
The TEFRA option allows Medical Assistance (MA) eligibility for children with disabilities whose parents have too much income to qualify for MA or other Minnesota Health Care Programs or who qualify but the cost would be too high
Who qualifies for the TEFRA option?
To qualify, a child must meet all the following:
- Be ineligible for MA when counting parent’s income
- Live with at least one parent
- Be under age 19
- Be certified disabled by the Social Security Administration (SSA) or the State Medical Review Team (SMRT)\
- Need a level of care to stay at home that is similar to the level of care provided in a hospital, nursing home or intermediate care facility for people with developmental disabilities (SMRT makes the level-of-care determination)
- Have home care costs that are less than the cost of care in a medical facility
What does the TEFRA option do for children with disabilities?
Only the child’s income is counted for MA when the child is eligible for the TEFRA option. The child’s income limit is the same as the MA limit for a person who has a disability. See the Income and Asset Guidelines (PDF).
For regular MA, parents’ income is counted. If the parents’ income is more than the MA limit, the child may not qualify for MA or the child may have a spenddown (PDF).
Is there an asset limit?
Children do not have an asset limit.
What does the TEFRA option cost?
Parents may have to pay a parental fee. The amount of the fee is based on the parents’ income. You can estimate your parental fee online or using this paper worksheet (PDF). The exact amount is calculated based on your income and other information you provide.
Children do not have copays.
How do I apply for MA with the TEFRA option for my child?
Apply in either of these ways:
- Apply online through MNsure, Minnesota’s health insurance marketplace. Here are some tips for completing the MNsure online application.
- Fill out and return the MNsure Application for Health Coverage and Help Paying Costs (DHS-6696) (PDF).
If your child is found ineligible for MA when counting parents’ income, your county or tribal office will then separately determine whether your child is eligible under the TEFRA option.
When will MA coverage start?
After your child is approved, coverage may:
- Go back to the date we get your application
- Go back three months from the date we get your application
Call your county or tribal office if you have questions about when coverage can start.
What if my child has other health insurance?
Your child may still get coverage. You must tell us whether your child has other health insurance or could be covered by someone else’s insurance. Sometimes we can pay the cost of the other insurance so you can keep that coverage.
What does TEFRA stand for?
It is short for the Tax Equity and Fiscal Responsibility Act, the federal law that set the rules for this option.
- County and tribal offices
- Minnesota Health Care Programs Member Help Desk
- Disability Linkage Line at 866-333-2466
- TTY: Use your preferred relay service
This article was copied from a government document.