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Medical Assistance topics:


Medical Assistance-TEFRA (Tax Equity and Fiscal Responsibility Act) program provides Medical Assistance (MA) benefits for children with disabilities who do not otherwise qualify for MA due to their parents’ income being above the program limits. Under MA-TEFRA, only the child’s income is counted. The program is administered by county and tribal lead agencies in Minnesota and is supervised by the Department of Human Services (DHS).

The program is administered by county and tribal lead agencies in Minnesota and is supervised by the Minnesota Department of Human Services (DHS).

See common questions about MA-TEFRA below.

MA under the TEFRA Option may be available to your child or children who have a disability and who were denied MA because your family income is too high. 

Children who may be eligible for this program: 

  • Live with at least one parent 
  • Under 19 years of age  
  • Certified disabled by the Social Security Administration (SSA) or State Medical Review Team (SMRT) 
  • Require a level of care to live at home that is comparable to that provided in a hospital, nursing home or group home for people with disabilities 
  • The costs for the child to remain at home are less than those at a hospital, nursing home or group home 
  • Child’s income (not family income) is less than 100% of the Federal Poverty Guideline. If the child is over income, they may still be eligible for the TEFRA Option with a spenddown. Refer to What is a Spenddown (DHS-3017) to learn more about a spenddown. 

If your child qualifies for MA-TEFRA, they will receive the same MA coverage benefits as children enrolled in standard MA, such as doctor visits, prescriptions and hospital stays.  

It can also cover PCA services. A PCA worker can help your child with things like daily living activities and health-related procedures and tasks.  

Refer to Minnesota Health Care Programs Summary of Coverage, Cost Sharing and Limits (DHS-3860) for a complete listing of benefits and services covered by MA.

Applications may take up to 60 days to process for someone with a disability. How long it takes depends on whether additional information or verifications are needed to determine eligibility. A worker may extend the 60 days if your family needs additional time to gather and submit paperwork.

The MA-TEFRA Application Checklist can help you understand your responsibilities during the application process, as well as the responsibilities of your county or tribal eligibility worker and the SMRT.

Minnesota law requires that most parents of children who enroll in MA-TEFRA  contribute to the cost of services by paying a sliding scale parental fee. The fees are based on your adjusted gross income. 

There are two ways to get an estimate of what your MA-TEFRA parental fee may look like: 

  • Online, using the Parental Fee Estimator 
  • By calling the Parental Fees Unit at 651-431-3806 or 800-657-3751 

Refer to the Important Notice and Parental Fee Worksheet for more detailed information about fees. 

While counties and tribes administer the program, it is the Minnesota DHS that collects parental fees. They will determine your fee and mail you information that indicates your parental fee for the year and the amount of monthly payments you are responsible for paying.

When your child is enrolled in MA-TEFRA, they do not pay deductibles or copays.


Your child on MA-TEFRA is required to complete a renewal annually. Renewal paperwork will be provided to you by the county or tribe once the renewal date approaches. Additionally, you must complete and return forms needed for the parental fee determination. The parental fee forms will come to you separately and may be due at a time other than the MA-TEFRA renewal.


Children with disabilities who qualify for the TEFRA Option may also qualify for an HCBS waiver program. Children approved under an HCBS waiver program do not need to use the TEFRA Option. Refer to Disability Hub MN - Waivers to learn more about HCBS services and what is covered. 

Some children’s needs may be met through PCA services. Others may need to be enrolled in a HCBS waiver program to meet their health care needs.  

HCBS waivers offer tailored services and supports which supplement the services received under MA. A MnCHOICES Assessment at your county or tribal agency will help determine which supports and services your child may need.

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