Medical Assistance under the TEFRA (Tax Equity and Fiscal Responsibility Act) option 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. MA under the TEFRA option only counts the child’s income.
The program is administered by county and tribal lead agencies in Minnesota and is supervised by theMinnesotaDepartment 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 but are 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 under the TEFRA option, 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.
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.
When your child is enrolled in MA under the TEFRA option, they do not pay deductibles or copays.
Beginning July 1, 2023, parents are not required to pay a parental fee, unless their child is in out of home placement. Before July 1, 2023, some parents of children enrolled in MA under the TEFRA option had to contribute towards the cost of the child's care by paying a parental fee.
If your child received services before July 1, 2023, you are responsible for any payments. You may receive paperwork requesting information for those services.
Yes.
Your child on MA under the TEFRA optionis required to complete a renewal annually. Renewal paperwork will be provided to you by the county or tribe once the renewal date approaches.
Yes.
Children with disabilities who qualify for the MA under the TEFRAoption may also qualify for an HCBS waiver program. Children approved under an HCBS waiver program do not need to use the MA under the TEFRA option.Refer toDisability Hub MN - Waiversto 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.
