Health care coverage
Medical Assistance under the TEFRA option for children with disabilities
Medical Assistance under the TEFRA option helps children with disabilities qualify for Medical Assistance, even if their family’s income is too high to qualify. TEFRA is short for the Tax Equity and Fiscal Responsibility Act, the federal law that set the rules for this option.
To qualify for Medical Assistance under the TEFRA option, a child must meet all the following requirements:
- Be otherwise ineligible for Medical Assistance when parents’ income is counted
- Be under age 19
- Live with at least one biological, adoptive or stepparent
- 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).
How is the TEFRA option different?
The TEFRA option helps children with disabilities get Medical Assistance coverage by only counting the child’s income, not the whole family’s income.
Under TEFRA:
- The child’s income must be below the limit for people with disabilities to qualify for Medical Assistance.
- If the child’s income is higher than this limit they may still qualify by meeting a spenddown. A spenddown is like a deductible for medical expenses.
How much does it cost?
Children eligible for Medical Assistance, including Medical Assistance under the TEFRA option, do not have copays or deductibles.
When can my child's coverage start?
After your child is approved, coverage may:
- Go back to the first day of the month that we got your application.
- Go back up to three months before the month we got your application, if you request it.
Call your county or Tribal office if you have questions about when coverage can start.
Find your local county or Tribal officeWhat's covered under the TEFRA option?
If your child qualifies they will receive the same coverage as children enrolled in Medical Assistance. This includes doctor’s visits, prescriptions and hospital stays. In addition, it can cover Community First Services and Supports which is a Minnesota health care program that allows flexible options for those requiring more support to remain independent in their homes and communities by providing assistance with:
- Activities of daily living, such as eating, bathing, grooming and transferring
- Health-related tasks
- Instrumental activities of daily living, such as shopping, cooking and laundry
Children on Medical Assistance under the TEFRA option are not enrolled in managed care plans. Their Medical Assistance coverage is provided on a fee-for-service basis. Fee-for-service means that providers bill the state directly for services that they provide.
Learn about Community First Services and Supports (PDF) Summary of covered servicesIs there an asset limit?
No. Children do not have an asset limit for Medical Assistance. This includes children eligible for Medical Assistance under the TEFRA option.
What if my child has other health insurance?
Your child may still be eligible for Medical Assistance under the TEFRA option. 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.
Learn how other insurance could impact eligibility