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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).
If you've already applied for coverage
If you have already applied for health care coverage and:
- Your child was denied because of income above the Medical Assistance limit OR
- Your child was denied Medical Assistance and was found eligible for MinnesotaCare or a qualified health plan
You do not have to reapply for Medical Assistance under the TEFRA option. Contact your county or Tribal office for next steps.
Find your local county or Tribal officeWhat if my child is already enrolled in a Minnesota Health Care Program?
If your child is currently enrolled in a Minnesota Health Care Program, such as Medical Assistance under a different basis of eligibility or MinnesotaCare, you will not need to complete the full MNsure application again if a disability was indicated on your original application or reported any time after you submitted the application. Your county or tribal agency will begin the SMRT referral process.
Ways you can apply
If you have not yet applied for Medical Assistance for your child, then the first step to apply for Medical Assistance under the TEFRA option is to complete an application for Medical Assistance. Your child can be the only one in the household applying for health coverage. If your child is eligible for Medical Assistance, you do not need to pursue Medical Assistance under the TEFRA option. The services granted under TEFRA are available to all children who qualify for Medical Assistance.
You can apply in either of these ways:
Important note about applying for your child
When completing either application, you would answer “yes” to at least one question about disability. Examples of the questions to answer “yes” to are the following:
- Is your child Blind?
- Does the child have a physical, mental or emotional health condition that limits daily activities (such as bathing, dressing or doing chores)?
- Does your child need assistance to stay in your home or help paying for care in a long term care facility?
- Are you applying for a child that has a disability determination or a condition you believe is disabling, and needs additional services or supports?
- Has your child been determined disabled by the Social Security Administration or the State Medical Review Team (SMRT)?
Online
Note: You will need to create an account if you do not already have one.
Mail, fax or in person
Complete the Application for Health Coverage and Help Paying Costs and send it to your local service agency by mail or fax or drop it off in person.
Download the application Find your local county or Tribal officeDo not speak English?
The paper application is also available in the following languages:
What happens next?
Your county or Tribal office will review the application and if the child is found ineligible for Medical Assistance due to family income, the agency may send out a request for more information along with TEFRA information. Your county or Tribal office will need to send a referral to SMRT for a disability determination and level of care determination.
Once the county or Tribal agency has referred the case to SMRT, the following will happen:
- SMRT will evaluate your child’s level of care and may also certify your child’s disability if the Social Security Administration has not already done so. SMRT will contact you directly to request any more information they need.
- SMRT sends a certification or denial letter to your child, the authorized representative, and the county or Tribal agency.
- If SMRT certified your child’s disability, a county or Tribal worker approves Medical Assistance under the TEFRA option.