Medical Assistance under the TEFRA option for children with disabilities

To use MA under the TEFRA option, a child must meet all the following requirements: 

• Be otherwise ineligible for MA 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) 

In general, a child’s total family income is counted when determining a child’s eligibility for MA. When a child is eligible for MA under the TEFRA option, only the child's income is counted. 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). If the child’s income exceeds the MA income limit for a person who has a disability, the child may still be eligible for MA under the TEFRA option with a spenddown.

Children eligible for MA under the TEFRA option do not have an asset limit.

Effective July 1, 2023, parents are no longer assessed a parental fee for children enrolled in MA under the TEFRA option. Parents are still responsible for parental fees assessed for children under the TEFRA option before June 30, 2023.

Parental fees may still be assessed for children who have a developmental disability, or a physical disability or emotional disturbance in 24-hour care outside the home. This includes a:

• medical facility such as a nursing home or an intermediate care facility for a person with a developmental disability,
• state-operated psychiatric hospital for children, or
• psychiatric residential treatment facility

Children eligible for MA under the TEFRA option do not have copays.

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) to your county or tribal office.

When you apply, pay special attention to questions we ask about your child: 

• Has your child been determined disabled by SSA or SMRT? 
• Does your child have a disability determination or a condition you believe is disabling, and need additional services or supports? 

Your county or tribal office will use this information and ask for any additional information or verifications they need to decide whether your child is eligible for MA under the TEFRA option. If you applied for MA through MNsure and were found eligible for MinnesotaCare or a qualified health plan (QHP), you do not have to reapply for MA under the TEFRA option. The county or tribal agency will request additional information, and if appropriate, make a referral to SMRT. SMRT will contact you directly to request any information they need.

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.

Your child may still be eligible for MA 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.

• County and tribal offices
• DHS Health Care Consumer Support (HCCS) TTY: Use your preferred relay service

• Disability Hub MN at 866-333-2466
• TEFRA Information Sheet DHS-7960