Medical Assistance under the TEFRA Option

Medical Assistance (MA) under the TEFRA option is for children with a disability who are otherwise ineligible for MA because household income is above the MA for Families with Children and Adults (MA-FCA) income limit. The TEFRA option for children with a disability is named after the Tax Equity and Fiscal Responsibility Act (TEFRA) of 1982 that created the option.

Under the MA TEFRA option, children who are otherwise ineligible for MA due to household income may become eligible. Only the income of the child is counted when determining eligibility for MA. Parents’ income is not counted.

MA under the TEFRA option is available for children who meet all of the following:

• Are under age 19
• Live with at least one biological or adoptive parent
• Require a level of care:
  • comparable to that provided in a hospital, nursing home or an intermediate care facility for people with developmental disabilities (ICF/DD), and
  • for which the cost for home care would not be more than MA would pay for the child's care in a medical institution.
• Are certified disabled

Children who are eligible for MA when counting parental income do not need to use the TEFRA option. Children approved under a home and community-based services waiver do not need to use the TEFRA option.

In general, MA eligibility under the TEFRA option follows the policies for MA for People Who Are Age 65 or Older and People Who Are Blind or Have a Disability (MA-ABD). Specific differences are indicated in the policies for MA under the TEFRA option listed below.

MA under the TEFRA option eligibility is determined using a variety of non-financial, financial and post-eligibility requirements. This subchapter includes policies that apply to the MA under the TEFRA option and links to policies that apply to all MA programs, MA-ABD, and all Minnesota Health Care Programs (MHCP) programs.

1. TEFRA General Requirements
2. TEFRA Applications
3. MA Cooperation
4. MHCP Fraud
5. MHCP Inconsistent Information
6. MA Referral for Other Benefits
7. MHCP Rights
8. MA Third Party Liability 1. MA Cost Effective Insurance 2. MA Medical Support 3. MA Other Third Party Liability
9. TEFRA Non-Financial Eligibility
10. MA-ABD Non-Financial Eligibility 1. MA-ABD Bases of Eligibility 2. MA-ABD Certification of Disability 3. MA Citizenship and Immigration Status 4. MA County Residency 5. MHCP State Residency 6. MA Social Security Number
11. TEFRA Level of Care
12. TEFRA Financial Eligibility
13. TEFRA Post-Eligibility
14. MA Begin and End Dates
15. MHCP Overpayments
16. MA Third Party Liability
17. MA Cost-Effective Insurance
18. MA Medical Support
19. MA Other Third Party Liability
20. MHCP Change in Circumstances
21. MA Cooperation
22. MA Cost Sharing
23. MHCP Fraud
24. MA-ABD Health Care Delivery
25. MHCP Inconsistent Information
26. MA Qualifying Health Coverage
27. MA Referral for Other Benefits
28. MA-ABD Renewals