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.

Parents may have to contribute to the costs of the child’s care by paying a parental fee. The amount of the fee is calculated on a sliding scale based on the parents' income. You can estimate your parental fee online or by using this paper worksheet (PDF). The exact amount is calculated based on your income and other information you provide. The parental fee is determined and billed in a separate process, and is not a part of determining the child’s eligibility for MA under the TEFRA option.

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.

If your child is found ineligible for MA when counting parental income, you will be asked to fill out and return the Supplement to MNsure Application for Health Coverage and Help Paying Costs (DHS-6696A). Your county or tribal office will then use the information provided on the MNsure application and the supplemental form to determine whether your child is eligible under the TEFRA option. If a SMRT determination is needed, SMRT will contact you directly to request any information they need.

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 worker will request additional information, and if appropriate, make a referral to the SMRT. SMRT will contact you directly to request any information they need.

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
• Minnesota Health Care Programs Member Help Desk
• Disability Hub MN at 866-333-2466
• TTY: Use your preferred relay service