Medical Assistance under the TEFRA Option

2.3.6.1.1 Applications

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.

Because the MA under the TEFRA option is only available to children with a disability who are not otherwise eligible for MA, children must first apply for MA using the MNsure online application or the paper MNsure Application for Health Coverage and Help Paying Costs (DHS-6696).

Both the online and paper DHS-6696 application forms asks:

  • Are you blind?

  • Do you have a physical, mental, or emotional health condition that limits your activities (like bathing, dressing, daily chores, etc.)?

When an application for a child indicates yes to either question, and MA is denied because the household income exceeds the child’s income limit, a referral must be made for MA under the TEFRA option.

Because the information needed to make an eligibility determination for MA-FCA is different than the information needed to determine eligibility for MA for People Who Are Age 65 or Older and People Who Are Blind or Have a Disability (MA-ABD), the applicant must then complete the Supplement to MNsure Application for Health Coverage and Help Paying Costs (DHS-6696A). This paper supplement gathers information, not requested on the MNsure application, needed to determine eligibility for MA-ABD.

The county, tribal or state servicing agency must complete a State Medical Review Team (SMRT) Referral for a Disability Determination (DHS-6123). SMRT makes both the level of care determination and a disability determination, if the child is not already certified disabled by the Social Security Administration. See the MA-ABD Certification of Disability policy for more information. See the TEFRA Level of Care policy for more information.

Legal Citations

Code of Federal Regulations, title 42, section 435.225

Code of Federal Regulations, title 42, section 435.907

Code of Federal Regulations, title 45, section 155.405

Code of Federal Regulations, title 45, section 155.310

Minnesota Statutes, section 256B.08

Minnesota Statues, section 256B.055, subdivision 12

United States Code, title 42, section 1396a, subdivision e

The Tax Equity and Fiscal Responsibility Act (TEFRA), Public Law 97-248, section 134