2.3.6 Medical Assistance under the TEFRA Option (Archive)

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. Parents may be required to pay a parental fee.

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

   1. TEFRA Applications

   2. MA Cooperation

   3. MHCP Fraud

   4. MHCP Inconsistent Information

   5. TEFRA Parental Fees

   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

2. TEFRA Non-Financial Eligibility

   1. 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

   2. TEFRA Level of Care

3. TEFRA Financial Eligibility

4. TEFRA Post-Eligibility

   1. MA Begin and End Dates

   2. MHCP Overpayments

   3. MA Third Party Liability

   4. MA Cost-Effective Insurance

   5. MA Medical Support

   6. MA Other Third Party Liability

   7. MHCP Change in Circumstances

   8. MA Cooperation

   9. MA Cost Sharing

   10. MHCP Fraud

   11. MA-ABD Health Care Delivery

   12. MHCP Inconsistent Information

   13. MA Qualifying Health Coverage

   14. MA Referral for Other Benefits

   15. MA-ABD Renewals

Published:  November 1, 2019

Archived: June 11, 2024