Medical Assistance under the TEFRA Option

2.3.6.2.1 Level of Care

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.

The State Medical Review Team (SMRT) reviews all referrals for MA under the TEFRA option to determine:

if the child is considered disabled according to the Social Security standards, and
if the child's needs meet the level of care requirements.

The child must meet one of the following level of care requirements:

Hospital (including, but not limited to, Severe Emotional Disturbance)
Intermediate care facility for people with developmental disabilities (ICF-DD)
Nursing facility (including, but not limited to, Severe Emotional Disturbance)

See the MA for People Who Are Age 65 or Older and People Who Are Blind or Have a Disability (MA-ABD) Certification of Disability policy for more information.

Legal Citations

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

Code of Federal Regulations, title 42, section 435.225

Minnesota Statutes, section 256B.055, subdivision 12

Minnesota Statutes, section 256B.092

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