MA-TEFRA in Minnesota: Medical Assistance for Children with Disabilities

What is MA-TEFRA?

TEFRA comes from the federal Tax Equity and Fiscal Responsibility Act of 1982, which let states offer Medicaid to children with disabilities who live at home, even when their parents earn too much for regular Medicaid. Minnesota's version is called MA-TEFRA, or the TEFRA option.

Nationally, this kind of option is sometimes called the “Katie Beckett” pathway, after the child whose family's situation inspired it. Once enrolled, your child has Minnesota Medical Assistance with the same covered services as other children on MA. That matters because many disability services here — including EIDBI autism therapy — are MA benefits.

MA-TEFRA is not the same as SSI. Social Security's SSI program generally does count parents' income for children, so many families are turned down for SSI. That denial doesn't mean your child can't get MA-TEFRA.

Who qualifies for MA-TEFRA in Minnesota?

The key point: parents' income and assets aren't counted when deciding whether the child is eligible, so middle- and higher-income families qualify regularly. In general, a child must meet all of these requirements:

• Be under age 19
• Live at home with their family
• Be certified disabled by the Social Security Administration or Minnesota's State Medical Review Team (SMRT)
• Need a level of care typically provided in a hospital, nursing facility or intermediate care facility, while being safely cared for at home
• Meet MA rules for the child's own income and assets, plus residency and citizenship or immigration requirements

How does the disability determination work?

Most children applying for MA-TEFRA don't already have a Social Security disability finding, so Minnesota's State Medical Review Team (SMRT) reviews the case. Your county submits the request along with medical records and forms you complete about your child's functioning.

Many autistic children qualify, particularly when their disability significantly affects daily functioning, but it's decided case by case. A diagnosis alone doesn't guarantee approval; the review looks at how the condition limits your child's everyday life.

Strong records help: autism or other diagnostic evaluations, therapy notes, IEP or IFSP documents, and provider letters describing how your child's condition limits daily activities. Describe real, typical days — not your child's best moments. The review can take weeks to a few months, so start early.

What is the MA-TEFRA parental fee?

Families of children on MA-TEFRA may owe a monthly parental fee. It's calculated on a sliding scale based on household income and family size, and lower-income families may owe little or nothing. The state sets and updates the fee schedule, so we don't quote amounts here — ask your county for an estimate based on your situation.

Compare the fee with what you'd otherwise pay in copays, deductibles and uncovered services. For families using therapy several times a week, MA-TEFRA often saves far more than it costs, but run your own numbers.

If a fee bill arrives that you can't afford, contact your county right away rather than ignoring it. Ask whether your fee can be reviewed if your income or family situation has changed.

How does MA-TEFRA work with private insurance?

MA-TEFRA commonly works as secondary coverage. Your private plan, through an employer or MNsure, pays first. Medical Assistance can then cover remaining costs for MA-covered services, such as copays and deductibles, and services your private plan doesn't cover.

Families are generally expected to keep and use private insurance when they have it, and to tell providers about both plans. Make sure your providers accept Minnesota MA and bill both correctly. Our insurance guide covers private plan mandates and self-funded plan exceptions in more detail.

How does MA-TEFRA unlock EIDBI and other services?

EIDBI — Minnesota's Early Intensive Developmental and Behavioral Intervention benefit for autism therapy — is an MA benefit. If your child has MA through TEFRA and a qualifying CMDE, EIDBI can cover ABA and other approved approaches, even when your private plan limits hours or doesn't cover them.

Beyond EIDBI, MA can help with other covered care your child may need, such as speech and occupational therapy, mental health services, prescriptions and medical equipment, subject to MA's usual coverage rules.

MA-TEFRA also makes your child eligible to be assessed for PCA/CFSS and disability waivers such as CADI, which fund in-home help, respite and more. See our EIDBI and CMDE guides for the therapy side, and our CADI and MnCHOICES articles for home supports.

How do you apply for MA-TEFRA?

Families in Minneapolis, St. Paul, Rochester, Duluth and everywhere else in Minnesota follow the same basic path. If you also want home supports, request a MnCHOICES assessment from your county at the same time — in Hennepin County, through Front Door.

1. Apply for Medical Assistance for your child through MNsure online, or with a paper application through your county. Note that your child has a disability.
2. Tell your county human services that you're applying under TEFRA, and ask which disability forms they need.
3. Complete the disability paperwork so the county can send your child's case to SMRT, unless your child already has a Social Security disability finding.
4. Gather supporting records: diagnoses, evaluations, IEP or IFSP, therapy notes and medication lists.
5. Respond quickly to county requests for information, and keep copies of everything you submit.
6. Once approved, review the parental fee notice and give your child's MA information to providers.

Keep in mind

Medical Assistance must be renewed periodically, and the disability determination may be reviewed too. Watch your mail for renewal notices and respond on time so coverage — and therapy — doesn't lapse.

This article is general information, not legal, medical or benefits advice. Eligibility rules, parental fees and application steps change. Confirm current details with your county or tribal nation, MNsure, or the Minnesota Department of Human Services.