The TEFRA option may help pay for the treatments needed by a child with a serious, prolonged mental health condition. To use the TEFRA option, you will need to work directly with the Anoka County Economic Assistance department. The Children's Mental Health unit can help you with advice and information.
TEFRA stands for the Tax Equity and Fiscal Responsibility Act, a federal law that set the rules for this option. The TEFRA option allows a disabled child to receive Medical Assistance (MA) payments, even if the child's parents have too much income to qualify for the MA program. You can read more about TEFRA on the Minnesota Department of Human Services website.
Steps to Follow to use the TEFRA option These steps are current as of January 27, 2015. Call Children's Mental Heath at 763-712-2772 for the latest information.
1. Estimate your parental fee Using the TEFRA option, the MA program helps pay for a child's mental health treatments, but the child's parents may have to pay a monthly fee for using the option. In general, parents with higher incomes will pay a larger fee than parents with lower incomes. Use the Parental Fee Estimator to calculate your payment or call 651-431-3806 or 800-657-3751 for help.
2. Contact the Anoka County Economic Assistance TEFRA worker The Economic Assistance department has a staff person who focuses on TEFRA applications. Contact Children's Mental Health at 763-712-2772 for the name, direct phone number, and email address of the current TEFRA worker. You will be communicating with the TEFRA worker frequently during the application process.
Call the TEFRA worker before applying for Medical Assistance. The worker needs to put you on the TEFRA list so she/he can watch for your MA application in the MnSure system.
3. Apply online for Medical Assistance Use the MnSure website at www.mnsure.org to apply for regular MA.
Apply for MA under your child's name, not your name.
Enter your income, not the child's income.
When you finish the online application, print out a copy. You will need to use the same information to fill out a paper copy of the application at a later time (this doesn't match with info in step 4).
Do not be alarmed when the system says your child is not eligible for MA. This is to be expected because of your income level. Your child's MA application is now in the system to be considered for the TEFRA option.
4. Let the TEFRA worker know you have completed the Medical Assistance application The TEFRA worker will then send you:
A paper copy of your child's MnSure application that you will need to use later in the process.
An application form for the State Medical Review Team (SMRT) that has questions about your child's disability. This form is used in the process that determines whether or not your child qualifies for the TEFRA option. If you have any questions about filling out the SMRT form, you should ask your case manager.
5. Collect additional information about your child's situation Collect the following documents and give them, along with the SMRT form, to the TEFRA worker:
The results of the most recent medical/physical exam your child has received. Preferably, the exam should have occurred within the last 3 months.
The results of a complete psychiatric and/or psychological evaluation performed by a licensed psychiatrist or psychologist. The evaluation should have occurred within the last 12 months.
A copy of your child's current treatment plan, prepared by your child's current therapist, case manage, in-home workers or others. The plan must include a paragraph about the level of supervision your child needs and a schedule of who watches your child. You should include therapy progress notes and goals in this document.
Discharge summaries from any hospitalizations or day treatments.
A copy of your child's IEP or 504 plan and your child's most recent Special Education Evaluation.
Grades, behavior reports, and other documents from your child's school.
6. Wait for approval
The TEFRA evaluation process may take three to four months. You will receive a phone call or letter from the Minnesota Department of Human Services about your child's application for Medical Assistance.
During the wait, you may receive numerous form letters stating that your child was not approved for MA. This is normal because the MnSure application process for MA does not include your SMRT form and all the other information you submitted.
While waiting, you can contact the TEFRA worker by phone or email to check on the status of your child's application.