Get help using the TEFRA option
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 1, 2019.
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 at 763-422-7200 for a screening
Staff will review your household information to see if you should apply for MA in METS (MNsure) or if you need to apply for MA-TEFRA. If you are determined to be UNDER the income limits for MA, you will be directed to apply on mnsure.org or go to an assistance center for help in applying on mnsure.org. If you are found to be OVER the income limits for MA, and you have a child under 18 that can be certified disabled by the state that is living with a parent or guardian, you will be mailed a packet to fill out to apply for MA-TEFRA. This is the process:
- Economic Assistance will mail you informational materials and a paper application for MA called the Supplement to MNsure Application (DHS-6696) for Health Coverage and Help Paying Costs. On this application, you can only apply for TEFRA for children under 18 that you feel could be certified disabled by the State Medical Review Team. Any other household members interested in applying for medical would need to do so on mnsure.org.
- You will need to fill out the Application for Certain Populations form and return that to the Anoka County office to start the process. This will “pend” your application so that further action can be taken.
The applications can be returned to:
Anoka Co Economic Assistance
P.O. Box 10
Anoka, MN 55303
Or you can email it to: [email protected]
Or you can fax it to: 763-324-3630. Please include a cover sheet to ATTN: TEFRA
Or you can drop off the application in any office (Blaine, Anoka, Lexington or Columbia Heights)
- Once the application is received it will be pended, or entered in to the computer system. Once the application is pended, Economic Assistance can then send a referral to the State Medical Review Team (SMRT). SMRT is the department that will gather information to make a disability certification determination for your child. Please note that during this pending time, our system will automatically send you a notice around the 45-day mark letting you know you are still pending and you haven’t turned in your verifications. This can be ignored, as we are not waiting on any verifications from you to process your case (just waiting on the SMRT decision).
3. Watch your mail for paperwork from SMRT
SMRT may also make a “welcome call” to notify you who they have assigned your case to there. They will send a release form and additional information gathering forms. These need to be returned to SMRT. SMRT is part of the Department of Human Services (DHS) and is not located in Anoka County offices. If you turn these forms in to the Anoka County offices, they will be forwarded to SMRT, but it may delay SMRT’s receipt of the documents.
- The SMRT decision often takes 3 to 4 months. Once SMRT has made a decision, they will fax that to the county office and they will mail a copy to your home.
- If the SMRT decision is a certification of disability, you will get a follow up call from TEFRA Staff to go over your pending application and current need for TEFRA. They will also go over the available start months based on the current application that is filed. Don’t worry if things have changed, you are not required to accept TEFRA coverage that is offered to you, even if a SMRT has been completed. Also, you do not need to accept coverage off the original application. Often times things change in those 3 to 4 months while you’re waiting for SMRT’s decision. It may be necessary to deny the previous application and do a new one for a more appropriate start month, but you won’t need to redo the SMRT process. Once your child is certified disabled by SMRT that certification remains. SMRT certifications are typically extended for four years.