04.07.2026

The Arc Guide to Medical Assistance – TEFRA


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What You Will Find in This Guide

This guide explains Medical Assistance (MA) through the Tax Equity and Fiscal Responsibility Act (TEFRA) option in Minnesota. You will learn about:

  • What TEFRA is.
  • How it benefits your child and family.
  • Who qualifies for it.
  • The role of the State Medical Review Team (SMRT).
  • What services TEFRA may cover.
  • Steps to apply.
What is TEFRA?
  • TEFRA is a Minnesota Medical Assistance (MA) program for children with disabilities. It provides health care coverage for children under 19 who would not otherwise qualify for MA because their parents’ income is too high.
  • Instead of looking at family income, TEFRA eligibility is based on the child’s disability and care needs. This means families who have higher income can still access important services for their child with a disability.
  • TEFRA helps pay for disability programs, services, and therapies that private insurance may not cover—or only covers partially.
Benefits of TEFRA

TEFRA gives families access to a wide range of supports and services to help children live at home, stay healthy, and be part of their communities.

Some examples of services TEFRA may cover include:

  • Medical visits and hospital stays.
  • Therapies (speech, occupational, physical).
  • Medications and medical supplies.
  • Mental health services.
  • Home care nursing or personal care assistance (PCA).
  • Specialized medical equipment.
  • Transportation to medical appointments.
  • Because every child’s needs are different, what TEFRA covers will depend on their medical and disability-related needs.

Refer to “Minnesota Health Care Programs Summary of Coverage, Cost Sharing and Limits (DHS 3860)” for a complete listing of benefits and services covered by MA.

Who Qualifies for TEFRA?

To qualify for TEFRA, a child must meet all of the following:

  • Live with at least one parent.
  • Be under age 19.
  • Be certified disabled by the State Medical Review Team (SMRT) or the Social Security Administration (SSA).
  • Require a level of care at home that is similar to what would be provided in a hospital, nursing home, or group home.
  • The cost of caring for the child at home must be less than the cost of institutional care.
What is SMRT and Why Does it Matter?
  • The State Medical Review Team (SMRT) is a group that reviews medical records to decide if someone meets the federal definition of disability.
  • If your child already receives Supplemental Security Income (SSI), they may already be considered certified disabled and do not need SMRT.
  • If your child does not receive SSI, the county will send medical and school records to SMRT. SMRT will then decide if the child qualifies as disabled for Medical Assistance purposes.
What to Expect from the SMRT Process:
  • Your county worker will ask you to provide medical, psychological, and educational records.
  • Sometimes SMRT may request additional records from your child’s providers.
  • The process can take several months, but counties may be able to provide temporary coverage while waiting.
  • If SMRT approves, your child is considered “certified disabled,” which is required for TEFRA.
  • If SMRT denies the application, you have the right to appeal or provide new information for reconsideration.
What Services are Not Covered?

TEFRA does not cover everything. Families may still have costs such as:

  • Room and board (housing, rent, or food).
  • Non-medical transportation.
  • Services unrelated to the child’s disability or medical needs.
What Do I Do Next?

Step 1: Contact Your County Financial Unit

  • Before applying, reach out to your county’s financial services unit. They can explain the application process and what information you’ll need. You can also connect with a MNSure Navigator for help.

Step 2: Apply Online or by Paper

  • Apply online at www.mnsure.org (preferred).
  • Or apply by paper using the “MNsure Application for Health Coverage and Help Paying Costs” (DHS 6696).
  • When completing the application:
    • List the child as the only household member applying.
  • Answer “yes” to the disability question: “Does anyone applying have a physical or mental health condition that limits the ability to work or perform activities of daily living?”

Step 3: Wait for Initial Results

  • After the application is submitted, the child may show as “denied” for standard programs or marked eligible for a Qualified Health Plan (QHP). This is normal because eligibility is based on parental income.

Step 4: Contact Your County Again

  • Once the application is processed, contact your county financial unit to let them know you are applying for TEFRA. They will review disability certification through SMRT or SSA and level of care needs.
If You Qualify for TEFRA

If your child is approved, here are the next steps:

  • Meet with a caseworker: They will help you understand what services are covered.
  • Start services: Once approved, you can begin using TEFRA-covered supports.
  • Annual review: Your child’s eligibility will be reviewed yearly to ensure they still qualify.
If You Do Not Qualify for TEFRA

If your child is denied, you can:

  • Ask your county worker to explain the denial and see if another program is a better fit.
  • Request an appeal if you believe the decision was wrong. Instructions will be in your denial letter.
  • Ask for a reassessment if your child’s needs change.
Resources for More Information
  • MNsure Website
  • MA-TEFRA Checklist
  • Arc Guide to Medical Assistance
  • Arc Guide to MnCHOICES Assessment
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