Coverage guide
Minnesota MA-TEFRA for children with autism
A plain-language family guide to the Medical Assistance TEFRA option: who it may help, the disability review, how to apply and how coverage connects to EIDBI.
This guide does not replace DHS policy, payer requirements, legal advice or professional judgment. Never change, omit or invent diagnoses, symptoms, service times, signatures, evaluations or household information to obtain eligibility or payment. Report corrections through the responsible provider, health plan, county, Tribal Nation or DHS.
What MA-TEFRA is
Medical Assistance under the TEFRA option helps some children with disabilities qualify when they are otherwise ineligible for MA because parental income is counted. Minnesota then counts the child’s income for TEFRA financial eligibility. TEFRA is not an autism diagnosis, waiver or therapy program.
- The child must meet every TEFRA condition; an autism diagnosis alone is insufficient.
- TEFRA provides the same covered-service package as children’s Medical Assistance on a fee-for-service basis.
- Other insurance is allowed but must be reported.
Check every TEFRA requirement
Current DHS guidance requires the child to be otherwise ineligible for MA when parental income is counted, be under age 19, live with a biological, adoptive or stepparent, be certified disabled by SSA or SMRT, need an institutional level of care determined by SMRT, and meet the child-income rules. DHS currently states children have no MA asset limit.
- Disability and institutional level of care are separate findings.
- School eligibility or an autism diagnosis can be evidence but does not by itself establish TEFRA eligibility.
- If the child’s income exceeds the limit, ask the eligibility worker whether a spenddown applies.
- Use the written DHS decision for the family’s case rather than relying on an online estimate.
Follow the official application and SMRT sequence
Start the Medical Assistance application through the correct state, county or Tribal process. The financial worker decides whether to refer the case to SMRT. DHS specifically says not to send records to SMRT until a referral has been verified in its system.
- Submit complete, truthful household, income, insurance and medical information.
- After referral, return SMRT forms and objective medical evidence by the deadlines.
- Keep copies, delivery confirmation, worker name and case number.
- If denied, use the notice’s review or fair-hearing instructions instead of changing facts or diagnoses.
Coverage still has service-specific rules
Once approved, the child receives fee-for-service Medical Assistance. Each requested service retains its own coverage, eligibility, medical-necessity, enrolled-provider and authorization rules. TEFRA approval does not automatically approve EIDBI, a number of treatment hours or a particular provider.
- Complete the diagnosis, CMDE and authorization requirements for EIDBI.
- Confirm that providers are enrolled and qualified for the specific service.
- Report other insurance so benefits can coordinate correctly.
- Do not bill MA for a service another payer already paid or for care not delivered.
Current costs, changes and renewals
The current DHS public page says children eligible for MA, including TEFRA, have no copays or deductibles. DHS also says parents have not been assessed a TEFRA parental fee since July 1, 2023; certain 24-hour out-of-home placements can follow different fee rules. Laws and budgets can change, so use the current DHS page and the family’s official notice.
- Complete renewals and continuing-disability reviews on time.
- Report address, household, income, insurance and living-arrangement changes as required.
- Never hide employer insurance or a change in where the child lives.
- Ask the county, Tribal Nation or DHS to explain any premium, spenddown or fee in writing.
Common questions
Frequently asked questions
Is MA-TEFRA only for children with autism?
No. It is a Medical Assistance eligibility option for children who meet Minnesota’s disability, level-of-care and other program requirements.
Does family income count for MA-TEFRA?
TEFRA is used when the child is otherwise ineligible for MA with parental income counted. Under the TEFRA option, DHS determines financial eligibility using the child’s income. The worker still needs accurate household and financial information to decide which pathway applies.
Does TEFRA approval guarantee EIDBI services?
No. TEFRA can provide qualifying Medical Assistance coverage, but EIDBI has separate age, diagnosis or related-condition, CMDE, medical-necessity, provider and authorization requirements.
Is there still a monthly parental fee?
The current DHS parental-fee page says parents are no longer assessed a fee for children enrolled under TEFRA, effective July 1, 2023. Some 24-hour out-of-home placements can be different. Check the current DHS page and the child’s official notice because proposed legislation or budget language is not itself a current charge.
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