What is Tefra?
- The Tax Equity and Fiscal Responsibility Act (TEFRA) is a Medicaid program that can help families with children younger than 19 years old who have a disability receive care in their homes rather than an institution.
- The TEFRA program can help pay for the cost of those services for eligible children. Some families will not have to pay anything as part of the program. Others pay a premium on a sliding scale, depending on their income. Children who live in an institution or receive extended care in an institution are not eligible for TEFRA
Tefra Eligibility
Approval for the TEFRA program is based on Financial Eligibility and a Medical Evaluation Process to determine if all of the three requirements below are met.
Eligibility
- Disability Requirement
- A child must meet the Social Security Administration’s (SSA) definition of disabled.
- If SSA has not established a disability
- Medical Review Team will review your child’s medical records to establish whether your child has a disability.
- Medical Necessity And Appropriateness Of Care Requirement
- Medical necessity is based on services that improve or maintain a child’s health or prevent a child’s health from getting worse.
Financial Requirement
The child cannot have personal income that exceeds the Long Term Care Medicaid limit, which is three times the SSI income limit and can change each year. The child cannot have countable resources that exceed $2,000. Countable resources for a child include cash on hand, bank accounts, vehicles, etc. Parental income and resources are not considered.
Applying For TEFRA
Application Packet
You can apply for TEFRA by downloading this entire TEFRA application packet, filling out the required forms, and submitting it to your local DHS County Office.
- Application for SNAP, Health Care, and TEA/RCA Benefits form (DCO-0004)
- Application for SNAP, Health Care, and TEA/RCA Benefits form (DCO-0004) (Spanish)
- Authorization for Release of Information form (DCO-4000)/ Español
- Physician Assessment form to be completed by child’s medical provider(s) (DMS-2602)
- Social Report form to be completed by parent (DCO-108C)