Quick Answer
What is TEFRA? It is a Minnesota Medical Assistance option that looks at your child’s disability and care needs instead of your household income. If you were told you earn too much for coverage, that denial may not be the final answer, and approval can lead straight to autism therapy.
Kids Care Inc provides EIDBI and ABA therapy in Saint Paul, and we regularly talk with Minnesota parents who were turned down because of household income.
| Question | Short answer |
| Who it helps | Children under 19 with a certified disability who live with a parent |
| Whose income counts | Only your child’s |
| Who approves it | A county financial worker, after the State Medical Review Team (SMRT) certifies |
| What it covers | The same medical assistance benefits are available to other enrolled children. |
| Link to autism therapy | Meets the coverage requirement for EIDBI |
Does Earning Too Much Rule Out TEFRA?
Earning above the regular medical assistance limit does not rule out TEFRA. The option exists for children whose parental income would otherwise block coverage.
Regular MA counts household income. In our experience, many middle-income families stop right there with a denial letter and assume nothing else is available.
So what is TEFRA doing differently? The Minnesota Department of Human Services (DHS) explains on its TEFRA page that the option counts only the child’s income. That is disability-based eligibility, not income-based eligibility. DHS also explains that a child who was denied MA due to income does not need to submit a new application to be considered.
Three things TEFRA is not:
- Not a spenddown. DHS compares a spenddown to a deductible for medical expenses. TEFRA excludes parental income from the eligibility calculation, and children enrolled in MA have no copayments or deductibles.
- Not a monthly bill. Since July 1, 2023, Minnesota no longer assesses parental fees for children on MA under TEFRA. Fees can still apply in 24-hour care outside the home.
- Not automatic. Your child must be certified disabled and meet a level of care standard. SMRT makes that call, not your family and not a therapy provider.
Not sure whether your family fits? Talk with our team and we will help you work out where to start.
What Is TEFRA and Who Qualifies?
TEFRA changes how your child’s eligibility for Medical Assistance is decided. Your child then receives the same MA coverage as other enrolled children.
| Regular Medical Assistance | MA under TEFRA | |
| Whose income counts | Household income | Child’s income only |
| Basis for eligibility | Income and household size | Disability-based eligibility plus level of care |
| Who decides | County financial worker | County worker, after SMRT certifies |
DHS lists these requirements. A child must:
- Would not qualify for MA if parental income were included in the calculation.
- Be under age 19
- Reside with at least one biological parent, adoptive parent, or stepparent.
- Be certified disabled by the Social Security Administration (SSA) or SMRT
- Require a level of care at home comparable to care provided in a hospital, nursing facility, or intermediate care facility.
No checklist can promise an answer. SMRT looks at how your child’s disability affects daily life, so the records you bring matter as much as the diagnosis.
Is TEFRA insurance a separate health plan?
No. TEFRA provides access to medical assistance through an alternative eligibility pathway. Your child gets the same MA benefits as other enrolled children, with nothing new to buy.
What does MA-TEFRA stand for?
MA-TEFRA means Medical Assistance under the TEFRA option. You may see it written that way in county and DHS materials. The name comes from the federal Tax Equity and Fiscal Responsibility Act of 1982.
Is TEFRA the same as the Katie Beckett option?
Yes. Katie Beckett is the name several other states use for the same federal option. Parents searching for the Katie Beckett option Minnesota offers will find it listed as MA under the TEFRA option.
How Do You Apply for TEFRA Minnesota Through Your County?
Applying for TEFRA Minnesota starts with a Medical Assistance application, then your county refers your child to SMRT. A county financial worker approves it once SMRT certifies your child’s disability.
- Apply for MA. Use the MNsure online application or the paper version. Answer yes to at least one disability question.
- Call your county or Tribal office. State autism resources suggest asking the county to start the SMRT referral right after you apply.
- Respond to SMRT quickly. SMRT evaluates the required level of care and may determine disability status if the Social Security Administration (SSA) has not already done so. . Keep diagnostic reports, school records, and medical records together.
- Watch for the letter. SMRT sends a certification or denial letter to you and to the county.
- Wait for county approval. If SMRT certifies, a county or Tribal worker approves MA under the TEFRA option.
In our experience, the families who move fastest keep one page with the date they applied, their county financial worker’s name, and their case number. Applications pass through several desks, so a clear paper trail saves time.
Stuck on the paperwork? Contact our team and we will help you sort out what to send first.
How Does TEFRA MN Coverage Connect to EIDBI Funding?
TEFRA approval in Minnesota may help a child access autism therapy, but it satisfies only one of the four EIDBI eligibility requirements. TEFRA gives your child medical assistance, which meets the coverage requirement.
Your child also needs an autism or related-condition diagnosis, a comprehensive multi-disciplinary evaluation (CMDE) showing medical need, and must be under 21, as the DHS EIDBI page explains.
Think of it as two approvals with two jobs. SMRT certification opens the Medical Assistance door, and the CMDE assessment shows why your child needs EIDBI services. One does not replace the other.
For many middle-income families, TEFRA is what makes EIDBI funding possible at all. Once both approvals are in place, our team builds an individual treatment plan, submits it for authorization, and bills Medical Assistance directly.
Therapy itself is ABA delivered by a Registered Behavior Technician, supervised by a BCBA or QSP. New to ABA? Our guide to how ABA therapy supports your child’s development explains what sessions look like. Still sorting out a diagnosis? Our comparison of speech delay vs autism can help.
Plan ahead for age. TEFRA covers children under 19, while EIDBI runs to age 21. Rules around age 18 can differ, so ask your county financial worker well before your child’s 18th birthday what will apply. So what is TEFRA’s role in autism care? It secures the coverage, while the CMDE and treatment plan secure the therapy.
Does Your Employer Plan Have to Cover Autism Therapy?
Minnesota requires health plans issued to large employers to cover autism diagnosis and treatment, including ABA, for children under 18. Self-funded employer plans fall under federal law instead and may not be required to. Most answers to “what is TEFRA” leave this out.
The rule sits in Minnesota Statutes, section 62A.3094. It covers diagnosis, evaluation, and medically necessary care, including all types of applied behavior analysis, speech therapy, and occupational therapy. It does not change benefits under Medical Assistance.
The catch is that a fully-insured group plan and a self-funded employer plan look identical on your insurance card. In a self-funded plan, the employer pays claims itself, so the state mandate may not apply.
To find out which you have:
- Ask your HR department: “Is our plan fully insured or self-funded?”
- Check your summary plan description for the plan funding type
- Call the member services number on your card and ask whether Minnesota’s autism coverage rule applies
| Plan type | State autism rule | Next step |
| Fully insured, issued to a large employer | Applies to children under 18 | Ask for ABA benefits and prior authorization rules |
| Self-funded employer plan | May not apply | Get benefits in writing, and look at TEFRA |
| Smaller employer or individual plan | Varies by plan | Review plan documents closely |
In our experience, families are often surprised to learn the plan type, not the insurer’s name, decides which rule applies. Not sure which plan you have? Send us your insurance details and we will help you read them.
Can my child have TEFRA and employer insurance?
Often yes. Many families keep both. Medical Assistance is generally the payer of last resort, so private coverage is usually billed first and MA covers what remains. State autism resources add that when a family’s private insurance is deemed cost effective, the family may be eligible for premium reimbursement. Ask your county financial worker how your child’s employer plan is treated, since details depend on the case.
Who Will Guide Your Child’s Care at Kids Care Inc?
Kids Care Inc is a Saint Paul EIDBI and ABA provider serving families across the Twin Cities metro. A qualified supervising professional (QSP) directs your child’s treatment and approves the plan, board-certified behavior analysts lead treatment planning, and Registered Behavior Technicians deliver the 1:1 sessions.
Parents receive monthly written progress reports and a monthly meeting, plus a treatment plan renewal meeting every six months. We respond to new inquiries within one business day.
Which Insurers Does Kids Care Accept?
Kids Care Inc currently accepts UCare, Medical Assistance, HealthPartners, and Aetna. We verify each child’s insurance benefits before their first appointment. Families usually ask “what is TEFRA” first and “who pays” second, and we answer both.
Our team confirms your benefits, handles prior authorization submissions and follow-ups, and bills your insurance provider directly. Our ABA therapy insurance coverage guide explains the process. Children on MA under TEFRA are not enrolled in managed care plans, so their coverage runs through Medical Assistance itself.
Accepted insurers can change, so confirm with our team before you schedule.
Conclusion: What Is TEFRA and Why It Matters
If you’re wondering “what is TEFRA,” here’s the simple explanation: it allows Minnesota children with certified disabilities to qualify for Medical Assistance based on their own income rather than their parents’ income.
The path runs through your county and SMRT. TEFRA eligibility is separate from the CMDE required for EIDBI, and your employer-sponsored health plan type may affect which coverage rules apply. A denial for income is a reason to ask one more question, not a reason to stop. That is why Kids Care Inc reviews your child’s coverage before therapy begins.
Ready to Explore Your Child’s Eligibility Options?
You do not have to work through county paperwork, SMRT letters, and plan documents alone. Confused about what you qualify for? We’ll walk through it with you.
When you contact Kids Care Inc, our team can:
- Review your child’s coverage and plan type
- Help you understand how TEFRA, the CMDE, and EIDBI work together.
- Check your benefits before the first visit
Call 651-441-6245 or contact our team today. More answers are in our EIDBI FAQ for Minnesota families.
Because program requirements may change, check with your county or Minnesota DHS for the latest information before applying.
Kids Care Inc
📍 1400 Energy Park Dr Ste 18, Saint Paul, MN 55108
📞 651-441-6245
✉️ info@kidscareinc.com
Questions about your child?
Call 651-441-6245 or send us a note. No question is too small.
