Does TEFRA count our family's income?

No — that's the entire point of it. TEFRA looks at your child's own income, and parental income is disregarded. The child's income has to be under 100% of the Federal Poverty Guideline, and if they're over, a spenddown may still make them eligible. For most children, who have no income at all, this test simply isn't the obstacle.

Is there a parental fee for TEFRA?

Not for children living at home. Minnesota eliminated parental fees for children on MA-TEFRA living at home effective July 1, 2023. If you were told years ago that TEFRA meant a monthly fee, that information is out of date. Fees can still apply for children in 24-hour care outside the home.

Does an autism diagnosis qualify my child for TEFRA?

No, and this is the part families are most often blindsided by. TEFRA requires the State Medical Review Team to certify your child as disabled and to find that they need an institutional level of care at home. A diagnosis of autism, on its own, does not establish either. Many autistic children do qualify; the diagnosis isn't what does it.

Can my child have TEFRA and our private insurance at the same time?

Yes, and you generally shouldn't drop a private plan to get MA. Your commercial plan stays the primary payer and MA wraps around it. Whether therapy with Ability Avenues would be covered in that situation is a separate question — we bill Straight Medical Assistance and Blue Plus, not commercial plans — so call us and we'll work out where your family actually stands.

TEFRA in Minnesota: Medical Assistance, Whatever You Earn

What is the TEFRA option?

TEFRA is the reason a Minnesota family earning a comfortable living can still get Medical Assistance for their disabled child.

Normally, Medical Assistance looks at household income, and a working family is over the line. The TEFRA option changes what gets counted: eligibility is assessed on the child's own income, and parental income is disregarded entirely. For most children — who have no income — that test stops being an obstacle at all.

It matters for autism families specifically because of what sits on top of it. EIDBI, the Minnesota benefit that pays for autism therapy including ABA, requires enrollment in a qualifying health care program as one of its four eligibility criteria. TEFRA is one way to satisfy that. So TEFRA is the coverage, and EIDBI is the benefit that runs on it.

Keep those two separate in your head, because their age limits differ and conflating them causes real confusion: TEFRA stops at 19. EIDBI runs to 21. (Ability Avenues serves children ages 2 to 12 within all of it.)

What does TEFRA cost your family?

Nothing, for a child living at home — and this is the fact most likely to be out of date wherever else you heard it.

Minnesota eliminated parental fees effective July 1, 2023 for children on MA-TEFRA living at home. Before that, TEFRA came with an income-based monthly fee, which is why plenty of parents, case workers, and internet posts still describe one. The fee is gone. If someone quotes you a monthly figure for TEFRA, they're working from a version of the rules that's now years old.

Two honest edges on that: fees can still apply for children in 24-hour care outside the home, and "no parental fee" is not the same as "no work" — the application is genuine effort, and the next section is about that.

What does TEFRA actually require?

Here's where we're going to be less cheerful than most pages on this topic, because a family who walks in expecting a formality and gets a denial has been badly served by whoever told them it was easy.

TEFRA is not automatic. Four things must be true:

Your child is under 19 and lives with at least one parent. Not 21 — that's EIDBI. TEFRA's limit is 19.
Your child is certified disabled by the State Medical Review Team (SMRT) or the Social Security Administration. A SMRT referral is required for every TEFRA case, even when SSA has already certified your child — because SMRT also makes the determination in point 3, and nobody else can.
SMRT finds your child needs an institutional level of care. This is the requirement families are most often blindsided by, so here it is plainly: SMRT has to find that the care your child needs at home is comparable to what they'd receive in a hospital, a nursing facility, or an intermediate care facility for people with developmental disabilities — and that providing it at home costs less than the institution would. An autism diagnosis alone does not qualify a child. Not a severe one, not a formal one, not one from a well-known clinic.
Only your child's income counts. Under 100% of the Federal Poverty Guideline, with a spenddown possible above it. This is the unlock, and for most children it's a formality.

None of that means don't apply. Plenty of autistic children meet the level-of-care standard, and you can't know which side of it your child falls on without a determination — SMRT's job is to make that call, not yours. What it means is: apply with clear eyes. Point 3 is a real gate, it's assessed on your child's day-to-day support needs rather than on a diagnosis, and it's the reason this takes months instead of weeks.

How do you apply for TEFRA?

Through your county — not through us, and not through a provider. The path:

Contact your county or tribal financial worker. They're who processes it. Applications go to county and tribal lead agencies, which DHS supervises.
Apply using the MNsure application — paper form DHS-6696 — and say you're applying for MA under the TEFRA option.
List only your child as the applicant. See the checklist below; this is the step that goes wrong.
The SMRT referral goes in. Your worker initiates it. SMRT reviews your child's medical documentation and makes both the disability certification and the level-of-care determination.
A decision comes back, and if it's a yes, your child is enrolled in Medical Assistance — at which point the fourth EIDBI criterion is satisfied and the EIDBI path is open.

The things worth getting right, most of which are just questions asked at the right moment:

List only your child as the applicant — The single most important line on the form, and the one families get wrong. TEFRA works by looking at your child's income instead of yours. Applying as a household invites the answer you were trying to avoid.
Ask for the TEFRA option by name — It isn't a separate program with its own front door — it's an option within Medical Assistance. If you don't name it, a worker has no way to know that's what you're after.
Ask your worker for DHS's TEFRA application checklist — DHS publishes its own checklist of what your county needs. Ask for it rather than trusting any list you found online, including ours — county paperwork changes and yours is the version that counts.
Confirm a SMRT referral has been made — Required for every TEFRA case, even if the Social Security Administration has already certified your child as disabled — SMRT also makes the level-of-care determination, and nobody else can. Ask explicitly whether it's been sent.
Ask what SMRT still needs from you — SMRT decides on documentation. Missing records are the most common reason a case sits still, and the wait is measured in months — so ask early rather than discovering a gap later.
Ask for more time if you need it — Processing can take up to 60 days, and your worker may extend that window if you need longer to gather paperwork. Asking is better than being closed out for a missing document.
Put the renewal date in your calendar the day you're approved — TEFRA renews annually. A lapse in coverage is a lapse in the EIDBI eligibility that sits on top of it — this is the one piece of ongoing homework the benefit hands you.

How long does it really take?

Longer than you want, and this is the single best argument for starting before you feel ready.

County processing: up to 60 days. Your worker may extend that if you need more time to gather paperwork — an extension is better than a closed application.
SMRT: several months on top of that. It's a separate review with its own queue.

We're not going to give you a total, because we'd be making it up and you'd plan around it. What's reliably true is that this runs in months, that it's the slowest step on the whole road to therapy, and that it does not require a diagnosis, a CMDE, or a chosen provider to begin. Nothing else in the process is waiting on it — so run it in parallel with everything else rather than after.

If you take one thing from this article: start the county paperwork on a week when nothing else is happening. It's the piece where waiting costs you the most and asking costs you the least.

Can you keep your private insurance?

Yes — and you generally should not drop it.

Under Minnesota's third-party payer rules, a commercial plan held by someone on Medical Assistance is the primary payer, and MA sits behind it as a wraparound. A child can hold both at once. Anyone telling you to give up working coverage to qualify for MA is giving you advice that could cost your family real money.

The honest limit, which we'd rather state here than after you've done months of paperwork on our account: Ability Avenues does not bill commercial plans. We bill Straight Medical Assistance and Blue Plus. So if your child's primary coverage is commercial, getting TEFRA does not automatically mean therapy with us is covered — that depends on your specific plan, and it's a conversation, not a webpage answer. Our insurance page explains the mechanism in full, and we'll talk it through with you.

That's worth saying because TEFRA is genuinely valuable to your family regardless of where your child receives therapy. It isn't a thing you do to become our client.

What happens once your child is approved?

Two things.

The EIDBI door opens. Coverage was the fourth criterion. With it in place, the remaining work is a qualifying diagnosis and a CMDE establishing medical necessity — and then choosing a provider, which is the one decision in this whole process that's genuinely yours.

And you get one piece of ongoing homework: the renewal. TEFRA renews annually. Put it in your calendar the day you're approved, with a reminder a month ahead. A lapse in your child's coverage is a lapse in the EIDBI eligibility built on top of it, and re-establishing it is far more work than keeping it. It's a small piece of admin that protects a large benefit.

Frequently asked questions

Does TEFRA count our family's income?
No — that's the entire point of it. TEFRA looks at your child's own income, and parental income is disregarded. The child's income has to be under 100% of the Federal Poverty Guideline, and if they're over, a spenddown may still make them eligible. For most children, who have no income at all, this test simply isn't the obstacle.
Is there a parental fee for TEFRA?
Not for children living at home. Minnesota eliminated parental fees for children on MA-TEFRA living at home effective July 1, 2023. If you were told years ago that TEFRA meant a monthly fee, that information is out of date. Fees can still apply for children in 24-hour care outside the home.
Does an autism diagnosis qualify my child for TEFRA?
No, and this is the part families are most often blindsided by. TEFRA requires the State Medical Review Team to certify your child as disabled and to find that they need an institutional level of care at home. A diagnosis of autism, on its own, does not establish either. Many autistic children do qualify; the diagnosis isn't what does it.
Can my child have TEFRA and our private insurance at the same time?
Yes, and you generally shouldn't drop a private plan to get MA. Your commercial plan stays the primary payer and MA wraps around it. Whether therapy with Ability Avenues would be covered in that situation is a separate question — we bill Straight Medical Assistance and Blue Plus, not commercial plans — so call us and we'll work out where your family actually stands.

If TEFRA sounds like it might fit your family and you don't know where to start, call or message us — we'll talk you through it and point you at your county, whether or not you ever enroll with us. The application is yours to make, but you shouldn't have to decode it alone.

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TEFRA in Minnesota: Medical Assistance for your child, whatever you earn