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Department of Human Services Improves Criteria

for Children's Mental Health TEFRA Eligibility

by Anne L. Henry, Minnesota Disability Law Center

In May of this year (2002), the Department of Human Services (DHS) agreed to use broader criteria for determining whether a child is eligible for Medical Assistance (MA) under the TEFRA (Tax Equity Fiscal Responsibility Act) option. To be eligible for regular Medical Assistance, a child's family must meet low income limits. The TEFRA option gives Medical Assistance eligibility to certain children with disabilities who live at home with their families whose income and assets are above the low income limits.

In order to be eligible for Medical Assistance through the TEFRA option, a child must:

1. Be under age eighteen and certified as disabled by the State Medical Review Team (The DHS Team determines whether the child meets the disability requirements of the Social Security Administration).
2. Need the level of care provided in a facility.
3. Be appropriately cared for at home.

Medical Assistance eligibility can be beneficial for families of any income level with children who have mental health needs. This coverage can supplement private coverage and help pay for co-payments, deductibles, insurance premiums and noncovered medically necessary services. Parents with incomes above $30,000 will be assessed a parental fee for TEFRA/MA.

The Minnesota Disability Law Center recently discovered that the Department of Human Services was using more stringent criteria to determine eligibility for children with mental health conditions than the law allows.

The new criteria that the Department will now apply includes a broader list of symptoms, an additional impairment related to functioning within the family, and a requirement that the child be receiving services from one system, such as mental health, school accommodations, juvenile justice, or child protective services instead of two systems. The criteria now being applied at the Department of Human Services should allow more children with mental health needs to obtain MA coverage to receive critical services needed to avoid out of home placement and remain in the community with their families.

The Department of Human Services has agreed to review all cases where TEFRA/MA eligibility was denied for children with mental health conditions since mid-1996. If your child was denied TEFRA/MA eligibility during the past six years due to not meeting the level of care criteria, call the Minnesota Disability Law Center at 1-800-292-4150 or (612) 332-1441 or TDD (612) 332-4668, for further information.