Written by a parent, not a doctor. Nothing here is medical advice.

Childhood Cancer Lantern
Search Saved

Arkansas program

Medicaid that leaves out parents' income (TEFRA)

Medicaid for a child with a disability who can receive care at home. Parents' earnings do not decide eligibility.

What it is

Medicaid for a child with a disability who can receive care at home. Parents' earnings do not decide eligibility.

TEFRA can open Medicaid when parents earn too much for ordinary child coverage. The state checks disability and the care your child needs. Parents' income sets a possible premium, so this needs a medical and a money conversation.

Eligibility rules
  • TEFRA is for an Arkansas child age 18 or younger who meets disability and substantial care-need rules. The state also checks that appropriate care is available at home and costs no more than institutional care. Parents’ income does not decide eligibility, but the child’s own countable income and resources do.
  • The child must meet Social Security's disability standard. The state medical review team can decide without a Social Security award.
  • The care test is hospital or nursing-home level of care, or risk of needing it. Home care must be appropriate, available and cost no more than institutional care.
  • The child’s own countable monthly income limit is 300% of the SSI rate: $2,982 in 2026. The child’s countable resources cannot exceed $2,000. Parents’ income and assets are excluded from eligibility.
What you get
  • Full Medicaid, including behind a work plan.
  • Parents’ income may lead to a premium. DHS calculates the amount before you compare costs.
Coverage and limits
  • Parents' income sets a monthly premium, never more than 5% of family income over a year. Ask DHS for the amount before you decide.
If you decide to apply
  1. Ask the county DHS office or hospital social worker for the current TEFRA packet.
  2. If TEFRA seems useful, ask the social worker to help with the parent report and physician assessment.
  3. Have ready: records of your child's daily care, your child's savings and family income for the premium.

County DHS / TEFRA application page · Official page ↗

After you apply
  • The social worker can obtain the current TEFRA packet from DHS, including the health-care application and medical assessment. The general decision standard is 45 days, or 90 days for a disability-based determination, with limited exceptions; the application date and any missing information should be recorded.
Good to know

Your child’s own income and savings have separate limits. The care assessment is another test.

Other details
  • The social worker can get the current packet directly from DHS and help identify the forms the doctor must sign.
  • If your child is in hospital now, the stay is a good time to plan care at home. Ask whether TEFRA coverage can reach back to the hospital months.

Federal background: Medicaid without using parents’ income (TEFRA background).

Official sources
Ask your social worker

“Could our child's care needs meet TEFRA's rules? What would the premium and extra coverage mean for us, and could you help with the medical packet if applying makes sense?”

Why I’m asking: I want to explore coverage that does not depend on what we earn.

More background and detailed requirements
Additional program information and published rules

Who does what

The three parts, side by side. The agency decides; nobody on this page does.

You

Ask for the TEFRA packet, fill in the parent social report, and get the physician assessment signed.

Your social worker

The hospital social worker knows the packet and can send it in with the medical records attached.

The care team

The oncologist completes the physician assessment (DMS-2602) describing the daily care your child needs.

Who decides
The Department of Human Services decides, using Social Security's disability standard and a level-of-care decision.
Ask your social worker
“We earn too much for ARKids. Can we file a TEFRA application now, and can the doctor complete the physician assessment before we go home?”

How to apply

First step: The hospital social worker can help compare TEFRA with other coverage and obtain the current packet if it is worth pursuing.

  1. The hospital social worker can help compare TEFRA with other coverage and obtain the current packet if it is worth pursuing.
  2. The oncology team can describe daily care needs for the assessment without assuming the child is currently in hospital.
  3. Ask the county what your premium would be before you worry about it.

Official application / program page ↗

Where it starts: Ask the county office or the hospital social worker for the TEFRA packet. The application page lists the benefits application (DCO-0004), a release (DCO-4000), a physician assessment (DMS-2602) and a parent social report (DCO-108C); an older report names a different form, so ask for the current packet by name.

What to gather

  • The diagnosis date and the oncologist's letter
  • The physician assessment form (DMS-2602)
  • Your child's Social Security number and any account in the child's name
  • Family income for the premium calculation

How long: The state page gives 45 days, or 90 when the disability has to be decided. In late 2024 the state's own report showed an average of 23 days and a worst case of 176.

What a yes looks like

A Medicaid card for your child and, if your income is above the line, a premium notice. Pay the first premium on time and keep the receipt.

What a no looks like, and the next move

Ask which test the no was on: disability, level of care or the home-care cost test. Appeal by the date on the notice and ask the oncologist for a letter about daily care.

Watch out

  • DHS calculates the premium separately from eligibility. The ceiling is not the actual premium.
  • DHS confirms current good-cause and hardship relief for missed premiums.
  • Your child's own savings must stay at or under $2,000. Money in a child's name from a fundraiser counts.
  • Ask which packet is current. The application page and an older state report name different forms.

Dates that change this

2026-01-01: Arkansas runs TEFRA under a federal demonstration approved for January 1, 2026 through December 31, 2030, on fee-for-service Medicaid. The 2026 premium schedule was not published where we could read it.

The numbers and the rules

The arcane layer, kept on purpose. Checked September 11, 2026.

What it is worth

Full Arkansas Medicaid for a disabled child at home without counting parents' income; a sliding premium above 150% of the poverty line, capped at 5% of family income.

  • $2,000 — Child's own countable savings ceiling (parents' assets not counted)
  • $150 — Income level above which a monthly premium starts
  • $5 — Monthly premium ceiling

Covers: Everything Arkansas Medicaid covers for a child · Home nursing and personal care when approved · Rides to appointments

Legal protection: Parents' income is not counted for eligibility · Parents' savings are not counted

What it costs the family: Parents’ income may lead to a premium under the current schedule. DHS calculates the premium and any relief; the 5% ceiling is not the actual charge.

The eligibility facts, as published

Age
18 or younger
Age max inclusive
18
Income
Parents’ income and assets do not count for eligibility. The child’s own countable income limit is 300% of SSI ($2,982 a month in 2026), with a $2,000 child-resource limit. Parents’ income is used for any premium calculation.
Disability
The Social Security definition of disability; the state medical review team can decide where Social Security has not
Level of care
Meets the medical need for hospital or nursing-home level of care, or is at risk of it in future
Home care test
Care at home must be available, appropriate and cost no more than institutional care
Processing standard
45 days, or 90 days when the disability itself has to be decided (state application page, read only in a search listing)
Residency
Arkansas

Decisions this site cannot make: Social Security disability standard (or the state medical review team) · Institutional level-of-care decision

Expect friction on: A monthly premium above 150% of the poverty line · Historical processing ran to 176 days at worst in late 2024

The trap: Above 150% of the poverty line there is a monthly premium, set on a sliding scale and capped at 5% of family income. It is the one thing families are caught by. If a premium is missed, ask for the good-cause rule: the demonstration lets the state forgive up to three past-due months, and one hardship exception a year.

Where I read this

← Back to your options