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

Childhood Cancer Lantern
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Minnesota program

Coverage that leaves out parents’ income (TEFRA)

A route into Medical Assistance for a child with a disability who needs substantial care at home.

What it is

A route into Medical Assistance for a child with a disability who needs substantial care at home.

TEFRA can make full coverage possible when parents earn too much for ordinary Medical Assistance. There is no parental fee. The state still checks your child’s own income, disability and care needs.

Who can qualify
  • Your child must be under 19, live in Minnesota and live with a biological or adoptive parent. Parents’ income and savings are excluded. The child’s own finances, disability and care rules still matter. A relative-only home needs a separate Medical Assistance or waiver-category review.
  • The child is a financial household of one. The July 2026 one-person reference line is $1,330 a month, or 100% of the poverty guideline.
  • A spenddown can apply when the child’s own income exceeds that line.
  • Your child must separately meet Minnesota’s disability and facility-level-of-care tests. That care may be hospital, nursing-facility or intermediate-care-facility care. Care at home must be appropriate and no more costly. An ALL diagnosis, relapse or Social Security approval is evidence, not a substitute for the care assessment. Time since diagnosis alone does not decide this route.
What you get
  • Full Medical Assistance with no parental fee.
  • Coverage can sit behind your work insurance.
What the help includes
  • Coverage runs directly through the state, rather than through a health plan.
  • The old parental sliding-fee schedule does not apply to this route.
If you decide to apply
  1. Ask the social worker whether a TEFRA assessment is useful for your child.
  2. If you decide to pursue it, the county worker can arrange the medical-review referral. The oncology team supplies the diagnosis, care plan and description of needs at home.
  3. The worker can check whether expedited review applies. Your child’s own income information is also needed.

Your county or tribal human services agency and the State Medical Review Team. · Official page ↗

After you ask
  • The county sends your child's file to the State Medical Review Team, and the oncologist fills in the medical forms it asks for.
  • The oncologist explains what your child needs at home and why the required facility level of care is met.
  • Acute lymphoblastic leukemia is on the national fast-track list. An expedited request does not replace Minnesota’s care assessment.
  • The county has 60 days when the decision depends on disability. The notice explains the decision and appeal deadline.
Good to know

A Social Security disability approval alone is not enough. Minnesota must also find that your child needs the required level of care.

Other details
  • Ordinary child Medical Assistance is checked first. A preliminary income estimate does not settle that decision or the separate TEFRA care assessment.
Official sources
Ask your social worker

“Could TEFRA cover our child without counting our income? What would the assessment involve, what are the benefits and drawbacks, and would you help us apply?”

Why I’m asking: I want to know whether our child’s care needs open another route to coverage.

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

File the application, say the child has a disability, and ask for the referral to be marked expedited.

Your social worker

The social worker gathers the records the review team needs and chases the referral.

The care team

The oncologist writes what the child needs at home and why hospital-level care is needed.

Who decides
The county or tribal agency decides the application; the State Medical Review Team decides disability and the level of care.
Ask your social worker
“Can we apply under the TEFRA option, and can the referral to the State Medical Review Team be marked expedited because acute lymphoblastic leukaemia is on the fast-track list?”

How to apply

First step: Apply for Medical Assistance, tick that the child has a disability, and ask the county to mark the review-team referral expedited.

  1. Apply for Medical Assistance and tick that the child has a disability.
  2. Ask the county to send the review-team referral and to mark it expedited.
  3. Ask the oncology team for the records the review team needs, including what care the child needs at home.

Official application / program page ↗

Where it starts: Apply for Medical Assistance and say the child has a disability. The county sends the review-team referral. Ask for an expedited referral: acute lymphoblastic leukaemia is on the national fast-track list.

What to gather

  • The child's records showing the diagnosis and treatment plan
  • A note from the oncology team about the care needed at home
  • The child's own income, if any

How long: The county has 60 days where the decision runs on disability. The review team can take a referral expedited for a fast-track condition, but no measured waiting time was published.

What a yes looks like

A notice opening Medical Assistance for the child with no parental fee, run directly by the state.

What a no looks like, and the next move

If the no is about the level of care, ask what the review team needed and appeal by the date on the notice. If it is about the child's own income, ask about a spenddown.

Watch out

  • There is no parental fee for this route; an old sliding-fee schedule does not apply to it.
  • A Social Security disability approval is not enough on its own: the state review team still has to find the level of care.
  • This coverage is run directly by the state rather than through a health plan.

The numbers and the rules

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

What it is worth

Full Medical Assistance with parents' income left out. The child is treated as a household of one, where the one-person 100 percent line is $1,330 a month.

  • $1,330/month — Household-of-one reference line for the child's own income (100 percent of the poverty guideline)

Covers: Everything ordinary Medical Assistance covers · Home care nursing and personal support when approved · Rides to appointments

Legal protection: No parental fee · No copays or deductibles for a child

What it costs the family: No parental fee and no child copays.

The eligibility facts, as published

Age
under 19
Age max exclusive
19
Income
only the child's own income; financial household size of one; a spenddown applies above the one-person line
Level of care
Separate disability and required facility-level-of-care findings; hospital, nursing-facility or intermediate-care-facility care, with appropriate home care no more costly. Diagnosis, relapse or a Social Security finding does not replace the care assessment.
Residency
Minnesota; the child lives with at least one biological or adoptive parent
Determination
State Medical Review Team, using forms DHS-6124 and DHS-6126

Decisions this site cannot make: State Medical Review Team disability certification · State Medical Review Team level-of-care determination

Expect friction on: The level-of-care finding is separate from a Social Security disability decision · Coverage runs as fee-for-service, not through a health plan

The trap: There is no parental fee. The statute leaves TEFRA families out of the parental-contribution rules, so an old sliding-fee schedule does not apply. Even a child already approved by Social Security still needs the state review team's separate level-of-care finding.

Where I read this

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