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

Childhood Cancer Lantern
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Oklahoma program

SoonerCare based on your child’s own finances (TEFRA)

SoonerCare for a child with substantial care needs, without counting the parents’ income or savings.

What it is

SoonerCare for a child with substantial care needs, without counting the parents’ income or savings.

TEFRA is worth discussing when ordinary child SoonerCare may not fit and your child needs substantial care. OHCA checks disability, the care needed, whether home care is suitable and the cost. It also checks your child’s own finances. The diagnosis date alone neither proves nor rules out eligibility.

Eligibility rules
  • Your child must be under 19 and meet Social Security’s disability definition.
  • The child’s countable monthly income ceiling is $2,982 and own-resource ceiling is $2,000. The income figure is 300% of the federal benefit rate in Appendix C-1 dated July 1, 2026.
  • The rule concerns 60 days of hospital-level need, or 30 days of nursing-facility or ICF/IID-level need. This is the documented duration of need, not a requirement to spend that time in a facility.
  • Care at home must be appropriate and cost no more than institutional care.
What you get
  • Full SoonerCare benefits, including alongside private insurance.
  • Equipment, supplies and rides.
  • Home nursing and personal care when approved.
What this covers
  • The benefit is SoonerCare coverage, rather than a cash payment to a parent.
  • Parents’ income and resources are left out of this financial test.
If you decide to apply
  1. If you and the social worker decide TEFRA is worth pursuing, ask the TEFRA unit for its current packet.
  2. Fill in the financial form with your child's own income and account records, and ask the doctor to complete the medical assessment form.
  3. Have the child's income and account records ready. The unit may also ask for an SSI denial letter and for medical records from the last 90 days.

OHCA TEFRA unit: 405-522-7752 · Official page ↗

What happens next
  • OHCA reviews the financial application and physician assessment.
  • Approved TEFRA children remain outside SoonerSelect plans.
  • A refusal letter can identify whether the concern is finances, level of care or the cost comparison.
Good to know

The $2,982 monthly income limit belongs to the child, not the household. The medical assessment matters too.

Other details
  • The TEFRA unit can explain family charges and expected decision timing in writing before you decide.
  • The separate home-care assessment decides any nursing hours.
  • A decision usually comes within 90 days because a disability finding is needed. Bills from the three months before you applied can be covered for months your child already qualified. Approval of coverage is not approval of nursing hours; that is a separate assessment.
Official sources
Ask your social worker

“Could our child meet TEFRA’s care test? What would the benefits, costs and drawbacks be, and if you think we should apply, could you help with the doctor’s assessment?”

Why I’m asking: I want to know whether our child can get SoonerCare based on their own finances and medical needs.

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

Call the TEFRA unit for the packet, fill in the financial application on the child's money only, and get the doctor's assessment back.

Your social worker

The oncology social worker helps assemble the packet and keeps the assessment moving.

The care team

The doctor completes the TEFRA-1 assessment and describes the level of care the child needs.

Who decides
The Oklahoma Health Care Authority decides, on a physician assessment of the level of care and on the child's own income and resources.
Ask your social worker
“Could our child meet TEFRA’s care test? What would the benefits, costs and drawbacks be, and if you think we should apply, could you help with the doctor’s assessment?”

How to apply

First step: If you and the social worker decide TEFRA is worth pursuing, ask the TEFRA unit for its current packet.

  1. If you and the social worker decide TEFRA is worth pursuing, ask the TEFRA unit for its current packet.
  2. With that packet, use your child’s financial records for form 08OA002E-002 and ask the doctor about TEFRA-1.
  3. Have the child’s income and account records ready. The unit can confirm the SSI financial-denial item and medical records from the preceding 90 days.

Official application / program page ↗

Where it starts: Call 405-522-7752 for the packet: the financial application (form 08OA002E-002) and the TEFRA-1 assessment the doctor completes.

What to gather

  • The child's own income and bank accounts, not the parents'
  • Medical records and the treatment plan
  • The TEFRA-1 assessment from the doctor
  • Form 08OA002E-002, the financial application

How long: Children under 21 do not owe SoonerCare copays for covered care. Federal rules generally allow no more than 90 calendar days for a disability application, with documented exceptions. The TEFRA unit can confirm any premium and the written coverage start date. Under the 2026 certification rule, covered bills from the three months before the application month can be reviewed. Your child must meet the applicable requirements in each month; coverage approval does not itself approve home nursing.

What a yes looks like

A SoonerCare card for the child, outside the SoonerSelect plans, with coverage behind any private plan.

What a no looks like, and the next move

Usually the level-of-care test or the cost comparison. Ask which, get the doctor to answer it directly, and appeal by the date on the notice.

Watch out

  • The $2,982 limit is the CHILD's own income, not the household's, and it is set off the federal benefit rate, not the poverty line.
  • There is a level-of-care test: the doctor must describe care at a hospital, nursing-facility or ICF/IID level.
  • No premium schedule and no decision deadline are published. Ask the unit for both in writing.
  • A child on this route stays outside the SoonerSelect health plans.

The numbers and the rules

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

What it is worth

Full SoonerCare decided on the child's own money: $2,982 a month countable income and $2,000 in the child's own resources.

  • $2,982/month — Child's countable monthly income ceiling (300% of the federal benefit rate)
  • $2,000 — Child's own resource ceiling

Covers: Everything ordinary SoonerCare covers, behind any private plan · Private duty nursing and personal care through the state plan · Equipment, supplies and rides

Legal protection: The parents' income and resources are not counted

What it costs the family: No premium schedule was published. Ask the TEFRA unit in writing what, if anything, the family pays.

The eligibility facts, as published

Age
under 19
Age max exclusive
19
Disability
Social Security's disability definition
Level of care
The rule concerns 60 days of hospital-level need, or 30 days of nursing-facility or ICF/IID-level need. This is the documented duration of need, not a requirement to spend that time in a facility.
Child income
$2,982 a month countable (300% of the federal benefit rate), Appendix C-1 edition July 1, 2026
Child resources
$2,000
Cost effectiveness
home care must be appropriate and cost no more than institutional care
Managed care
TEFRA children are excluded from SoonerSelect and stay in their current arrangement

Decisions this site cannot make: Oklahoma Health Care Authority TEFRA financial determination · Physician level-of-care assessment (TEFRA-1)

Expect friction on: Separate medical and financial decisions · The unit must confirm any premium and precise coverage dates

The trap: The $2,982 figure is 300% of the federal benefit rate, not a percentage of the poverty line, and it is the CHILD's income, not the household's. The level-of-care test asks what care the child needs, not how long anyone has waited: 60 days of hospital-level need, or 30 days of nursing-facility or ICF/IID need. Home care must be appropriate and must cost no more than institutional care.

Where I read this

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