Care For Children with Disabilities

TEFRA (Tax Equity and Fiscal Responsibility Act of 1982) gives states the option to make Medicaid (SoonerCare in Oklahoma) benefits available to children with physical or mental disabilities who would not ordinarily be eligible for Supplemental Security Income (SSI) benefits because of their parent's income or resources. This option allows children who are eligible for institutional services to be cared for in their homes.

Eligibility

To be eligible, a child must:

• be under age 19;
• meet the Social Security definition of disability at this link:
  http://ssa-custhelp.ssa.gov/app/answers/detail/a_id/1381
• have qualifying income and resources;
• meet an institutional level of care - 1 of 3 levels
  • intermediate care for the mentally retarded,
  • nursing facility,
  • or hospital.

Other requirements to be eligible include:

• It must be appropriate to care for the child at home;
• The estimated cost of caring for the child at home cannot exceed the estimated cost of caring for the child in the institution.

Services

Depending upon the person's needs, services may include:

• child health/EPSDT
  Learn more at this link:
  http://www.okhca.org/individuals.aspx?id=174&menu=42&parts=7487
• dental care
• emergency and non-emergency transportation
• inpatient and outpatient treatment
• medical equipment
• occupational therapy
• pharmacy
• physical therapy
• vision

Application

You can apply at any Oklahoma Department of Human Services (OKDHS) county office. Find it here: http://www.okdhs.org/okdhslocal/

Call your county office to see if you need to schedule and appointment.

To help with the process, please bring:

• Assessment form (TEFRA-1 for families) here:
  http://www.oklaw.org/link.cfm?3361
• Letter of denial from Social Security Administration
  Information on the Social Security application process:
  http://www.socialsecurity.gov/disability/index.htm

Tips for Completing TEFRA Application

Ffinancial eligibility for TEFRA is established first.
Then the TEFRA application is reviewed to see if the criteria for disability, institutional level of care, cost effectiveness, and safety and appropriateness have been met.

Be sure that both you and your child's doctor have completed all sections of the TEFRA-1 assessment form.

In addition, we will need supplemental documentation to support information provided on the TEFRA-1 Assessment Form for families (http://www.oklaw.org/link.cfm?3361):

• intermediate care for the mentally retarded,
• nursing facility,
• or hospital.
  This is more complicated than it seems. Here is some general information that may help:
• 
  

1. Cost Effectiveness - Be sure you fully document all cost information requested as follows before submitting your TEFRA application.

1. • If your child has private insurance coverage that you intend to keep in addition to any TEFRA eligibility, document only your actual costs per month for the services listed.
     If the service is not covered by the insurance provider, indicate the full cost of each service provided.
   • Itemize the child's prescription drug costs on a separate page and attach to the application. The TEFRA-1 application asks for a list the child's current medications, but space was not provided on the form to indicate prescription costs.
2. • If your child has private insurance coverage that you intend to keep in addition to any TEFRA eligibility, document only your actual costs per month for the services listed.
     If the service is not covered by the insurance provider, indicate the full cost of each service provided.
   • Itemize the child's prescription drug costs on a separate page and attach to the application. The TEFRA-1 application asks for a list the child's current medications, but space was not provided on the form to indicate prescription costs.