Tax Equity and Fiscal Responsibility Act (TEFRA)
CMS (Centers for Medicare and Medicaid Services) Manual Section 3589 states: “Under Section 134 of the Tax Equity and Fiscal Responsibility Act of 1982 (P.L. 97-248) – States are allowed at their option to make Medicaid benefits available to children, age 19 or under, at home who qualify as disabled individuals under Section 1614 (a) of the Social Security Act provided certain conditions are met, even though these children would not ordinarily be eligible for SSI benefits because of the deeming of parental income or resources. The specific statutory provisions, establishing this option, are contained in Section 1902(3) of the Social Security Act” (also refer to 42CFR435.225).
Oklahoma Health Care Authority (OHCA) opted to participate in TEFRA to assist families that earn too much money to be eligible for SSI or SoonerCare. Families with members under the age of 19 and have severe disabilities that they require 24-hour care, may meet level of care in a facility but prefer to keep their loved one at home rather than place them in a facility.
Please reference the following articles and policy for additional information on TEFRA:
ABD: TEFRA Application Procedure
Tax Equity and Fiscal Responsibility Act
ABD: TEFRA related policy:
317:35-1-2. Definitions
317:35-5-4 Determining categorical relationship to the disabled
317:35-5-4.1 Special level of care and cost effectiveness application procedures for TEFRA
317:35-5-4.2 Determining nursing facility level of care for TEFRA children
317:35-5-4.3 Determining acute hospital level of care for TEFRA children
317: 35-5-41 Determination of capital resources for individuals categorically related to aged, blind, and disabled
317:35-5-41.11 Maximum resources
317:35-5-42 Determination of countable income for individuals categorically related to aged, blind, and disabled
317:35-5-49 Determination of income and resources for categorical relationship to TEFRA
317: 35-7-36 Financial eligibility of individuals categorically related to ABD
317: 35-7-60 Certification for SoonerCare
317:35-7-61 Redetermination of eligibility for persons receiving ABD or TANF
317:35-9-48.1 Determining ICF/IID institutional level of care for TEFRA children
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