Health Insurance & Waiver Services
Medical Assistance is Minnesota’s Medicaid program and provides services to low-income senior citizens, families, children, and people with disabilities. There are income limits to qualify for this program, and you can apply through your local county human services office.
TEFRA (Tax Equity and Fiscal Responsibility Act of 1982) is a Medical Assistance (MA) program that provides services to children with disabilities who live at home with their families and meet ALL the eligibility criteria below. To receive TEFRA, children must:
- live with at least one parent
- be under age 19
- be determined to have a disability by the State Medical Review Team, with information provided by the child's parent and doctors, including certification of disability by Social Security, if applicable
- need a certain level of home health care to stay at home which compares to the level of care provided in a hospital, nursing home or an intermediate care facility persons with developmental disabilities
- need home care that does not cost more than the cost for care in a medical institution
Under TEFRA, families may have to pay a parental fee based on income and family size. You may use this printable worksheet or the online Parental Fee Estimator to calculate a monthly parental fee estimate. Once the child turns 18, there is no longer a parental fee, and the individual is switched to MA for disabilities.
Home and Community Based Waiver Programs are for Minnesotans with disabilities or chronic illnesses that are enrolled in Medical Assistance and need care or services beyond what MA covers. These programs are designed to support children and adults with a disability or chronic illness in their home who might otherwise be in a hospital, nursing facility or intermediate care facility if they did not have this program. Usually, these services are for people with specific needs or diagnosis. There are some differences in the services and amount of money available in each waiver.
- Developmental Disability (DD) Waiver is for children and adults with developmental disabilities or related conditions who need the level of care provided in an Intermediate Care Facility for Persons with Developmental Disabilities (ICF/DD)
- Community Alternative Care (CAC) Waiver is for children and adults who are chronically ill and medically fragile who need the level of care provided in a hospital
- Community Access for Disability Inclusion Waiver is for children and adults with disabilities who require the level of care provided in a nursing facility
- Brain Injury (BI) Waiver is for children and adults who have a traumatic or acquired brain injury who need the level of care provided in a nursing home or neurobehavioral hospital
- Waivers Made Simple
Children's Mental Health Collaboratives were established in Minnesota because children with severe emotional disturbances or who are at risk of such disturbances often require services from multiple systems. Through collaboratives, children with emotional disturbances and their families receive a coordinated, multi-agency response to their needs and participate in the design and implementation of a coordinated plan of care.
MinnesotaCare is a health care program sponsored by the state for people who live in Minnesota and do not have access to health insurance. There are income limits and other guidelines to qualify. Enrollees pay a monthly premium based on income and/or family size.
Supplemental Social Security Income (SSI) can pay monthly checks to people who are 65 or older, or blind, or have a disability and who do not own much or have a lot of income. SSI is not just for adults. Monthly checks can go to children who are disabled and/or blind. Income and resources of family members in the home are counted when determining eligibility for SSI for children with disabilities under 18. People who get SSI usually get food stamps and Medical Assistance.
To learn more about insurance and health services, contact PACER’s Health Information Center at (952) 838-9000 or (800) 53-PACER, toll free in Minnesota.