About TEFRA
What is TEFRA?
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 Requirements
To be eligible, a child must meet the following requirements:
- Be under age 19;
- Meet the Social Security definition of disability;
- Have qualifying income and resources;
- Meet an institutional level of care. The three levels are: intermediate care for individuals with intellectual disabilities, nursing facility, or hospital;
- 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.
What to submit for your TEFRA application:
- TEFRA Financial Application Form 08OA002E-002 (completed).
- Assessment form (TEFRA-1 for families): English | Spanish
- TEFRA child letter of denial from Social Security Administration due to excess income and/or resources
- Current (within last 90 days) medical documentation from an MD or DO (specialist or PCP) the child sees
- Current IEP or educational plan (if applicable)
- Developmental tool (such as SoonerStart Batelle or DP-3) (if under age 3)
- Psychological evaluation with full-scale IQ and age equivalency (if age 3 and over)
- Out-of-pocket expenses statement
- TEFRA Parent Guide
How to Apply
Call 405-522-7752 or email [email protected]. A packet of forms and information will be emailed to you.
You can email your completed forms and documents to [email protected], fax the information to 405-530-3312 or you can mail your information to:
Oklahoma Healthcare Authority
Attention: TEFRA unit
4345 N. Lincoln Blvd
Oklahoma City, OK 73105
Reference/Credit: Tefra children overview – care for children with disabilities. Welcome To The Oklahoma Health Care Authority. (n.d.). Retrieved April 26, 2023, from https://oklahoma.gov/ohca/individuals/programs/tefra.html
Follow these instructions explicitly. If you have any questions, do not contact Speech Pathway, call 405-522-7752 or email [email protected] and they will assist you.
The first thing you need is a denial letter from the Social Security Administration stating that you do not qualify SSI because of your income. Call the toll-free number, 1-800-772-1213. Explain that you want to “file an SSI application on behalf of a child and need a denial letter so I can apply for TEFRA.” While you wait on the denial letter to arrive you need to start completing the following documentation for the TEFRA application.
Here is a cheat sheet of what you will need to do to apply for TEFRA: First you have to apply for SSA and be denied due to income and or resources. They will mail you a denial letter that you must have as part of the application. While you wait on the denial letter to arrive complete and gather all this paper work.
- Denial Letter for SSI
- Call the OK Social Security Administration (1.80.772.1213) and apply for coverage for your kiddo.
- Tell them, “I need file an SSI application on behalf of a child and need a denial letter so I can apply for TEFRA.”
- 08MP001E (Request for Benefits)
- 08MP002E (Eligibility Information for Benefits)
- 08MP003E (Rights, Responsibilities, and Signature for Benefits)
- 08OA001E (Physician Assessment)
- On page 5 & 6 there is a place the doctor completes and signs
- Identify Affidavit
- IEP if school aged -or- IFSP if under 3
- (you get the IFSP from SoonerStart)
- Psychological Evaluation if age 3 and above.
- (get from private child psych or school)
– OR – - Battelle if under age 3 (get from SoonerStart)
- (get from private child psych or school)
- Medical information
- Doctors letter describing the child’s current health condition. Here is an example of the letter.
- The letter should describe the child’s degree of severity, their functioning level, delays, diagnosis, etc. The letter needs to be an accurate assessment of your child’s needs from the physician. This could also include hospital admit/discharge summaries.
- Prepare two months worth of all your assets, which should include:
- Two months of check stubs from any income producing household members
- two months of all bank statements and accounts from primary guardians
- copy of all life insurance policies
- two months of statements from any/all investment accounts
- copy of child’s birth certificate
- copy of child’s social security card
- Email everything to [email protected].
- Lori Kann is the direct contact for TEFRA and can help with your application AFTER you have submitted it.
CONTACT: [email protected]
Phone: 405-522-7267
Address: OHCA, 4345 N Lincoln Blvd, OKC, OK 73105
Group Email: [email protected]
We recommend joining the facebook page “OK TEFRA Families“. It is a great resource where you can find all these documents that I have attached and a community of people that have gone through the process. They are quick to answer any questions you have as well.
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