Health Related and Medical Services

Parent Guide for Tax Equity and Financial Responsibility Act (TEFRA)

Health Related and Medical Services

Parent Guide for Tax Equity and Financial Responsibility Act (TEFRA)

Contact or submit paperwork to your local Oklahoma Deparment of Human Service (OKDHS) office to apply for TEFRA services. Use this link to find the mailing address and phone number for your local OKDHS office.

You may call or visit your local OKDHS office. You will be given or sent form 08MP003E (Request for Benefits). You may also print this forms, fill it out and take it to the office.

Complete and return the Request for Benefits as soon as possible so an interview can be scheduled and completed. You may send or take the form to the office. An DHS social services specialist will determine your child's financial eligibility for TEFRA.

The social services specialist will determine if your child is eligible for any other SoonerCare programs first. For these programs, verification of the income and resources of all the family members in your home will be needed. If your child is not eligible for these other programs, only your child's income and resources will be considered for TEFRA.

To determine if your child meets the disability requirement for TEFRA, you must apply for SSI for your child if you have not done so in the past. Call the Social Security Administration (SSA) at (800) 772-1213 to file an application. If SSA states your income is too high for your child to be eligible for SSI, you must request a denial notice to give to your DHS social services specialist. This information is needed to determine your child's financial eligibility.

The Physicians Assessment for TEFRA and must be completed and returned with supporting documentation so a medical eligibility decision can be made. The Oklahoma Health Care Authority (OHCA) will determine your child's medical eligibility for TEFRA. (This form does not have to be completed before your interview with your DHS social services specialist.)

Medical eligibility has two parts: disability and level of care.

Disability: If Social Security determines your child is disabled, the social services specialist will need verification of that decision. If your income is too high for your child to be eligible for SSI, Social Security may not make a disability determination. If that happens, OHCA can make a disability determination.
Level of Care: To be eligible for TEFRA, a child must need special types and amounts of care, like that received in a nursing home (only you want your child to receive this care in your home). The level of care refers to the type and amount of care your child would need. Your child must need a certain level to be eligible for TEFRA.

You will need to include the following medical documentation when you turn in the Physicians Assessment for TEFRA:

Current Medical information (such as hospital admit/discharge summaries and doctor's notes/statements which should include a detailed description of the child's diagnosis and prognosis that is less than 90 days old)
In the event additional information is needed by OHCA, they may request a detailed summary (more than a sentence) from the physician indicating your child's diagnosis and what specifically OHCA will need. Examples are given below.

If it is noted your child has Down's Syndrome then your physician may need to indicate the degree of severity and their functioning level.
If it is noted your child has a developmental delay then your physician may need to describe the delay and the child's functioning level.
If it is noted your child has an Intellectual Disability then your physician may need to indicate the severity (such as mild, moderate, profound or severe)
If it is noted your child has Autism/Autistic Behaviors then your physician may need to indicate the kinds of behaviors (such as verbal, nonverbal, antisocial, lack of eye contact, etc.)

Psychological evaluations from a school psychologist who is certified with the Oklahoma Department of Education are now acceptable. The state licensed psychologist or school psychologist's evaluation must include the following:

A full-scale IQ score obtained from administration of either the Wechsler tools (WSPPSI-R, WISCIII, OR WAIS-R) or the Stanford-Binet (5th edition). If a child cannot be tested with these tools, other tests may be used but the reasons for doing so should be provided in the IQ section of the evaluation. (OHCA will not accept Woodcock Johnson tests.)
A composite age equivalent obtained from an adaptive function evaluation using either the Vineland Behavior Scales, or the Battelle Development Inventory (2nd edition)
Eligibility for TEFRA ICF/MR level of institutional care requires an IQ < 70 (for intellectual disability, and a full-scale functional assessment showing at least a 50% composite delay or a functional age that does not exceed 50% of the child's chronological age. In no case shall eligibility be granted for a functional age greater than 8 years, 0 months.

Please include an estimate of the costs of your child's medications when you send in all the other documents.

Once the Physicians Assessment for TEFRA has been completed and needed documentation gathered, return it to your DHS social services specialist. The Physicians Assessment for TEFRA and other documentation will be submitted to OHCA so medical eligibility can be determined. OHCA will inform the social services specialist if more or different documentation is needed.

OHCA will inform the DHS social services specialist of their medical eligibility decision. You will then be sent notification of your child's eligibility for TEFRA.

If your child is approved for TEFRA, there will be an annual review. The DHS worker will ask for the family's income and resources. It will have to be determined if the child is still ineligible for SSI and only remains eligible under TEFRA. The worker will also ask for a copy of your child's IEP (if the child is in school) or an IFSP (if the child is receiving SoonerStart services) and current medical summary information within the last 90 days to send to OHCA.