TEFRA

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 TEFRA is a Medicaid program that helps children with developmental delays, medical conditions, or behavioral needs get access to care at home — no matter how much their parents earn.
It allows children to qualify for Medicaid based on their own needs, even if the family wouldn’t normally qualify for traditional Medicaid. 

Children approved for TEFRA receive full Medicaid benefits, including:

• Speech, occupational, and physical therapy 
• ABA therapy for autism 
• Medical and specialist visits 
• Mental and behavioral health care 
• Medications 
• Medical supplies and equipment 
• Incontinence products (diapers, wipes, etc.)

 To be eligible, a child must:

• Be under age 19 
• Have a diagnosed condition that affects daily functioning (such as a speech delay, developmental delay, autism, sensory needs, or medical condition) 
• Need regular support or care to stay healthy and safe at home 
• Meet Medicaid’s disability criteria (often met if the child is receiving therapy or has documented needs) 
• Be a U.S. citizen or qualified non-citizen
   

Note: Parent income is not considered — eligibility is based only on the child’s needs.

 Families pay a monthly premium based on income (typically $20–$250).
There are no co-pays for services.

Pro tip:
If your child qualifies for TEFRA and your family has access to private health insurance (including employer-sponsored coverage or COBRA), there may be additional assistance available to help pay your insurance premium through a program called ARHIPP.

Learn more about ARHIPP 

 Many families don’t realize their child qualifies.
Even if your child “just” has a speech delay or developmental delay, they may still meet the criteria.
If your child is in therapy or receiving special education services, it’s worth applying.