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MEDICAL SERVICES POLICY MANUAL,SECTION C C-200 Alternative Application Processes

C-231 TEFRA Re-Application When Case Closed Due to Non-Payment of Premiums MS Manual 07/01/20 When the TEFRA case is closed due to non-payment of premiums, a new application must be made before eligibility can resume. Eligibility will be redetermined at the time the new application is made. If the case has been closed less than 12 months because of failure to pay premiums, the past due premiums must be paid in full before the child can be re-approved for TEFRA Waiver services. If a case is closed 12 months ormore due to failure to pay premiums, payment of the past due premiums will not be required to reopen the case.

C-232 TEFRA Eligibility Determination MS Manual 07/01/20 With the exception of the Appropriatenessof Care requirement, eligibility will bedetermined by the eligibility worker in the same manner as Long-Term Services and Supports (LTSS) cases. A child who would not be eligible or potentially eligible for Medicaid in an institution cannot be considered for TEFRA. If the child’s countable income is less than the current LTSS income limit (Appendix S) and the child’s countable resources are less than the current resource limit, he/she will meet the TEFRA income and resource requirements. Parental income and resources will be disregarded when determining eligibility. However, parental income will be considered when calculating the monthly premium amount. Refer to MS F-170 - MS F-172. C-233 TEFRA Disability Determination MS Manual 07/01/20 To qualify for TEFRA, a child must be considered an individual with a disability according to the SSI regulations that govern children with disabilities. Disability for a child will either be established by the Social Security Administration (SSA) or the DHS Medical Review Team (MRT). If a child received SSI within one year prior to making TEFRA Waiver application but was terminated for reasons other than lack of disability, (e.g. parental income or resources), documentation will be obtained for the case record. A disability decision made by SSA on a specific disability is controlling for that disability, until the decision is changed by SSA. The child C 231 TEFRA Re Application When Case Closed Due to Non Payment of Premiums