TEFRA 134(a), a provision of the Tax Equity and Fiscal Responsibility Act of 1982, allows states to extend Medicaid coverage to certain disabled children. Also known as the Katie Beckett option, TEFRA is a category of Medicaid that provides care to disabled children in their homes rather than in institutions. To qualify for TEFRA benefits, the child must be disabled according to the Supplemental Security Income (SSI) definition of disability and must meet the medical-necessity requirement for institutional care. Children who live in institutions or who receive extended care in institutions are not eligible in the TEFRA category.
To qualify for TEFRA benefits, the child
- must be younger than 19
- cannot have income that exceeds the Long Term Care Medicaid limit
- cannot have countable resources that exceed $2,000
Parental income and resources are not considered. Only the income and resources of the child are counted. Appropriate medical services must be available to provide care for the child in the home. The estimated cost of care in the home cannot exceed the estimated cost of care for the child in an institution.
Children who receive SSI but lose coverage intermittently due to fluctuating parental income may be eligible for TEFRA benefits in the months they do not receive SSI. The child’s parent or guardian can apply for TEFRA at the DHS office in the child’s county of residence. Applications also are accepted at Arkansas Children’s Hospital and by Children’s Medical Services service team workers.
The TEFRA program is coordinated by the Office of Long Term Care. For more information about the program, contact the Office of Long Term Care at
Tax Equity and Fiscal Responsibility Act (TEFRA) 1115 (a) Demonstration Waiver Extension Renewal Application
Arkansas is submitting an extension renewal request to the Centers for Medicare and Medicaid Services (CMS) for a three-year extension renewal of its TEFRA-like 1115 demonstration waiver. A second 30-day comment period has been extended an additional 10 days (September 8 – October 17, 2017.)
All comments MUST be submitted no later than October 17, 2017. Comments may be provided in writing to:
Division of Medical Services
Office of Policy Development
700 South Main Street
PO Box 1437, S-295
Little Rock, AR 72203-1437
or by email to firstname.lastname@example.org
TEFRA Important Informational Documents
To view or print a document, click a link below.
- CMS Approval Letter for TEFRA Waiver Evaluation Design (PDF, new window)
- CMS Approved TEFRA Waiver Evaluation Design (PDF, new window)
- View the CMS TEFRA waiver renewal acceptance notification letter. (PDF, new window)
- View the special terms and conditions for the TEFRA waiver renewal. (PDF, new window)
- View the Arkansas TEFRA Interim Evaluation Report. (Word, new window)
- View the fourth quarter (October – December 2016) and 2016 TEFRA annual report (PDF, new window)