Policy                                                                        Issuance Number: MS 02-10

Medical Services Policy Manual                       Issuance Date: January 1, 2003

From: Joni Jones, Director                               Expiration Date: Until Superseded

Subj: TEFRA Waiver

TEFRA policy has been amended according to the provisions of a Section 1115 Demonstration Waiver to impose cost sharing measures in the form of monthly premiums to be paid by the parent(s) of the TEFRA child. The monthly premium will be based on the total gross income of the custodial parent(s). Only TEFRA Waiver households with annual income over $25,000 will be required to pay premiums. Households with more than one TEFRA child will be assessed only one premium. The amount of monthly TEFRA premiums to be assessed is found at Appendix P, TEFRA Premium Schedule.

Sections of policy have been added to address determining monthly premiums and payment of premiums. The TEFRA Premium Unit will collect the TEFRA Medicaid premium payments and send the premium invoices to TEFRA households. When a TEFRA case is approved, the TEFRA Premium Unit will send a TEFRA Premium Payment Selection Form to the recipient giving the option of authorizing automatic bank drafts or making quarterly payments in advance.

A six-month period of ineligibility for voluntarily dropping primary comprehensive health insurance on the TEFRA Waiver child has also been added. If insurance is voluntarily dropped in the six months prior to application, the child will be ineligible for TEFRA benefits for a period of six months from the date the insurance was dropped. For recipients, if it is found that coverage was dropped after the case was approved, the case will be closed for six months beginning with the month following the month of discovery.

All new TEFRA approvals must be keyed to the TEFRA Enrollment screen. The caseworker should also remember to always key any changes or closures to the TEFRA Enrollment Screen.

All other eligibility requirements for TEFRA remain unchanged.

See [MS 27000]-27075 and [Appendix P] TEFRA Premium Schedule.

Inquiries to: Jack Tiner, 501-682-8259

Diana Teal, 501-682-1562