TEFRA : helping Oklahoma children with disabilities = cómo ayudar a los niños incapacitados en Oklahoma = giúp do’ tre em bi khuyet tat o’ tieu bang Oklahoma.

              QBRESV-TEFRAA-2009
This publication, printed by O. U. Printing Services is issued
by The Oklahoma Health Care Authority as authorized by
Title VI and Title VII of the 1964 Civil Rights Act and the
Rehabilitation Act of 1973. 40,000 copies have been
prepared and distributed at a cost of $3,585.00. Copies
have been deposited with the Publications Clearinghouse
of the Oklahoma Department of Libraries. [74 O.S.2001 §
3105 (C)] Order additional copies on the OHCA Web site
www.okhca.org.
What is TEFRA?
TEFRA is a SoonerCare program that allows
children with disabilities to be cared for in
their homes. In TEFRA, only the child’s
income, not the family’s, is counted to decide
if he or she qualifies.
Who qualifies for TEFRA?
TEFRA is for children who meet an
institutional level of care for a hospital,
nursing facility or intermediate care facility
for the mentally retarded.
(The child does not have to
be institutionalized to meet
the level of care.)
The child also must:
• Be under age 19.
• Be an Oklahoma resident.
• Be a citizen or a qualified alien.
• Have a Social Security number.
• Meet the SSA disability definition.
• Meet certain income standards.
• Be safely and appropriately cared for at
home.
• Have a cost for home care that is less
than the cost would be in an institution.
Where can I apply?
You can apply at any Oklahoma Department
of Human Services (OKDHS) county office.
Call your county office to see if you need to
schedule an appointment.
To help with the process, please bring:
• A denial letter from the Social Security
Administration (SSA). If you do not
have a denial letter, call SSA at 1-800-
772-1213 and talk to the tele-service
representative about your child’s
eligibility for SSI.
• A completed TEFRA-1 Physician
Assessment form. This form is
available from OKDHS offices, the
SoonerCare Helpline or the Oklahoma
Health Care Authority Web site. Phone
numbers and Web site information
are listed at the end of the brochure.
What happens after I apply?
You will get an approval or denial letter from
OKDHS.
What happens if my
child is approved?
• You will get a letter from OKDHS
telling you when the benefits begin and
for how long they last.
• You will get a white plastic medical ID
card. Have this card with you when
your child needs services.
• A home visit will be made to see if safe
and appropriate care can be provided in
your home.
How long is my child covered under
TEFRA?
• Your child may be covered for up to
12 months.
• You must reapply every year.
What services will my child receive?
Under TEFRA, your child will get full
SoonerCare services. Some of the benefits
are:
• Office visits, including well-child visits.
• Hospital care.
• Outpatient services.
• Pharmacy.
• Emergency and non-emergency
transportation.
• Medical equipment.
• Physical therapy.
• Occupational therapy.
• Speech therapy.
• Dental care.
• Home-based services.
How does my current insurance work
with TEFRA?
• You must use your insurance first.
• You must follow the rules of your
insurance.
• For your insurance and SoonerCare to
pay, you must see providers who have
contracts with both your insurance and
SoonerCare.
Where can I get more information?
SoonerCare Helpline
1-800-987-7767 Toll Free
(405) 522-7171 Oklahoma City Area
(405) 522-7179 TDD/TTY
TEFRA Web site:
http://www.okhca.org/TEFRA