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Strengthen the Evidence for Maternal and Child Health Programs

New: MCHbest strategies database for sample ESMs

Evidence Tools
MCHbest. NPM 15: Continuous and Adequate Insurance

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Strategy. TEFRA (Katie Beckett Option)

Approach. Support the implementation of the Tax Equity and Fiscal Responsibility Act.

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Overview. Under the Tax Equity and Fiscal Responsibility Act (TEFRA), states may provide Medicaid coverage to children with severe disabilities younger than 19 who require a level of care that could be reasonably provided in a hospital, skilled nursing facility, or an intermediate care facility for individuals with intellectual disabilities (ICF/IID), without using household income as an eligibility criterion.

When a child receives extended care in an institutional setting, Medicaid disregards family income as an eligibility requirement and makes the determination based solely on the child’s income. The TEFRA/Katie Beckett State Plan Option makes it possible to do the same for a family whose child requires care at the level provided in an institution, but who can safely be cared for at home, as long as it is cost neutral to the state to do so. Because states vary widely in the availability of institutional care for children and in the clinical criteria they use for determining a child’s level of care needs, the number of children and youth with disabilities who receive Medicaid benefits under this state option varies widely from state-to-state.1

Evidence. Expert Opinion/Field Generated. The Catalyst Center/National Center for Health Insurance and Financing for Children and Youth with Special Health Care Needs (CYSHCN) has identified this strategy as an innovative strategy. Read more in theirĀ practice report.

Target Audience. State/Systems.

Outcome. Percent of children, ages 0 through 17, who are continuously and adequately insured. For detailed outcomes related to each study supporting this strategy, click on the peer-reviewed evidence link above and read the "Intervention Results" for each study.

Examples from the Field. Access descriptions of ESMs across all states/jurisdictions that use this strategy directly or intervention components that align with this strategy. You can use these ESMs to see how other Title V agencies are addressing the NPM.

Sample ESMs. Using the approach “Support the implementation of the Tax Equity and Fiscal Responsibility Act,” here are sample ESMs you can use as a model for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies):

Quadrant 1:
Measuring Quantity of Effort
("What/how much did we do?")

  • Number of children eligible for TEFRA benefits.

Quadrant 2:
Measuring Quality of Effort
("How well did we do it?")

  • Percent of children eligible for TEFRA benefits.

Quadrant 3:
Measuring Quantity of Effect
("Is anyone better off?")

  • Number of children insured through implementation of TEFRA.

Quadrant 4:
Measuring Quality of Effect
("How are they better off?")

  • Percent of children insured through implementation of TEFRA.

Notes. ESMs become stronger as they move from measuring quantity to measuring quality (moving from Quadrants 1 and 3, respectively, to Quadrants 2 and 4) and from measuring effort to measuring effect (moving from Quadrants 1 and 2, respectively, to Quadrants 3 and 4):

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.


Reference:

1 Catalyst Center/National Center for Health Insurance and Financing for Children and Youth with Special Health Care Needs. TEFRA Financing Strategy.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.