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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Adequate Insurance.

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Strategy. TEFRA (Katie Beckett State Plan Option)

Approach. Support the implementation of the Tax Equity and Fiscal Responsibility Act (TEFRA)/Katie Beckett State Plan Option

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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. Strategies with this rating are recommended by credible, impartial experts...

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source.

Potential Data Sources. Data to support this strategy can be accessed through:

  • Technical assistance provision logs
  • Resource development and dissemination tracking
  • Interagency collaboration activity logs

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Cost. This strategy helps to decrease the financial expenditure incurred by individuals, healthcare systems, and society in general for healthcare services.
  • Community Health Factors.
  • Health Care Access for All MCH Populations.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Policy Development and Enforcement (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Population/Systems-Focused

Examples from the Field. Access descriptions of ESMs that use this strategy or aligned components.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the RBA framework (see The Role of Title V in Adapting Strategies).

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

  • Number of state policies for procedures developed to implement the TEFRA option for children with severe disabilities. (Measures the establishment of the program)
  • Number of Medicaid eligibility workers trained on the TEFRA criteria and enrollment process. (Builds capacity for facilitating access to coverage)

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

  • Percent of eligible children with severe disabilities who are enrolled in Medicaid through the TEFRA option. (Measures the uptake and penetration of the program)
  • Percent of TEFRA enrollees who receive care coordination for case management services. (Evaluates the integration of coverage with support for navigating the system)

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

  • Number of partnerships established with disability organizations and family support groups to promote TEFRA. (Engages key community partners in outreach and education)
  • Number of state agencies collaborating to streamline the TEFRA application and renewal process. (Reflects efforts to create a family-friendly and efficient system)
  • Number of hospitalizations for institutional placements avoided among TEFRA enrollees due to access to home and community-based services. (Demonstrates potential cost savings)
  • Number of school days attended by children enrolled in TEFRA. (Shows the impact on educational participation and progress)

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

  • Percent of children with severe disabilities in the state who are potentially eligible for TEFRA based on level of care needs. (Estimates the unmet need for the program)
  • Percent of TEFRA outreach and enrollment materials available in usable formats. (Reflects a commitment to access)
  • Percent reduction in the number of children with severe disabilities who are institutionalized for placed in nursing facilities. (Evaluates the impact on promoting community integration)
  • Percent increase in the quality of life and functional outcomes for children enrolled in TEFRA. (Reflects the ultimate goal of supporting optimal health and development)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

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

References

1 Catalyst Center/National Center for Health Insurance and Financing for Children and Youth with Special Health Care Needs. TEFRA Financing Strategy.
https://ciswh.org/project/the-catalyst-center/financing-strategy/tefra/

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.