After you or your child receives a diagnosis of autism spectrum disorder (ASD), the next step is to identify available services and supports. People with ASD or related conditions often need a variety of supports and services over the course of their lifetime. To meet the needs of each person and family, the state of Minnesota offers programs that provide basic health care services, behavioral health services, services for people with physical and developmental disabilities and educational services.
If you or your child is enrolled in a health plan and you have questions about coverage for services, call that health plan's member services. Contact information for the health plan is typically found on the back of your health plan member card.
If you do not have health insurance, you may want to go to the MNSure website. This website is a marketplace where you can apply for Minnesota health insurance plans and also find out if you meet the requirements for Minnesota Health Care Programs.
Complete a MNSure application online to determine your eligibility for Minnesota Health Care Programs (MHCP). If you qualify, this application will enroll you or your child into Medical Assistance (MA) or MinnesotaCare. To apply, visit the MNSure website or call 1-855-366-7873.
If you have questions about eligibility, contact the local county agency or tribe where you or your child resides or contact the Minnesota Health Care Programs Member Help Desk. Applicants for and members of Minnesota Health Care Programs can call the Minnesota Health Care Programs Member Help Desk with questions about Medical Assistance and MinnesotaCare.
If you already have healthcare coverage and you are looking for extra financial support for your child under 18, you may apply for Tax Equity and Fiscal Responsibility Act (TEFRA). The TEFRA option allows Medical Assistance eligibility for children with disabilities whose parents have too much income to qualify for Medical Assistance or other Minnesota Health Care Programs or who qualify but the cost would be too high.
If applying online, select applying “WITH” financial help/assistance.
Indicate that the child who needs MA-TEFRA, has a disability-on the application (online or paper)
If submitting the paper application, it is helpful to write “TEFRA” on the application when indicating the child has a disability.
After submitting the online application, to speed up the process, call your county or tribal nation to request the referral to the state medical review team (SMRT) for MA-TEFRA be started.
Once you receive the SMRT welcome packet in the mail, you can also complete the following two forms and get medical records, diagnoses, educational evaluations, and other helpful documentation together to send to the SMRT. You could also send this paperwork to your county or tribal nation financial worker to fax to the SMRT once the referral has been made (which is initiated by the financial worker).
Once the SMRT receives all the documents needed, they’ll review and determine if the child is certified disabled for the purpose of MA-TEFRA, and they’ll send a letter to the parent(s)/ guardian and let the financial worker know as well.
Disability Benefits 101 (DB101) is a website that gives people tools and information on health coverage, benefits and employment. DB101 helps people with disabilities learn how income may impact benefits so they can make informed choices, reduce fears, and ensure work is part of the plan.
DB101 provides:
Information: Learn about benefits programs and rules around work. Get answers to frequently asked questions. Find out how to avoid common pitfalls.
Estimators: Get results tailored just for you that helps you plan and set goals for work. Get tips for success for your individual situation.
Experts: Find answers to your questions. Connect to community resources. Get help understanding your next steps. DB101’s Chat with a Hub expert connects you to a real person who can help with your situation.
People who live in Minnesota may qualify for different programs and services through Minnesota Health Care Programs. People with ASD or their families may be eligible for coverage to help pay for health care and other needed services. Coverage and out-of-pocket costs vary depending on the program. Here is an overview of MN Healthcare Programs and how to apply.
Indian Health Services (IHS) is an agency within the Department of Health and Human Services and is responsible for providing federal health services to American Indians and Alaska natives. The Bemidji Area Office (BAO) provides service and support to 34 Federally-recognized Tribes and 4 Urban Indian Health programs located in Illinois, Indiana, Michigan, Minnesota and Wisconsin. Tribal Health services are provided through 11 P.L. 93-638 Title V compacts and 23 Title I contracts. Urban Indian Health programs are located in Chicago, IL; Detroit, MI; Milwaukee, WI; and Minneapolis, MN. Tribes in the Bemidji Area include Ojibwe (Chippewa), Ho-Chunk, Menominee, Mohican, Oneida, Odawa, Potawatomi, and Sioux. For questions or further information, call or send a message to Indian Health Services.
Bridge to Benefits is a project by the Children’s Defense Fund-Minnesota to improve the wellbeing of families and individuals by linking then to programs. A core component of the project is an online screening tool designed to help families and individuals understand if they are eligible for eight public work support programs and two income tax credits.
A tax-free Achieving a Better Life Experience (ABLE) account lets people with disabilities save for their future without affecting their benefits. It also lets family and friends give them money.
With MA-EPD, if you have a disability and work, you can earn any level of income, build more assets, and keep your MA coverage. MA-EPD pays for the same services that standard MA covers, including visits to the doctor, hospital stays, medical equipment, home care services, and mental health services.
Both the Social Security Administration (SSA) and the Minnesota State Medical Review Team (SMRT) use the SSA childhood listings book to determine disability. It is helpful to be familiar with the SSA childhood listing book to understand how disability is determined and what information may need to be submitted.
The SMRT process can be done alone or at the same time as social security income (SSI). A SMRT disability determination can also be done during an SSI appeal.
If a child already has SSI, they DO NOT need to go through the SMRT process. If a child is receiving social security disability insurance survivor benefits from a deceased parent or benefits from a retired or disabled parent, they also do not need to go through the SMRT process. Survivor benefits are from the parent’s disability, death, or retirement, not the children.
Some individuals or families may want to request social security income or social security disability benefits from the Social Security Administration. This can be a lengthy process. To apply for SSI, contact the local Social Security office or visit the Social Security Administration online.
Prior to applying online, families of children under 18 are encouraged to call their local office to determine if they meet the financial criteria. Social Security is income. If a family has applied for SSI benefits and are awaiting a decision, they can request the State Medical Review Team (SMRT) to use SSA criteria to make a disability determination while waiting for a determination from the social security administration.
A family should contact the SMRT when they have had SSDI, or SSI benefits denied or terminated for reasons other than lack of blindness or disability. A SMRT determination is for a certain period of time. Once a SMRT decision has been made, the letter sent to the applicant will state the length of time this certification is valid for.
A SMRT determination will be the disability determination needed for waiver eligibility while waiting on a SSA determination. Review Disability Determination Process on this page for information on the SMRT disability determination process.
When looking at SSI for children, financial need is always considered first. If a family is over income or assets, then they should utilize the SMRT process. They will not be eligible for SSI. Also, a family must factor in number of children, child support, etc. The Social Security Administration has resources to help understand SSI.
In Minnesota, there are different ways of accessing healthcare coverage. Having health care coverage may provide access to services and supports.
Private insurance is provided through an employer or not through MNSure.
Public health insurance includes Medical Assistance or MA. Also known as Medicaid. MA-TEFRA, MinnesotaCare, and pre-paid health plans, which are part of the MA system. These are administered by the Managed care organizations or MCOs.
Families may have coverage through private insurance, public insurance or both. If a family’s private insurance is deemed cost effective, then they be eligible for reimbursement for their premiums.
Cost effectiveness can help families receive reimbursement for co-pays, deductibles and other out of pocket costs. The county agency must pay health care coverage premiums if:
DHS or the county determines the premiums are cost effective, and
If the plan is deemed cost-effective, the family can submit pay stubs for monthly reimbursement. If a plan is deemed cost-effective and the child is on a pre-paid medical assistance plan (PMAP), the child will be moved to Fee-for-Service (FFS) MA.
An MA client is eligible for cost effective reimbursement retroactively, up to 12 months, if both of the following are met:
Family Support Grant (FSG) provides state cash grants to families of children with disabilities. The goal of the program is to prevent or delay the out-of-home placement of children and promote family health and social well-being by facilitating access to family-centered services and supports.
Community First Services and Supports (CFSS) is a Minnesota health care program that offers flexible options to meet the unique needs of people. CFSS allows people greater independence in their homes and communities. CFSS replaces personal care assistance (PCA) and the Consumer Support Grant (CSG).
