Turn a barrier into a question you can ask.

Before you pay for an evaluation

For in-person or virtual assessments, clarify scope, report, follow-up and possible extra testing. If you need documentation for a particular benefit or program, ask that program what it requires before buying an assessment solely for that purpose. An advertised diagnosis package does not guarantee acceptance for a separate disability or coverage decision.

• Who will evaluate my child, and how can I verify their credentials?
• Is it suitable for my child’s age and individual needs?
• Which questions does it answer, and which does it not answer?
• What comes from caregivers, teachers, prior reports or direct assessment?
• Will we receive a full written report and a chance to ask questions?
• Could extra testing be needed, and what would that cost?
• What happens if a conclusion cannot be reached remotely?
• Does the price include the report and feedback?

Compare scope, written findings, follow-up, expected family cost and the receiving program’s documentation requirements. A faster advertised assessment is not a guarantee of fit or acceptance.

MA, SMRT and TEFRA are separate decisions

A diagnosis describes a clinical finding. It does not automatically establish disability-benefit eligibility, enroll a child in Medical Assistance or authorize a service.

Medical Assistance (MA) is Minnesota’s Medicaid program. Ask the county or Tribal eligibility office which application route fits your child. Do not assume a disability-based route is required because a child has a diagnosis.

The State Medical Review Team (SMRT) reviews disability using Social Security standards when referral is appropriate. The county, Tribal Nation or state servicing agency makes the referral. Confirm that it exists before submitting documents, and follow the forms and evidence requests for your case.

TEFRA is an MA eligibility option for certain children under 19 who would otherwise be ineligible when parental income is counted. It considers the child’s income and has other requirements, including disability certification and a level-of-care determination. It provides MA coverage, not a separate therapy package.

Questions to ask

• Which MA application route fits our situation?
• Is disability certification needed, and who starts the referral?
• What documents are missing?
• Are we waiting for disability review, overall coverage eligibility or another decision?
• If approved, what is the effective date?
• What future notices or reviews should we expect?

Check coverage before the first service

Keep the answers with your private records. This website does not confirm eligibility or guarantee payment.

Questions to ask

• Can this provider bill my child’s particular coverage?
• Does this service need a referral, order or authorization?
• Has authorization actually been granted, if required?
• What happens if private insurance is also involved?
• Could there be a noncovered charge, and can I get the explanation first?

What is EIDBI?

Early Intensive Developmental and Behavioral Intervention (EIDBI) is a Minnesota benefit for eligible people younger than 21 with autism or a related condition. It is not a diagnosis or one therapy method. A comprehensive multi-disciplinary evaluation (CMDE) must establish medical necessity, and qualifying healthcare coverage is required.

Ask what proposed support would look like, which needs it addresses, how your child’s communication and preferences are included, how caregivers participate, and how progress or concerns are reviewed. Ask separately about eligibility, authorization, availability and cost. One answer does not settle all four.