Printable TSF HRA Guide

TN Strong Families Healthcare Reimbursement Account (HRA)

2024 Update

Payflex has rebranded and is now Inspira. We are trying to make sure all references are updated to reflect this change. If you happen to find a resource not yet updated contact our web guy

The TN Strong Families HealthCare Reimbursement Account (HRA) allows people to spend program dollars on IRS qualified HealthCare expenses.  Inspira is the TN Strong Families' HRA administrator. The HRA may be used with the Inspira card to cover out-of-pocket medical expenses or to reimburse claims from an itemized receipt.

Download a printable TN Strong Families Healthcare Reimbursement (HRA) Account Guide

Accessing HRA Services

Referrals to TN Strong Families HRA must come from Tennessee Department of Children's Services.  Children currently in state custody who have intellectual and developmental disabilities are eligible for this program. 

The TN Strong Families Independent Support Coordinator (ISC) assists families with requesting the TN Strong Families HRA benefit. It is a one-time per year allocation and cannot be modified. We strongly encourage families to review the types of expenditures listed below while considering how much of their TN Strong Families funds to allocate to the HRA.  DIDD cannot pay for claims submitted prior to the HRA authorization date on the plan. The $20,000 TN Strong Families budget expenditure cap may not exceed $20,000 across the calendar year and unspent funds cannot be rolled over into the next plan year. Once the services are authorized by the ISC on the child’s TN Strong Families support plan, Inspira will mail your HRA debit card to the address on file. 

Helpful tips on using the HRA may be found:

Inspira HRA Debit Card, Online Portal and Mobile App

Families may expect to receive the HRA debit card within 21 days of authorization. If the card has not arrived within 21 days, please contact Inspira at It will arrive in a plain white envelope in the foster parent’s name and contain instructions on how to set up the account. The date the HRA service is authorized on the child’s Person-Centered Support Plan (PCSP) is the first date expenses are eligible. For instance, if the HRA service is authorized on 8/1/23, a doctor’s visit that occurs on or after that date would be eligible for HRA use. A doctor’s visit that occurs on 7/28/23 would not be eligible.

Only the enrolled child is covered by the HRA. It is currently a one-time per year allocation and cannot be modified. Funds left over from one calendar year do NOT carry over into a new year. Families with 2023 expenditures have until 3/31/24 to submit claims.

You may log into the Inspira online portal at or download the Inspira mobile app to review your HRA balance, submit claims and check claims status. Additional information regarding the Inspira online portal are located at Inspira Reimbursement Quick Reference Guide. For information on the Inspira mobile app, click  Inspira Mobile Application Flyer

Changes in Placement

  • If there is a permanent disruption in the foster placement, the HRA Benefit follows the child to their new foster home. The ISC will work with the family to set up the new HRA account. The remaining balance of HRA funds will be made available and the date of eligibility remains unchanged.
    The previous foster family will have 90 days to submit outstanding claims for reimbursement. The ISC will work with the previous foster family to identify unpaid reimbursements and work with Inspira and the family to get claims submitted.
  • Children in the Strong Families HRA will have one year of continued HRA eligibility after adoption. The ISC will continue to work with the family and connect them with other programs they may be eligible for after TN Strong Families eligibility ends. 

Using your HRA Benefit

The HRA can be used two ways:

  • With the provided Inspira card to pay for covered out-of-pocket medical expenses.
  • Reimbursement claims with an itemized receipt. 

Information about eligible expenses can be found in the appendix of this document.  Those include but are not limited to:

  • Copays and deductibles
  • Speech Therapy, Occupational Therapy, Physical Therapy, and Non-Traditional Therapies
  • Medical Equipment and Supplies
  • Orthotics
  • Vision and Dental
  • Respite (reimbursement only)
  • Prescriptions

Using the Inspira Card:

The Inspira card can currently be used at medical offices such as hospitals, doctors’ offices, therapy offices, vision providers, dental offices, and pharmacies. When using the card, it’s important to run it as credit, not debit.  Please be aware that credit/debit card processing fees are not a covered expense. 

There is a daily spending limit of $2,650 on purchases made with the Inspira card. 

Receipts must be submitted to validate all card purchases, and some purchases require a Letter of Medical Necessity (LOMN) from a doctor to be an eligible expense. Inspira currently aims to review and approve supporting documentation within 30 days.

Please be aware that the card cannot be used to purchase future appointments.  For instance, the card cannot be used to purchase a block of 10 future therapy appointments, since there must be validation the visits have occurred.  Doing so, may lead to suspension of your Inspira card. 

Submitting Claims for Reimbursement:

Reimbursement requests are typically processed by Inspira within 7-10 business days but may take longer.  These claims are paid by check or direct deposit.

Submitting Claims

You may submit HRA claims by logging into the Inspira online portal at or into the mobile app and selecting “File A Claim” to upload all supporting documentation (including receipts and invoices) for the expense. All claims should be submitted as expense type: “medical with deductible”.   

The claim should include the following information:

  • Provider or merchant name
  • Type of expense (“medical with deductible”)
  • Date of service
  • Child’s name
  • Child’s DOB
  • Child’s last 4 digits of SSN
  • Description of service
  • EOB or other documentation showing reimbursement, or a statement that no other reimbursement is available and therefore no EOB to apply
  • Final amount of patient liability owed (final out of pocket cost after all reimbursement)
  • Letter of Medical Necessity (LOMN) if applicable

Inspira will send an alert should the expense require additional information for upload. Be sure to respond timely to any requests as to not delay the determination. If no documentation is received within 56 days of the first written request, the Inspira card will be temporarily inactivated until all appropriate supporting documentation of the expense is submitted and approved.

For information on how to file a claim, select  Video: How to File a Claim with Inspira.

For additional information on how to verify Inspira card purchases, click How to Verify Inspira Card Purchases Online.

To find helpful ways to submit claim documentation and prevent card suspension, please review Keep Inspira Card Active Flyer.


Letter of Medical Necessity

Inspira requires a Letter of Medical Necessity (LOMN) Form from the healthcare provider confirming the expenses are needed to treat a specific diagnosis. It must be completed by child’s physician or therapist, including - but not limited to - pediatrician, specialist, medical doctor, physician’s assistant, licensed/registered nurse practitioner, and occupational/physical/speech therapist. In addition, multiple expenses may be itemized on one form. If the form is not available, a statement on letterhead from the medical provider detailing each diagnosis and expense is acceptable. The letterhead should include the following information:

  • Employer Name: State of Tennessee Strong Families HRA
  • Member Number: last 4 digits of child’s social security number
  • Duration

To view the LOMN form, please click, Inspira Letter of Medical Necessity Form

A Letter of Medical Necessity form does not need to be renewed on an annual basis IF a healthcare provider indicates on the form that it is effective for the child’s duration of enrollment in the TN Strong Families Program.


Once approved, reimbursement claims from itemized receipts are typically processed in 7-10 business days and paid by check or direct deposit.


If your HRA account has been frozen due to an overpayment of funds, you can remediate this by:

  • Using another form of payment at the point of sale and submitting the claim to Inspira
  • Paying it back in full online in your Inspira portal or by calling Inspira at (855) 689-8943
  • Making payments to Inspira via check. The check will need to be made out to Inspira and the address to send the funds to are:

FSA Overpayments
PO BOX 8396
Omaha, NE 68103-8396

You must indicate you are part of the State of TN Strong Families HRA and the parent should indicate their full first and last name.


You may email Inspira at or call (855) 689-8943 if you have any questions. Be sure to indicate the child’s legal name and date of birth when contacting Inspira. You may contact your Independent Support Coodinator with any questions.

Contact Information:

Trey King
Director of TN Strong Families & Homes

Babs Tierno
Deputy Director of TN Strong Families & Homes

Appendix A

IRS Eligible and Ineligible Items

The following list is the complete list of IRS eligible and ineligible items. There are many items that may not be applicable to a child in the TN Strong Families Program, but out of an abundance of caution, DIDD is keeping the list in its entirety.  Items deemed eligible by the IRS do not require a letter of medical necessity, however some items require the form. You may include multiple expenses on one LOMN form.


* due to the lack of permanency in foster placements, Companion Animals and Service Animals will require a Letter of Medical Necessity