This document discusses the application of Medium Term Expenditure Framework (MTEF) in Tamil Nadu, India. It examines MTEF in the health and education sectors of Tamil Nadu. In the health sector, the MTEF developed bottom-up cost estimates for carrying out existing and new policies, which were then reconciled with available public health expenditure. A similar process was followed for the education sector. The analysis found gaps between required funding levels estimated by the MTEF and actual resource availability. Policy recommendations include regularly conducting MTEF, strengthening monitoring and evaluation, and improving coordination between departments.