Place a large pot of salted water over high heat to boil. When water is boiling, drop tortellini and cook according to package directions. Drain cooked tortellini and reserve.
Melt the butter, add the onion and garlic, and season with salt and pepper. Sauté until the onions soften.
Stir in flour and cook about a minute. Whisk in the milk and cook until the liquid comes up to a bubble and the sauce thickens, 2-3 minutes.
Stir in the nutmeg and pumpkin. Season with salt and pepper and simmer until thickened, about 1 minute. I found I needed quite a bit of salt.
Toss the tortellini with the pumpkin sauce and transfer to a casserole dish. Cover with cheese and broil until cheese is browned.
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