If your Tennessee Medicaid coverage or a covered service was denied, cut, or terminated, you have the right to appeal, request a fair hearing, and often keep your benefits during the appeal., TennCare, Tennessee's Medicaid program, runs two separate appeal tracks: a medical (service) appeal for a denied, reduced, or terminated health service, and an eligibility appeal for a coverage denial, a termination, an income or family-size error, or a delayed decision.

In This Guide

What you can appeal in Tennessee Medicaid

Federal Medicaid law guarantees every applicant and beneficiary the right to a fair hearing before the state agency. Section 1902(a)(3) of the Social Security Act (42 USC 1396a(a)(3)) requires each state plan to grant a hearing to anyone whose claim for medical assistance is denied or is not acted on with reasonable promptness, and the implementing rule at 42 CFR 431.220 extends that right to anyone who believes the agency acted erroneously or made an adverse determination.

In Tennessee, that right splits into two tracks depending on what TennCare decided.

A medical (service) appeal covers:

  • A denial of a covered health service, including a prior authorization denial
  • A reduction of a covered service, such as cutting authorized personal care hours
  • A termination of a covered service you were already receiving
  • A CHOICES or managed-care-authorized long-term-services-and-supports (LTSS) service decision

An eligibility appeal covers:

  • A denial of your TennCare application
  • A coverage ending or termination
  • An income or family-size error in the decision
  • A delayed decision, when TennCare has not acted on your case in time

The Tennessee Medicaid appeal deadlines that decide your case

The deadline on your notice, not the strength of your argument, controls whether the appeal is heard. TennCare publishes two numbers, and they answer different questions.

Medical (service) appeal: 60 days. For a service denial, reduction, or termination, you have 60 days to appeal after you find out there is a problem. That clock starts when you learn of the problem, not from a date printed on a letter.

An appeal of a termination or denial notice: 40 days. TennCare's appeals policy states that an appeal filed within 40 days from the date of the termination or denial notice is considered timely. That rule sits in the policy governing continuation of benefits and is written without reference to either track, so read it as the outside edge for acting on a notice rather than as one track's deadline.

If TennCare denied your application or ended your coverage, the instructions on the eligibility side cover where to file and when you can ask for a delayed hearing. Your date comes from the notice in your hand. Read the deadline printed on it, and if it is missing or unclear, call TennCare Connect at 1-855-259-0701 and ask what window applies to your case before it passes.

Neither number is the federal one. Federal law sets the outer ceiling at 90 days from the date the notice of action is mailed, and a state may set a shorter window, which is fully enforceable against you. Tennessee's published numbers are far shorter than 90 days, so do not use the federal number as your planning date; the deadline that governs you is the one on your notice.

A medical appeal is usually decided within 90 days after you file it. If you have an emergency and your health plan agrees that you do, you get an expedited appeal, which is decided in about one week. That 90 is a decision timeline, not a filing window.

On the eligibility side, you can ask for a delayed hearing if you have waited more than 45 days for a standard decision, or more than 90 days if you applied for long-term care.

One deadline is tighter than all of these. To keep your benefits flowing during the appeal, the request to continue them is due within 20 days of the notice, covered in the next section.

How to keep your benefits during a Tennessee Medicaid appeal

Continuation of benefits, sometimes called aid paid pending, turns on a deadline that is earlier than the deadline to appeal itself.

Under the Tennessee rule, an appeal filed within 40 days of the termination or denial notice is timely, but your benefits are continued only if the request for continuation is filed within 20 days of the notice, or before your coverage end date if that is later, pending the final decision of the Administrative Judge. The 20-day continuation window is tighter than either published number, the 40 days for acting on a notice or the 60 days for a medical appeal, so acting early is what protects your coverage.

This state rule implements a federal floor. Under 42 CFR 431.230(a), if the agency sent the required advance notice and you request the hearing before the date the action takes effect, the agency may not terminate or reduce your services until a decision is rendered after the hearing. Continuation is never automatic; you have to ask for it.

Managed care (MCO) appeals in TennCare CHOICES

Most TennCare long-term care is delivered through managed care. TennCare CHOICES, the state's long-term-services-and-supports program, contracts with three managed care organizations (MCOs): BlueCare, UnitedHealthcare Community Plan, and Wellpoint, formerly Amerigroup.

In Tennessee, an MCO service dispute is handled as a TennCare medical appeal. A member who is unhappy with an MCO decision on a covered service files directly with TennCare Member Medical Appeals, on the same medical-appeal track described above, with the same 60-day filing window and 90-day decision timeline. The expedited one-week track is available when you have an emergency and your health plan agrees that you do.

How to request a TennCare fair hearing

TennCare hears its own fair hearings, and the final decision on your appeal is rendered by an Administrative Judge. How you file depends on your track.

For a medical (service) appeal, within 60 days. Call TennCare Member Medical Appeals for free at 1-800-878-3192. They can take your appeal over the phone, and they can often solve a problem before you have to appeal at all. You can also file by mail, by fax, or online through your TennCare Connect account.

For an eligibility appeal, by the date on your notice. Call TennCare Connect at 1-855-259-0701, file online, or mail the Eligibility Appeal form to the Eligibility Appeals Unit, P.O. Box 23650, Nashville, TN 37202-3650.

Whichever track you are on, put your request to continue benefits in writing and file it within the 20-day window if you want your coverage to keep running while the case is decided.

Frequently Asked Questions

What should I do the day a TennCare denial or termination notice arrives?

Write down the date on the notice and keep it, because the 20-day continuation clock and the 40-day timeliness window both run from that date. Call TennCare Member Medical Appeals at 1-800-878-3192 for a service problem, which gives you 60 days from when you found out about it, or TennCare Connect at 1-855-259-0701 for an eligibility problem, where the date on your notice is what you work to. Put your request to continue benefits in writing within 20 days if you want coverage to keep running.

Will I have to pay back benefits if I keep them and then lose the appeal?

You might. If your benefits continue during the appeal and TennCare's action is later upheld, you may have to repay the cost of the benefits you received solely because they were continued. If you win, there is no interruption and nothing to repay.

Do I need a lawyer for a TennCare fair hearing?

No. You can file and pursue a TennCare appeal yourself, and TennCare Member Medical Appeals will even take your appeal over the phone. Representation can still help on complex service or long-term-care disputes, and free legal help may be available from Tennessee legal aid organizations. A physician letter documenting medical necessity is often the difference in a service appeal.

What if I miss the deadline, and is an MCO appeal different from a state hearing?

In Tennessee, a managed care organization (MCO) service dispute is filed directly with TennCare Member Medical Appeals as a medical appeal, on the same track and deadlines as any other service appeal. If you miss the deadline because your coverage ended only for failing to return a renewal form, federal law requires the agency to reconsider your eligibility without a new application if you submit the renewal form within 90 days of the termination date. That duty covers eligibility based on modified adjusted gross income (MAGI). If you qualify through age, disability, long-term care, a Medicare Savings Program, or the medically needy pathway, Tennessee may offer the same window but is not required to, so ask TennCare.

Learn More

MedicaidHow to Appeal a Medicaid DenialDenied Medicaid? You can appeal, and one deadline decides whether your benefits keep flowing during the appeal. Know your fair-hearing rights and act fast. MedicaidTennessee Medicaid: The Complete GuideTennessee Medicaid (TennCare) covers 1.4M Tennesseans in 2026. Eligibility, CHOICES, ECF CHOICES, Katie Beckett, MCOs, estate recovery, and how to apply. MedicaidTennessee Medicaid Managed Care PlansA 2026 plain-language comparison of Tennessee's three TennCare MCOs, BlueCare, UnitedHealthcare Community Plan, and Wellpoint, plus how to switch plans. MedicaidTennCare CHOICESTennCare CHOICES is Tennessee's Medicaid program for adults needing nursing-home-level care. Three groups, a Group 2 waitlist, 2026 eligibility inside. MedicaidTennessee Medicaid Eligibility and Income LimitsThere is no single TennCare income limit. Tennessee Medicaid uses five separate tests (ABD, CHOICES, ECF CHOICES, Katie Beckett, MSPs). 2026 numbers inside.

Find personalized help navigating a Tennessee Medicaid appeal at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

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Brevy Care Team

Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.