How to Apply for TennCare in 2026: Senior Application Guide

You can apply for TennCare, Tennessee's Medicaid program, three ways: online through the TennCare Connect portal, by phone, or on paper. Free in-person help is available too, from your county health department or your local Area Agency on Aging and Disability. The process is straightforward for someone applying for regular Medicaid coverage. It is much more involved if you are applying for CHOICES (long-term services and supports), ECF CHOICES (intellectual or developmental disabilities), or Katie Beckett (severely disabled minors), each of which adds a clinical evaluation, a longer document trail, and (often) a different intake agency.

This guide walks through every step for the 2026 program year: which channel to use, what documents to gather, how long you'll wait, what trips families up, and what to do if you get denied.

Key Takeaways

• Three ways to apply: TennCare Connect online (tenncareconnect.tn.gov), by phone (1-855-259-0701), or on paper (mail or fax). Free in-person help is available from your local Tennessee Department of Health office and, for long-term care, from your Area Agency on Aging and Disability (1-866-836-6678).1
• Which clock you are on depends on the basis you applied under. Federal rules (42 CFR 435.912(c)(3)) cap a state Medicaid agency at 90 days for an application filed on the basis of disability, and at 45 days for all other applicants, so a CHOICES applicant who applies on the basis of disability is on the longer clock while one who applies on the basis of age is on the 45-day clock, PAE or no PAE. Those are limits on TennCare, not a promise of a decision by then. A CHOICES application also needs a clinical Pre-Admission Evaluation (PAE), which the AAAD, hospital, or nursing facility files on the applicant's behalf.1,2
• Long-term care needs 60 months of financial history. TennCare reviews five years of bank statements, investment statements, and any asset transfers for CHOICES applications. Start gathering early.3
• Income over $2,982/month? You'll need a Qualified Income Trust. Tennessee is an income-cap state: a long-term-care applicant whose gross monthly income is above the $2,982 Medicaid Income Cap is given the opportunity to establish a Qualified Income Trust (QIT, sometimes called a Miller Trust) and must do so to become income-eligible. Income eligibility is then tested again.4
• Tennessee waived retroactive coverage, so the filing date is everything. Federal law (42 USC § 1396a(a)(34); 42 CFR 435.915) would backdate eligibility up to three months, but CMS let Tennessee out of it: under the TennCare III demonstration, TennCare does not extend eligibility earlier than the date the application is filed. The waiver spares only pregnant women (and the 60 days after the pregnancy ends), infants under one year old, and people under 21, who keep the federal window. Everyone else, including aged, blind and disabled applicants and CHOICES nursing facility and HCBS applicants, gets nothing from TennCare before the filing date, so every day you wait is a day TennCare will not pay for. File as soon as a nursing home stay begins, even if you are still gathering documents.5 (For the three populations that keep the window, federal law shortens it to two months for applications filed on or after January 1, 2027.)6
• Denied? Go by the date on your notice, not by the federal 90 days. An appeal filed within 40 days of a termination or denial notice is timely, and continued benefits need the request within 20 days; a medical or service appeal runs 60 days from when you find out there is a problem.7 The federal 90-day figure (42 CFR 431.221(d)) caps what a state may allow, so it binds TennCare, not you.7 The Tennessee Justice Center, Legal Aid offices, and Help4TN provide free legal help.

Before You Apply for TennCare: Know Which Program You Need

TennCare is not one program, it's at least four, and the right intake door depends on what you need. The application form is the same, but the supporting documents, the assessment process, and the case worker who picks up your file all differ.8

If you don't yet know which one applies to you, start with the TennCare programs hub for a side-by-side comparison.

Step 1: Gather Your Documents

The single most common reason TennCare applications stall is missing paperwork. Gather what you can before you start.

Identity and household:

• Government-issued ID for the applicant (driver's license, TN state ID, passport)
• Social Security numbers for everyone in the household applying
• Proof of Tennessee residency (utility bill, lease, recent mail)
• Birth certificates for children under 18 if they're applying

Income (60 days minimum, longer for LTSS):

• Two most recent pay stubs for any working household members
• Social Security or SSI award letter (current year)
• Pension or annuity statements
• Rental, dividend, or interest income statements
• Tax returns for the last two years

Assets:

• Bank statements for every account (checking, savings, CDs, money market)
• Investment and retirement account statements (IRAs, 401(k)s, brokerage)
• Vehicle titles and values
• Life insurance policies (face value and cash surrender value)
• Deeds and property assessments for any real estate
• Burial plots and pre-need funeral contracts

CHOICES, ECF CHOICES, or Katie Beckett applicants, 60 months of history:

This is where TennCare LTSS applications get heavy. For long-term care pathways, the case worker reviews five years of financial history looking for uncompensated transfers that could trigger the federal look-back penalty (60-month window under 42 USC § 1396p(c), with TennCare's operating rule at ABD Manual § 125.010 and regulatory authority at Tenn. Comp. R. & Regs. 1200-13-20-.08(5)(i-j)). You'll need:3

• 60 months of bank statements (every account)
• 60 months of investment and retirement statements
• Closing documents for any property sold in the last 5 years
• Documentation for any large or unusual gifts or transfers (even modest ones can be questioned, so document anything out of the ordinary)
• Records of any trusts, annuities, or pre-paid contracts
• Loan documents for any money lent to family members

Medical (CHOICES, ECF CHOICES, Katie Beckett):

• Current medications list
• Primary care physician's contact information
• Hospital discharge summaries from the last 2 years
• Diagnosis documentation supporting the level-of-care claim (especially for ECF CHOICES I/DD applications and Katie Beckett medical-complexity documentation)
• For CHOICES: the Pre-Admission Evaluation (PAE), usually completed by the AAAD, hospital, or nursing facility, not by the applicant directly2

Step 2: Choose How to Apply for TennCare

There are three channels for the financial side of any TennCare application, plus free in-person help if you'd rather not file it alone.1

Option A: TennCare Connect Online (Recommended)

TennCare Connect at tenncareconnect.tn.gov is the fastest option for most families. Create an account, answer the questions, upload scanned or photographed documents, and submit. The same portal lets you save progress, track your status, renew, and report changes once you're enrolled.

TennCare Connect is the central portal for Standard TennCare, Katie Beckett (Part B then Part A), and Medicare Savings Programs. It can also be the financial intake for CHOICES, but a CHOICES application also needs a clinical PAE, see Step 3. MSP applicants have a second route: a Part D Extra Help application filed with the Social Security Administration also starts an MSP application.9

Option B: TennCare Connect (Phone)

Call 1-855-259-0701 (Tennessee Relay Service 1-800-848-0298, ask to be connected to TennCare Connect).1 A TennCare Connect representative can take your application by phone and help you through the questions. Useful if you don't have reliable internet, are uncomfortable with the online portal, or have questions about the form.

Option C: Paper Application

Download the TennCare application (English or Spanish) from tn.gov/tenncare and mail or fax it:1

• Mail: TennCare Connect, P.O. Box 305240, Nashville, TN 37230-5240
• Fax: 1-855-315-06691

Paper takes longer because TennCare has to scan and key in your data, but it's a valid channel, particularly when your application carries a lot of supplementary documentation.

Option D: In-Person Help

TennCare does not take applications in person, but free help filling one out is available at:

• Tennessee Department of Health county offices (find yours at tn.gov/health)1
• Area Agencies on Aging and Disability (AAADs), the best starting point for older adults exploring CHOICES; statewide line 1-866-836-6678. That line is for someone who does not yet have TennCare; a current member is told to call their own health plan instead. If the applicant has a disability, an AAAD representative will come to the home to help.8,1
• Federally Qualified Health Centers (FQHCs) participating in TennCare outreach
• Hospital social workers, important if discharge is near and you need TennCare to cover post-acute care
• Nursing facility admissions staff, who typically file Group 1 CHOICES applications as part of admission
• Department of Disability and Aging (DDA) at 1-800-535-9725, free, if the applicant has an intellectual disability. DDA is also the intake agency for ECF CHOICES and Katie Beckett.1,8

Step 3: The CHOICES Pre-Admission Evaluation (PAE)

If your application is for CHOICES Group 1, 2, or 3, you need a clinical PAE in addition to the financial application. The PAE is what proves you meet the Nursing Facility Level of Care standard, and without it, the financial side of the application can't be completed.2

Who submits the PAE, and where to start: it is normally filed for you rather than by you. If you are still at home, start with the AAAD, Tennessee's nine Area Agencies on Aging and Disability provide local intake for home- and community-based programs for older adults and adults with physical disabilities, and an AAAD representative will come to the home of an applicant with a disability.8,1 If you are in a hospital or a nursing facility, the social worker or the admissions staff handles it. Ask whoever is helping you to confirm that yours was actually filed. (Applying to PACE instead? Tennessee's PACE program requires that you live in Hamilton County and runs through Ascension Living Alexian PACE in Chattanooga, 423-698-0802. PACE does not let you skip the clinical test: you must be 55 or older and meet the same nursing facility level of care CHOICES Groups 1 and 2 use, not the looser "At Risk" standard.)10

The Acuity Scale: TennCare scores the PAE on a 0–26 point scale (up to 21 points for deficiencies in activities of daily living and ADL-related functions, up to 5 points for skilled or rehabilitative services). A total score of at least 9 meets nursing facility level of care, the standard for CHOICES Group 1 or 2. Below 9, one other route to NF LOC exists: an applicant who meets the "at risk" criteria on an ongoing basis and whom TennCare determines, through a Safety Determination, does not qualify for CHOICES Group 3 can still be found to meet NF LOC. CHOICES Group 3 is itself the "At Risk" group, for adults who do not meet nursing facility level of care but need services to delay it, and it has its own enrollment target.11

Where it goes: The PAE is a determination made by the Bureau of TennCare, not by your MCO and not by DDA. Registered nurses in TennCare's Long-Term Services and Supports division review and adjudicate it, and decide medical (level-of-care) eligibility.2

If the PAE is denied, you have 30 days, not 40. Appeal rights attach any time a PAE is denied or approved with an end date, and the deadline is 30 days from the date of the notice, plus mailing time, a shorter clock than the 40 days on an eligibility appeal. The denial letter has to state the reason, your appeal rights, and a statewide list of legal aid offices. One kind of denial is not appealable: a technical denial, meaning a submission error, which the submitter corrects and resubmits instead. Two protections are worth knowing while you wait. If the applicant is already living in a nursing home, Section 5(a)(2) of the Doe v. Word consent decree bars the facility from discharging them because TennCare initially denied the PAE, "until any appeal is resolved or the time during which an appeal may be requested has passed without action," and that protection expressly covers someone denied for nursing facility level of care but approved for "At Risk" level of care. And when a PAE is denied, TennCare gives the nursing facility 10 calendar days to submit additional documentation, which preserves the original PAE effective date if it is enough to approve NF level of care.2

Step 4: ECF CHOICES and Katie Beckett: Different Doors

For ECF CHOICES, you do not start at TennCare Connect. You start at DDA.11

Three on-ramps:

• Online self-referral at perlss.tenncare.tn.gov/externalreferral
• Existing TennCare members: call your MCO and ask for ECF CHOICES referral
• Non-members: call DDA at 1-800-535-97251

Once DDA accepts the referral, you go onto the Referral List. Annual funding is limited, so applicants who cannot be enrolled right away are enrolled later based on priority groups and slot availability, or against a reserve-capacity slot. DDA also handles the I/DD diagnostic confirmation and the Person-Centered Support Plan.11

Name your reserve-capacity group when you refer. TennCare publishes the groups that can enroll ahead of the list because their need is most urgent, and it is wider than families expect. It includes Aging Caregiver, a custodial parent or caregiver at least 75 years old for a person with an intellectual disability or at least 80 for a developmental disability; Emergent Circumstances, which reach a primary caregiver who has recently died or is permanently incapacitated with no one else available, the recent loss of the person's living arrangement, "clear evidence of serious abuse, neglect, or exploitation in the current living arrangement" with no alternative available, a discharge from an acute care setting at imminent risk of nursing facility placement, aging out of state custody, discharge from an inpatient psychiatric hospital, and release from incarceration; and Multiple Complex Health Conditions, for a working-age person whose chronic or acquired conditions prevent them from working. TennCare adds that "other eligibility rules also apply," so fitting one of these descriptions is not by itself an enrollment, but say which one fits you rather than waiting to be found.11

For Katie Beckett, the application starts as a self-referral online at TennCare Connect, but families must apply for Part B first: only after a Part B determination can Part A be considered. The medical and financial sides start together but do not finish together. DDA determines medical eligibility (making the Part B level-of-care determination, then referring the child to Ascend for the Part A determination), TennCare determines financial eligibility, and the financial process cannot be completed until the medical determination is done.

Two Katie Beckett clocks catch families out. A denial at either stage carries a 30-day appeal window from the date of the notice, for the application itself and again for a Part A level-of-care denial. And Part A charges a premium where family income is above 150% of the federal poverty level, on a sliding scale by income and household size: the first two months are due before the child can be enrolled, and if they are not paid within 60 days the slot is released to another child. That is not the end of the road either: TennCare enrolls the child in Part B instead if a slot was available at referral. The premium is also reduced by the child's own share of any employer-sponsored or private coverage, and where that share is larger than the premium, there is no premium to pay at all.2

Step 5: What to Expect After You Submit

Federal rules (42 CFR 435.912(c)(3)) cap how long a state Medicaid agency may take to decide an application, running from the date of application:1

• 90 days for applicants who apply for Medicaid on the basis of disability
• 45 days for all other applicants (standard adult Medicaid, MSPs, and CHOICES applicants who apply on the basis of age)

Which cap applies turns on the basis you applied under, not on whether a disability determination happens to arise while your file is reviewed. A 78-year-old applying for CHOICES on the basis of age is on the 45-day clock even though the case also needs a PAE, so day 46 is late and worth chasing. And a cap binds TennCare; it is not a guarantee your decision will land by then. The rule also carries a real exception, at 42 CFR 435.912(e): the standards do not bind "in unusual circumstances," and the regulation's examples are the applicant or an examining physician delaying or failing to take a required action, and an administrative or other emergency beyond the agency's control. Where TennCare does delay, it must document why in your case record, so that is a fair thing to ask about. What it may not do is use the time standard as a waiting period, or deny you because it failed to decide within it.1

TennCare will acknowledge your application, and if it needs more documentation it will send a written request with a deadline printed on it. Respond to every TennCare letter by the date the letter gives you.

Retroactive coverage: Tennessee is not like other states. Federal law would cover services furnished in or after the third month before your application month, but CMS waived that requirement for TennCare under the TennCare III demonstration, and the waiver runs through December 31, 2030. TennCare's authority is "not to extend eligibility prior to the date that an application for assistance is made," and the only people it does not reach are pregnant women (plus the 60 days after the pregnancy ends), infants under one year old, and people under 21. So if you are applying as an aged, blind or disabled adult, or for CHOICES nursing facility or HCBS coverage, there is no three-month backdating to ask for, and TennCare will not pay for care received before the filing date. That is a statement about TennCare, not about your whole bill: whether some other payer covers those earlier months (Medicare's skilled-nursing benefit, for instance) is a separate question the waiver does not touch, so ask the facility's billing office what Medicare or a supplemental policy will pick up before you assume the balance is yours.5 If you are in one of the three groups that keeps the federal window, it still runs three months back today, and federal law shortens it to two months for applications filed on or after January 1, 2027.6

Step 6: Hospital Presumptive Eligibility (For Acute Care)

If you are admitted to a Tennessee hospital and need immediate Medicaid coverage, ask the hospital social worker about Hospital Presumptive Eligibility (HPE).12

Participating hospitals can screen you and grant immediate temporary TennCare coverage pending the full application. It is time-limited: the presumptive period ends on the last day of the month following the month the hospital made the determination if no full TennCare application is filed by then, so get the real application in inside that window.

Do not plan long-term care around presumptive eligibility. Nothing TennCare publishes describes HPE, or either of the other two presumptive routes below, as a way into CHOICES, ECF CHOICES, or Katie Beckett, and we have found no source describing a presumptive or fast-track pathway into TennCare's long-term services and supports at all. Neither do those sources say that no such route exists, so if you are told otherwise, confirm it against TennCare's own LTSS materials or with your AAAD. Plan on the ordinary path in the meantime: HPE can cover an inpatient hospital stay while the CHOICES application, with its PAE, is filed and decided separately.

TennCare runs two further presumptive routes, both through county health departments. Presumptive (Prenatal) Eligibility for Pregnant Women is available at every county health department on a walk-in or phone basis: pregnant women are covered in the mandatory category up to 195% of the Federal Poverty Level, with those between 195% and 250% FPL covered under additional TennCare III flexibilities. Breast and Cervical Cancer Presumptive Eligibility gives immediate TennCare coverage, regardless of gender, to a Tennessee resident under 65 who has a diagnosis of breast cancer, cervical cancer, or certain precancerous conditions, is enrolled in or screened for the Tennessee Breast and Cervical Screening Program at a county health department, has income below 250% FPL, and has no other insurance, not counting insurance that does not cover cancer testing or treatment, or a plan bought through the federal marketplace. It can only be obtained at a county health department, and coverage runs from the date of enrollment until the person is no longer in active treatment. TennCare notes that although other TennCare programs may cover breast or cervical cancer treatment, this is the only one that grants coverage immediately on diagnosis.12

Step 7: Annual Renewal

Once you're enrolled, TennCare redetermines your eligibility on a regular cycle, and federal renewal rules set how that has to work.13

The renewal process:

CHOICES members complete an annual financial review, and their level of care is re-established on TennCare's own schedule through the PAE process. Children under 19 are covered by 12-month continuous eligibility in both Medicaid and CHIP/CoverKids, so a child stays enrolled for the full 12 months even if household circumstances change mid-year, unless the child turns 19 or stops being a Tennessee resident first.6

Common Denial Reasons (and How to Avoid Them)

Most TennCare denials trace back to a handful of common issues:1

• Excess countable assets, TennCare's ABD pathway runs on SSI rules, where the resource limit is $2,000 for an individual and $3,000 for a couple; for CHOICES and institutional Medicaid, TennCare's own resource standard is $2,000. Not everything you own counts, and the biggest exclusion is the home: it is excluded when it is the principal place of residence of the applicant, spouse, or a dependent relative, or where intent to return is established. One vehicle is excluded too, regardless of what it is worth, if the applicant or a household member uses it for transportation. TennCare instructs its staff to "assume that a vehicle is used for transportation, absent evidence to the contrary." On the SSI-rules side that governs Standard TennCare, so are household goods and personal effects, burial spaces, burial funds of $1,500 or less each for the applicant and spouse, and life insurance whose combined face value is $1,500 or less. A Tennessee homeowner with a car is not over the limit on account of the house or the car (see the TennCare eligibility and income limits guide for how resources are counted). The $752,000 home-equity ceiling is a long-term-care rule specifically: it makes an institutional individual ineligible for LTSS (CHOICES) payments, and it is not a cap on the home exclusion for an ABD adult applying for Standard TennCare. Even in long-term care it has two off-ramps worth asking about: TennCare's manual applies it "unless one of the following lawfully resides in the individual's home," meaning the spouse, a child under 21, or a blind or disabled child; and the limit "can be waived if an undue hardship is requested, and a determination is made that undue hardship exists."4,14
• Income over the limit without a Qualified Income Trust, for CHOICES applicants whose income exceeds $2,982/month in 2026, a properly drafted and monthly-funded QIT is mandatory.
• Missing or expired PAE, no CHOICES application can be completed without an approved Pre-Admission Evaluation on file, so confirm with the AAAD, hospital, or nursing facility that yours was actually submitted.
• Un-rebutted asset transfers, any uncompensated gift or below-market transfer in the last 60 months can trigger a penalty period unless you can document a non-Medicaid-planning reason for it. The 2026 transfer-penalty divisor is $295.87/day per the TennCare ABD Eligibility Policy Manual § 125.010 (effective January 5, 2026). Post-DRA-2005 (42 USC § 1396p(c)) the penalty does not start when you make the transfer: it begins on the later of (a) the first day of the month in which the assets were transferred, or (b) the date you are eligible for Institutional Medicaid and would have been eligible for CHOICES but for the improper transfer. The same later-of rule applies to HCBS applicants. See TN's complete 5-Year Lookback and Penalty Divisor guide for the exempt-transfer list, hardship-waiver mechanics, and worked calculations.3
• Missing citizenship or identity verification, make sure to provide documentation (birth certificate, passport, naturalization papers) along with the application.

What to Do If You Get Denied

You have the right to appeal any TennCare denial, and TennCare's own clock is the one you race: an appeal filed within 40 days of a termination or denial notice is timely, and a medical or service appeal runs 60 days from when you find out there is a problem.7 The 90 days in 42 CFR 431.221(d) is a ceiling on what a state may allow, not time you are owed, and a shorter state deadline is fully enforceable.7 Tennessee uses a two-track appeal system, walked end to end in the TennCare appeals and fair hearings guide:15

Eligibility appeals, for denials, terminations, or an LTSS application that TennCare has left pending past its own 90-day delay threshold. File with TennCare Connect:

• Phone: 1-855-259-07011
• Online: tenncareconnect.tn.gov
• Mail: Eligibility Appeals, P.O. Box 23650, Nashville, TN 37202-3650
• Fax: 1-844-563-1728

The deadlines that actually govern. An appeal filed within 40 days of the denial or termination notice is timely. If you have coverage you want to keep running while the appeal is decided, the deadline is shorter: request continued benefits within 20 days of the notice, or before your coverage end date if that falls later.7 Work to the date printed on your own notice, and if it is missing or unclear, call TennCare Connect at 1-855-259-0701 and ask what window applies before it passes. One caution about those two numbers: the 40-day and 20-day windows come from TennCare's Administrative Manual policy 200.055, whose version history ends in December 2015, so confirm them with TennCare Connect rather than resting on them alone. That manual also prints an older filing address; use the P.O. Box 23650 address above, which is the one TennCare's live eligibility-appeal page publishes.

Waiting too long for a decision is itself appealable. TennCare's own threshold for a delay hearing is more than 45 days on a standard application, or more than 90 days on a long-term-care application: past that point you can ask for a hearing on the delay. Expect a short clock of your own once you do: when TennCare asks for the facts it needs to finish the application, or for proof that you applied at all, "You will have 10 days to send us the proof we ask for," and the application, or the delayed-hearing request, is denied if it does not arrive in time.15 Keep that TennCare threshold separate from the federal processing cap, which runs on the basis you applied under: 90 days only for applicants who apply for Medicaid on the basis of disability, and 45 days for everyone else, including a long-term-care applicant who applies on the basis of age.1 Neither number is a promise about when a hearing will be held.

Medical/service appeals, for any Adverse Benefit Determination on a TennCare service (denial, reduction, or termination of services). File with TennCare Member Medical Appeals:

• Phone: 1-800-878-31927
• Mail: P.O. Box 593, Nashville, TN 37202-0593
• Email: TMMA.Contact.Center@tn.gov
• Fax: 1-888-345-5575

Filing deadline is 60 days from the date you find out about the problem. Standard decision timeline is 90 days; an expedited appeal decided in about a week is available when there is an emergency and your health plan agrees.7

Count the 60 days from the letter, not from the day you opened it. That is TennCare's own wording above, but a CHOICES service decision comes from a managed care organization, and the federal managed-care rule gives an enrollee "60 calendar days from the date on the adverse benefit determination notice in which to file a request for an appeal to the managed care plan" (42 CFR 438.402(c)(2)(ii)). A member who starts counting from the day the envelope was opened can be out of time. The plan's own clocks are shorter than TennCare's 90 days, too: a standard plan appeal must be resolved within 30 calendar days and an expedited one within 72 hours. And the plan is not the last stop: after its notice of resolution you have no less than 90 and no more than 120 calendar days to request a state fair hearing, and if the plan misses its own notice or timing requirements you are deemed to have exhausted its process and can go straight to a state fair hearing.15

Continuation of Benefits (COB), on the eligibility track. If your coverage is being terminated, you can ask that it keep running while the appeal is decided. That takes both a timely appeal and a COB request filed within 20 days of the notice (or before your coverage end date, if later). If either date has already passed, file anyway: TennCare's appeals policy lets an appeal be accepted after the 40-day limit, and benefits be continued after the 20-day request window, when the appellant shows good cause for being late. The policy does not publish what counts as good cause, and designated attorneys in the Eligibility Appeals Unit decide, so state your reason and let them rule on it. Two caveats before you ask. Continuation is not unconditional: both TennCare's manual and 42 CFR 431.230(a) let the agency terminate or reduce benefits before the decision anyway if it is determined at the hearing that the sole issue is one of federal or state law or policy, and it promptly tells you so in writing. And if the Administrative Judge upholds TennCare's action, you can be asked to repay the cost of the services that were furnished only because you appealed.7

The 40-day and 20-day windows do not govern a medical/service appeal. No TennCare source states a continuation window for that track, so do not assume services keep running automatically on it. What governs a CHOICES or other MCO service decision is the federal managed-care rule: under 42 CFR 438.420(b) the plan must continue benefits only if all five of these hold: you file the appeal on time, the appeal is about the termination, suspension, or reduction of previously authorized services, the services were ordered by an authorized provider, the original authorization has not expired, and you file separately and on time for continuation. After the plan decides, the window to keep services running is 10 calendar days from the date it sends its notice of adverse resolution, far shorter than the 90 to 120 days you get to request the state fair hearing itself. And if the final decision goes against you, the plan may recover the cost of the services furnished while the appeal was pending.15

Free legal help:

The Grier Consent Decree (Grier v. Goetz, M.D. Tenn. 2005, modified) adds Tennessee-specific procedural protections beyond federal Medicaid appeal rights. The free legal-help resources above can advise on Grier protections specific to your case.

Where to Go Next

Approval is the start, not the end. Standard TennCare members are assigned to one of three MCOs (BlueCare, UnitedHealthcare Community Plan, or Wellpoint) and pick a primary care physician in that network.8 CHOICES members get an MCO Care Coordinator who builds the person-centered support plan (see the TennCare CHOICES guide); ECF CHOICES and Katie Beckett members get a DDA Support Coordinator (see the ECF CHOICES and Katie Beckett guides).

If you want to be paid for the care you're already providing, see How to Get Paid as a Family Caregiver in Tennessee.

Learn More

Find personalized help applying for TennCare 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.