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Estate Recovery

What is TennCare (Medicaid) Estate Recovery?

Estate Recovery is the way TennCare collects money from the estates of people who passed away and received TennCare long-term services and supports, such as nursing home care or home and community based services. TennCare services are paid for by the State and federal government. If TennCare pays for certain kinds of care, TennCare is required by federal law to try to get paid back for that care after your death.

Estate recovery is using the value of things you leave behind when you die to pay TennCare back for care you received while you were living. Your “estate” is made up of the things you own that you leave behind when you die and it includes your money, your home, other property, or other things you own. TennCare can’t ask for money back until after your death and TennCare can’t ask your family to pay for your care out of their own pockets.

Whose estate has to pay TennCare (Medicaid) back for their care?

TennCare must ask to be repaid for money it spent on your care if you are:

  • Any age and got nursing home care if you weren’t expected to return home (this includes care in an intermediate care facility for individuals with intellectual disabilities or ICF/IID)
  • Or age 55 and older and got care in a nursing home or ICF/IID, home care—called home and community based services or HCBS, home health or private duty nursing
How do I find out if the estate owes money to TennCare (Medicaid)?

After you die, the law says that your estate must be used first to pay the debts you owe. What’s left after your debts are paid is given to the people who should have it. This is called “probate.”

Your debts include any amount you must pay TennCare for care you received while you were living. The probate court cannot close your estate until your lawyer or executor of your estate gets a Release from TennCare. A Release says your estate doesn’t owe TennCare any money.

To get a Release, the person must complete a Request for Release Form and send it to TennCare. It must include all of the proof that’s asked for.

TennCare will send a Release if:

  • Your estate doesn’t owe TennCare any money,
  • OR, if you don’t have to pay TennCare any money from your estate right now.

What if you do have to pay TennCare money from your estate? TennCare will file a claim against your estate. It will say the amount your estate must pay TennCare for care you received. That money must be paid by your estate before TennCare will provide a Release.

How do I ask for a release from TennCare?

The person handling your things after you die may apply for a Release in one of three ways:

  1. Get the Release online at http://www.tn.gov/assets/entities/tenncare/attachments/releaseform.pdf
  2. Get the Release from the Probate Court Clerk’s office by asking for a “Request for Release from Estate Recovery”
  3. Get the Release from TennCare by sending a letter or fax to:
    Bureau of TennCare
    Estate Recovery Unit
    310 Great Circle Road
    Nashville, TN 37243
    FAX: (615) 413-1941

All of the information asked for in the Release must be included. And they must provide any other information TennCare requests to decide if the Release will be given.

How much will the estate have to pay TennCare?

TennCare is a managed care program. This means that TennCare contracts with health plans to provide the services enrollees need. This includes health and mental health services and some long-term services and supports (like care in a nursing home or some kinds of home care).

TennCare pays the health plan a monthly payment for care they are contracted to provide. The payment is based on the kinds of services enrollees are expected to receive from the health plan. It takes into account things like age, disability, and if someone receives long-term services and supports. Part of that payment is for the kinds of care that must be paid back to TennCare.

The payment made to your health plan is the same each month, no matter what services you actually receive that month. The monthly payment to a health plan may exceed $5,000 per month for people who receive long-term services and supports. It can also vary depending on which health plan you have and the part of the state you live in.

Federal rules say that the amount of money TennCare must be paid back for care you got from your health plan is the amount TennCare paid your health plan for those services. This may be different than the cost of services you actually received.

A few services are not part of managed care. They include care in an ICF/IID or home care for people with intellectual disabilities through an HCBS waiver program operated by the Department of Intellectual and Developmental Disabilities. But TennCare still has to be paid back for that care too.

TennCare can’t ask for the money back until after your death. TennCare can’t ask for more money back than we paid for your care. (This includes payments to your health plan and the actual cost of services that aren’t part of managed care.) And TennCare can’t ask your family to pay for your care out of their own pockets.

What are the exemptions from estate recovery?

TennCare may not have to get the money back from the estate if:

  • Your care did not cost much
  • The things you left can’t be used to pay people you owe through probate court. An example is life insurance money.

But these times do not happen by themselves. The person handling your things after you die must get a “Release” from TennCare. It says you don’t owe TennCare money. If your things have to go through Probate court, the Release must be filed there.

Sometimes TennCare must let your money or property stay in the family longer.

These times are if you leave your money or property to:

  • Your surviving husband or wife
  • Your child who is under age 21 when you die
  • Your child of any age who is blind or permanently and totally disabled

TennCare won’t try to get repaid until this family member dies or the child turns age 21. But the person who handles your things must file the TennCare Release in Probate Court.

Sometimes TennCare must let just your HOME stay in the family longer.

This happens when one of these family members lives in the home when you die:

  • Your surviving husband or wife
  • Your child who is under age 21 when you die
  • Your child of any age who is blind or permanently and totally disabled
  • Your child who lived in the home and took care of you if this care kept you out of a nursing home or home care for 2 years
  • Or your brother or sister who helped make the house payments if they lived there for a year before you got nursing home or home care.

By law, TennCare should not take the house until these family members die or the child turns 21. But the person who handles your things must file the TennCare Release in Probate Court.

TennCare may leave your money and property in the family because of undue hardship.

But the State does not do this very often. The family must prove that losing the money or property in your estate will cause an undue hardship. For example, if your property is a family farm and the family’s only income, then the person handling your things can ask the State not to take the property. The State may or may not agree.

Where do I obtain more information?
  • You can call TennCare for free at 1-866-389-8444.
  • OR, you can fax TennCare at (615) 413-1941.
  • OR, you can mail TennCare at:
    Bureau of TennCare
    Estate Recovery Unit
    310 Great Circle Road
    Nashville, TN 37243