Estate Recovery
If TennCare pays for nursing facility or other long term care services (such as care provided in someone’s home or home and community-based services), TennCare is required by federal law to recover these payments after your death. This is referred to as “estate recovery.”
Your “estate” consists of the property, belongings, money, and other assets that you own before death. This would include things like your house, car, or bank accounts. Estate recovery uses the value of all of these things to pay TennCare for the care you received. Estate recovery only occurs after your death, and your family is not personally responsible for the debt.
To provide long-term care, TennCare contracts with a health plan (also called a “managed care organization” or “MCO”). When someone receives TennCare, TennCare pays a monthly premium to the health plan (this is called a “capitation rate”). In return, the health plan pays the long-term care provider (such as a nursing facility or other entity providing long-term care in the home/community) for the member’s care. Through estate recovery, TennCare will recover the part of the premium that is for the member’s long-term care.
The payment made by TennCare to your health plan is the same each month, no matter what services you actually receive that month. It can also vary depending on the type of TennCare that you receive, the part of the state you live in, and whether the member has Medicare.
TennCare must seek recovery from the estate when all the following conditions are met:
1) The member received CHOICES Groups 1, 2, or 3 and
2) The member received care at age 55 or older and
3) The member is deceased (TennCare does not seek recovery while the member is living) and
4) There are no waivers or undue hardships that apply.
Under federal law, TennCare cannot recover (or must “waive”) estate recovery when the member is survived by:
1) A spouse or
2) A child under 21 or
3) A child that is blind or disabled.
TennCare also recognizes the following situations as “undue hardships” that will either waive or delay recovery:
1) When the property of the estate is the sole income-producing asset of the survivors, such as a family farm or other family business. This undue hardship acts as a waiver to estate recovery.
2) When a sibling of the member, who acted as the member’s caretaker, meets the following criteria:
a) The sibling was lawfully residing in the member’s home at least 1 year immediately before the member’s admission to the medical institution and
b) The sibling provided care to such member for that 1 year, which permitted the member to reside in the home rather than in an institution and
c) The sibling has lawfully resided in such home on a continuous basis since the date of the member’s admission to the medical institution.
d) This undue hardship only exists for as long as the member’s sibling resides in the home. This undue hardship no longer applies when the sibling caretaker moves out of the property, sells the property, or passes away.
3) When a son or daughter of the member, who acted as the member’s caretaker, meets the following criteria:
a) The son or daughter was lawfully residing in the member’s home for at least 2 years immediately before the member’s admission to the medical institution and
b) The son or daughter provided care to such member for those 2 years, which permitted the member to reside at home rather than in an institution and
c) The son or daughter has lawfully resided in such home on a continuous basis since the date of the member’s admission to the medical institution.
d) This undue hardship only exists for as long as the member’s child resides in the home. This undue hardship no longer applies when the child caretaker moves out of the property, sells the property, or passes away.
When a TennCare member passes away, your family members or estate representative can find out if the estate owes money to TennCare or apply for waivers and undue hardship by completing a Request for Release form.
After the Request for Release form is submitted to TennCare, if the estate owes money, TennCare will provide a claim and itemized statement explaining the amount that is owed. TennCare will also provide information on waivers and undue hardships. Remember, this amount can only be recovered from things you owned. Surviving family members are not personally responsible for paying this amount on your behalf.
If money is not owed to TennCare or if the estate qualifies for a waiver or undue hardship, TennCare will send you a letter releasing or deferring the estate from having to pay TennCare back.
Your family members or estate representative can locate the Request for Release form by:
- Downloading the Request for Release form (English) Request for Release form (Spanish).
- Calling, writing, or faxing us using the information below:
Mail: Division of TennCare
RFR Processing Unit
310 Great Circle Road, 3rd Floor
Nashville, TN 37243
Phone: 866-389-8444
Fax: (615) 413-1941
- Contacting your local Probate Clerk.
Please follow the instructions on the Request for Release form for completing the form and submitting it to TennCare. Please remember to attach any additional documentation that is required by the form.