How to Fill Out and Submit the TennCare Request for Release Form

The TennCare Request for Release form is a one-page notice an executor or estate representative sends to Tennessee’s Medicaid program to find out whether the decedent’s estate owes anything for benefits the state paid. You complete it with the decedent’s identifying information, attach a copy of the death certificate, and submit it to the RFR Processing Unit by email, mail, or fax. Tennessee law requires this notice within 60 days of the date letters testamentary or letters of administration are issued for anyone who was 55 or older at death, and a probate estate cannot close until TennCare’s response is on file with the clerk.¹

When You Need to File It

The 60-day clock starts on the date the probate court issues letters. The form is TennCare’s designated format for the statutory notice, and the clerk will not let you close the estate until one of three things comes back from the state: confirmation that nothing is owed, proof the claim was paid, or a written waiver.²

The form also comes up outside formal probate. Title companies and lenders routinely require a TennCare release before insuring or financing property that recently belonged to a decedent’s estate, and families settling small estates by affidavit use the release to show the state has no interest in the assets. Without it, a real property transfer can stall.

What to Gather First

Before you open the form, pull together the documents TennCare needs to process it. At minimum you must include a legible copy of the death certificate with the Social Security number visible and unredacted. TennCare will not process the request without it.³

If you plan to check a waiver or deferral box, gather the matching proof:

Surviving child under 21: the child’s birth certificate.
Blind or permanently disabled surviving child: the child’s birth certificate and the Social Security Administration determination or award letter confirming the disability.
Long-term care insurance: a copy of the policy.
Trust with a Medicaid payback provision: a copy of the trust.

A surviving-spouse deferral needs the spouse’s name and Social Security number on the form itself; the instructions do not list a separate document to attach for that box.

Filling Out Each Section

The form is available as a downloadable PDF on TennCare’s estate recovery page, and you can also request a copy from the RFR Processing Unit or your local probate clerk.⁴ It has five short sections on a single page.

Deceased person’s information. Enter the decedent’s first, middle, and last name exactly as they appear on the death certificate. The Social Security number comes from the death certificate as well; TennCare uses it to match the decedent against enrollment records.

Person submitting the request. Your name, street address, city, state, zip code, phone, and email. TennCare will send the release or claim notice to this address, so check it carefully.

Probate court case information. If a probate case has been filed, check yes and list the county, filing date, and case number. If no case has been opened, for example when you are only clearing title on real property, check no.

Waiver or delay request. Check any box that applies: surviving spouse, surviving child under 21, blind or permanently disabled surviving child, or long-term care insurance. Each triggers the supporting document listed above.

Trust information. If the decedent was the beneficiary of a trust with a Medicaid payback provision, check the box and list the trustee’s name, address, phone, and email, and attach a copy of the trust.

One point that catches people off guard: the form does not ask for property descriptions, parcel numbers, or deed information. It is keyed entirely to the decedent’s identity. TennCare calculates any claim from its own payment records, not from property information you supply.

Where to Send It

Submit the completed form and every supporting document to the RFR Processing Unit by any of these methods:³

Email: RFR.TENNCARE@TN.GOV
Mail: RFR Processing Unit, 310 Great Circle Road, 3W, Nashville, TN 37243
Fax: (615) 413-1941

Email is the fastest option and creates an automatic timestamp. If you mail the form, use a trackable service so you have proof of delivery. For questions, the toll-free number is 866-389-8444 and the direct line is (615) 741-0636.⁴

What Happens After You Submit

TennCare reviews its records to see whether it paid for any recoverable services on behalf of the decedent. If nothing is owed, it issues a release you file with the probate clerk or hand to the title company. If money is owed, TennCare sends a claim with an itemized statement, and that notice also explains the available waivers and hardship provisions, so you get a second chance to raise a defense even if you did not check a waiver box on the original form.⁴

One thing worth knowing before the claim arrives: if the decedent was enrolled in a TennCare managed care plan, the state may recover the monthly premiums it paid the insurer rather than only the cost of services the decedent used, which can make the claim larger than families expect.¹

There is no published deadline for TennCare to respond. The 60-day statute governs your notice to TennCare, not the state’s answer to you. If several weeks pass without a reply, calling 866-389-8444 to check status is reasonable. Once you have either a release or a paid-in-full confirmation in hand, file it with the probate clerk to satisfy the statutory requirement and let the estate close.

Waivers and Deferrals to Consider Before You File

Some situations block or delay recovery entirely, and the waiver section of the form is where you flag them. Recovery cannot proceed while the decedent is survived by a spouse, a child under 21, or a child of any age who is blind or permanently and totally disabled.¹ You still file the Request for Release in these cases; the state defers the claim rather than pursuing immediate payment.

TennCare also recognizes hardship situations that fall outside the form’s checkbox list, including cases where estate property is the sole income-producing asset of the survivors (a full waiver) and where a caregiver sibling or adult child has lived in the decedent’s home under specific conditions (a delay).⁴ If any of these may apply, raise them in a cover letter with the form or when TennCare’s claim notice arrives.

1
Justia. Tennessee Code 71-5-116 – Lien on Real Estate – Claim Against Estate – Restrictions
2
Tennessee Administrative Office of the Courts. Probate Guide
3
TennCare. TennCare Request for Release Form
4
TennCare. Estate Recovery