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Do you need to know how to file an eligibility appeal?



Are You Waiting for a Decision on Your Application for Medicaid?

TennCare can help. Some people applied at healthcare.gov but have still not gotten a decision. Have you waited for a decision for more than 45 days (or more than 90 days if you applied for long-term care)? You can now ask for a “delay hearing”. To ask for a delay hearing, call us at 1-855-259-0701. OR click here. If you click on the link, fill out the page and follow the instructions. That page tells you how to send it to us by mail or fax.   

Do you have a new baby (12 months old or less) that you’re trying to enroll?

You may be able to enroll your baby right now. TennCare and CoverKids have made it easy to enroll newborns over the phone:

  • Do you already have TennCare? Call 1-855-259-0701 when your baby is born.
  • Do you have CoverKids? Call 1-866-620-8864 when your baby is born.
  • If you don’t have TennCare or CoverKids, you can apply for your baby over the phone. Call 1-855-259-0701.

What happens if I file a delay hearing appeal?

After you file your appeal, we will look in the federal and state records we have to see if you applied.

What happens next?

If we can find proof you applied, we’ll work your application.  We may need more facts from you.  If we do, we’ll send you a letter that says what facts we need to finish your application.  You will have 10 days to send us the proof we ask for. After we get the facts we need, we will finish working your application and send you a letter about our decision.

What if we don’t get the facts we need within 10 days?  You will get another letter that says your application is denied.

If we can’t find proof you applied, we will send you a letter and ask you to give us the proof. You will have 10 days to send us proof that you applied.  After we get the proof from you, we’ll finish working your application.  What if we don’t get proof that you applied within 10 days?  You’ll get another letter that says your request for a delay hearing is denied.

When we have proof of your application date, we’ll give you a decision on your application. Or we will give you a hearing within 45 days (or 90 days for CHOICES applications). If we give you a hearing, we start counting on the day we find proof you applied or on the day that you send your proof to us (whichever day is earlier).

 

Has your application been denied?  Or do you have to pay co-pays and disagree with how much you have to pay?  Or do we have your income or family size wrong?

There are 2 ways to file a TennCare eligibility appeal:

1. Appeal by phone by calling 1-855-259-0701.

2. OR, appeal in writing. You can get an appeal page here. Or, you can write your appeal on plain paper. If you write your appeal on plain paper, be sure you include:

  • Your full name (first name, middle initial, last name)
  • Your Social Security Number
  • The names of anyone else in your household with the same problem
  • Your daytime phone number and the best time to call
  • The specific mistake you think we made
  • Any proof that shows why you think we made that mistake

Mail your appeal to this address:

Tennessee Health Connection
P.O. Box 305240
Nashville, TN 37230-5240.

Or fax it to 1-855-315-0669.  It's a free fax line.

Keep a copy of your appeal. Write down the date that you mailed or faxed it to us. If you fax it, keep the page that shows your fax went through.



Need Help with Your Appeal?

Is it because you have a health, mental health, or learning problem or a disability?  OR, do you need help in another language?  If so, you have a right to get help.  Call 1-855-259-0701.

Someone who has the legal right to act for you can also file an appeal for you.

Do you have a mental illness and need help with your TennCare? The TennCare Advocacy Program can help you. Call them for free at 1-800-758-1638.

Finally, Legal Services or Legal Aid may give you free help with your appeal. To find out more, click on the link below for the organization that serves your area.

 

View this document in a printable (pdf, 18kb).