TennCare Estate Recovery: What Happens After Long-Term Care in Tennessee

Quick answer: If TennCare pays for nursing facility or other long-term care, federal law requires it to recover those payments after your death. That is estate recovery. It reaches the property, belongings, money and other assets you own before death, such as a house, car or bank accounts. It happens only after death, your family is not personally responsible for the debt, and it does not apply when you are survived by a spouse, a child under 21 or a blind or disabled child. Nashville families planning an estate should know about it before they need long-term care.

Whose estate must pay TennCare back?

TennCare says it must seek recovery when all of these conditions are met:

• The member received CHOICES Groups 1, 2 or 3.
• The member received care at age 55 or older.
• The member has died. TennCare does not seek recovery while the member is living.
• No waiver or undue hardship applies.

How much does TennCare recover?

TennCare pays a monthly premium, called a capitation rate, to a health plan that pays the long-term care provider. Estate recovery covers the part of that premium that is for long-term care. The amount depends on the CHOICES group, whether the person had both Medicare and Medicaid (“Dual”) or only Medicaid (“Non-Dual”), and where in Tennessee the person received services.

For Middle Tennessee, TennCare lists these monthly rates, current as of June 1, 2026. It says they can change and will likely go up each year.

Middle Tennessee monthly rate	CHOICES 1 and 2	CHOICES 3
Duals (Medicare and Medicaid)	$4,926.74	$931.98
Non-Duals (Medicaid only)	$6,834.40	$1,892.72

Does the actual cost of care matter?

Less than people expect. TennCare says it must recover the amount it paid for long-term care services even if the services were not used, and even if the services cost less than the premium.

It gives two examples. If a CHOICES Group 2 member is hospitalized for six months, TennCare must still recover the premiums for those months. If care in the home only cost $1,000 in a month, TennCare must still be repaid the full premium it paid that month.

When can’t TennCare recover?

Under federal law, TennCare cannot recover when the member is survived by a spouse, a child under 21, or a child who is blind or disabled.

TennCare also recognizes undue hardships that either waive or delay recovery:

• Sole income-producing asset. The estate property is the survivors’ only income-producing asset, such as a family farm or other family business. This acts as a waiver.
• Sibling caretaker. A sibling lawfully lived in the member’s home for at least 1 year before the member’s admission to a medical institution, provided care during that year that let the member stay home, and has lived there continuously since.
• Son or daughter caretaker. The same test, with at least 2 years of living in the home and providing care.

The caretaker hardships last only as long as that person lives in the home. They end when the caretaker moves out, sells the property or dies.

What does the family do after a death?

Family members or the estate representative can find out whether the estate owes money, or apply for a waiver or hardship, by completing a Request for Release form. You can download it from TennCare, get it by phone, mail or fax, or contact your local Probate Clerk. Davidson County’s probate forms include it as well.

If money is owed, TennCare provides a claim and an itemized statement, along with information on waivers and hardships. If nothing is owed, or a waiver or hardship applies, TennCare sends a letter releasing or deferring the estate.

This also matters at the courthouse. Davidson County’s guidelines for closing a solvent estate list a TennCare release among the items to file, unless the person was under age 55 at death. See what closing an estate involves.

Where does a living trust fit?

TennCare’s page does not address living trusts. It defines your estate as the property, belongings, money and other assets you own before death, and that is the limit of what it says on the subject. So do not assume a living trust changes the result, and do not assume it doesn’t.

Raise it directly with an attorney before anyone is on long-term care, because the answer depends on your facts. Moving a home into a trust is also its own step, covered in our guide to recording the deed in Davidson County. Estate recovery is separate from tax as well; see does Tennessee tax your estate.

What should you ask before care begins?

Bring these to a consultation:

• Is anyone in the family 55 or older and receiving, or likely to need, CHOICES services?
• Who would survive that person: a spouse, a child under 21, a blind or disabled child?
• Is a house, farm or family business the main asset?
• Is a sibling or adult child living in the home and providing care? How long has that been true?
• Who would be the estate representative and handle the Request for Release?

Why talk with Thompson Law in Nashville?

Attorney Christopher “Kim” Thompson has practiced in Middle Tennessee for over 30 years, and you work directly with him. Read more about wills and estate matters. Call (615) 832-2335 for a free consultation, or contact the firm.