Denied TennCare? You Have 30 Days. Here's What To Do.

⚠️ Time-Sensitive Steps (Read First)

• You have 30 days from the date on your denial notice to file an appeal. Miss this and you may forfeit your right to challenge the decision.
• If you appeal within 10 days of an existing coverage being terminated, your benefits often continue while the appeal is pending. Call TennCare Connect immediately to confirm.
• If you or your child face a medical emergency (running out of medications, scheduled surgery, urgent specialist care), request an expedited appeal — these are decided in 72 hours.
• Save EVERY piece of paper. Original denial letter, envelopes (proof of date received), any correspondence, all medical records.

What Can Be Appealed?

• Initial application denial — TennCare said no when you first applied.
• Coverage termination — you had TennCare and they're cutting you off.
• Coverage reduction — they're cutting hours of in-home care, therapy sessions, or services.
• Service denial — TennCare refuses to cover a specific medication, treatment, or piece of equipment.
• Wrong level of care assessment — they say your loved one doesn't need nursing-home level of care when they clearly do.
• Katie Beckett / TEFRA denial — most common reason is "not meeting institutional level of care" — this is appealable with the right medical documentation.

The 5 Most Common Denial Reasons (and How to Beat Each)

• 1. "Level of care not met" — The most common Katie Beckett and nursing home denial. The fix: get a letter from your treating physician detailing daily care needs, hours of supervision required, and what would happen without home-based care. Specifics matter ("requires 24-hour skilled nursing for ventilator management"), not generalities ("has medical needs").
• 2. "Missing income/asset documentation" — They didn't get a bank statement or pay stub. The fix: resubmit complete documentation immediately. Often resolved in 14 days without a full hearing.
• 3. "Failed to respond to information request" — A letter got lost, ignored, or you missed a deadline. The fix: appeal AND immediately submit the missing information. Cite "good cause" for the missed deadline (illness, mail issues, caregiver crisis).
• 4. "Income exceeds limits" — Your gross income looks too high on paper. The fix: for nursing home applications, the spend-down and Miller Trust strategies often resolve this. For Katie Beckett, only the CHILD's income matters — make sure they're not counting yours by mistake.
• 5. "Look-back violation" — They found a gift or transfer in the last 5 years that created a penalty. The fix: document any return of gifted assets, exempt transfers (to spouse, disabled child, blind individual), or non-asset-protection purpose. An elder law attorney is worth the consultation here.

How to File the Appeal

• Method 1 — Phone (fastest): Call TennCare Connect at 1-855-259-0701. Tell them: "I want to file an appeal of a denial decision." Get a confirmation number. Write it down.
• Method 2 — Online: Log into TennCare Connect at tenncareconnect.tn.gov and use the Appeals tab.
• Method 3 — Mail/fax: The denial notice contains an appeal form on the back. Complete it, sign it, send via certified mail to the address listed. Keep your tracking receipt.
• Method 4 — In person: Visit your local DHS office and ask to file an appeal. Bring the denial notice and a photo ID.
• Whichever method you use, get proof of submission. Date, time, confirmation number, certified mail receipt — these matter if TennCare claims they never received it.

What to Include in Your Appeal Packet

• 1. A clear statement of why you disagree. Don't be emotional. Be specific. ("The denial cited insufficient evidence of level of care. Enclosed are updated medical records and a physician statement addressing each point.")
• 2. A copy of the denial notice. Reference its date and reference number.
• 3. Updated medical records. Hospital stays, specialist reports, therapy notes, diagnoses, prescriptions. Anything from the last 12 months that demonstrates the need.
• 4. A letter from the treating physician. This is often the most important document. Should specifically address the denial reason. Example: "My patient requires daily skilled nursing because [specifics]. Without home-based care, institutional placement would be medically necessary."
• 5. Documentation of daily care needs. A log of what care looks like in a typical day (meds, transfers, suctioning, feeding tube management, behavioral interventions). Hours per day. Number of caregivers.
• 6. Letters from other providers. Therapists, social workers, school nurses, home health agencies — anyone who can speak to functional needs.
• 7. For Katie Beckett specifically: Include the SSI disability determination if your child has one, and any educational evaluations or IEPs that show functional limitations.

Template Language You Can Adapt

Copy and customize this for your written appeal. Replace bracketed sections with your specifics.

What Happens After You File

• Acknowledgment within 5-10 days. You should receive a letter confirming TennCare received your appeal and assigning it a case number.
• Reconsideration first. A TennCare reviewer looks at your appeal and any new documentation. Many appeals are resolved at this stage without a hearing.
• Hearing scheduled if needed. If reconsideration upholds the denial, you'll get a hearing date — usually by phone, sometimes in person. You have the right to bring witnesses (doctors, caregivers) and present evidence.
• Decision in 90 days (standard) or 72 hours (expedited). The hearing officer's written decision is mailed to you.
• Further appeals possible. If you lose the TennCare hearing, you can request judicial review in Tennessee Chancery Court. This requires an attorney.

Free Legal Help — Use It

You do not have to handle a TennCare appeal alone. These organizations help Tennesseans for free or at low cost.

• Tennessee Justice Center — 1-877-608-1009 — Statewide TennCare advocacy. They literally specialize in this. Call them first.
• Legal Aid Society of Middle TN — 1-800-238-1443 — Free legal representation for low-income Middle Tennesseans.
• Legal Aid of East Tennessee — 1-865-637-0484 — Knoxville/Chattanooga area.
• West Tennessee Legal Services — 1-800-372-8346 — Memphis and West TN.
• Disability Rights Tennessee — 1-615-298-1080 — Specifically for disability-related denials including Katie Beckett.
• Tennessee Bar Association Lawyer Referral — 1-615-383-7421 — For elder law / disability attorneys.

The Bottom Line

• A denial is not a final answer. Most appeals succeed when families submit better medical documentation and meet the deadlines.
• The 30-day clock starts the moment you receive the notice. Don't wait.
• Free legal help exists and is excellent. Tennessee Justice Center is your first call.
• Document everything — denial letters, phone calls, names, dates, mail receipts.
• If you've been denied Katie Beckett based on "level of care," a strong physician letter often wins the appeal.