The Tennessee Affidavit — Bureatendererre Notification is a form used by the Tennessee Department of Human Services (DHS) to provide notice to applicants and recipients of Tenner of their rights and responsibilities. It is an acknowledgement of Tenner coverage and an assurance of compliance with Tenner rules and regulations. The Affidavit is also used to collect information about the applicant's or recipient's income and resources, as well as other eligibility criteria. There are four different types of Tennessee Affidavit — Bureatendererre Notification: 1) Initial Tenner Affidavit, 2) Renewal Tenner Affidavit, 3) Change in Circumstance Tenner Affidavit, and 4) Address Change Tenner Affidavit.
Tennessee Affadavit - Bureau of TennCare Notification
State:
Tennessee
Control #:
TN-SKU-1028
Format:
PDF
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Affadavit - Bureau of TennCare Notification
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Income & Asset Limits for Eligibility 2023 Tennessee Medicaid / TennCare Long-Term Care Eligibility for SeniorsType of MedicaidSingleIncome LimitAsset LimitInstitutional / Nursing Home Medicaid$2,742 / month$2,000Medicaid Waivers / Home and Community Based Services$2,742 / month?$2,0001 more row ?
TennCare has up to 45 days to process your application after you have turned in all the information they request. TennCare will make a determination. You will receive a notice in the mail stating whether your application was approved or denied.
TennCare Medicaid Children under age 21. Women who are pregnant. Parents or caretakers of a minor child (The child must live with you and be a close relative.) Individuals who need treatment for breast or cervical cancer. People who get an SSI check (Supplemental Security Income)
Use your online account at . Use the TennCare Connect mobile app. Fax it to: 855-315-0669. Be sure to keep the page that says your fax went through. Mail it to: TennCare Connect. P.O. Box 305240. Nashville, TN 37230-5240.
You should receive a response From TennCare Online Services within 5 business days.
For eligibility questions call 855-259-0701. To check the status of your application, change your address, or update personal information call 855-259-0701.
A blank Notarized Affidavit ? County Register of Deeds may be obtained by going to sos.tn.gov and entering the form name in the search bar; or, by requesting the affidavit from the Secretary of State by emailing TNSOS.CORPINFO@tn.gov; or, by calling (615) 741-2286.
TennCare will not seek recovery from the estate until the spouse dies, until the child under 21 turns age 21, or until the son or daughter who is blind or disabled dies. For this deferral to take place, a Request for Release must be submitted to TennCare, and TennCare must file a Release in Probate Court.