Key takeaways
Fill, sign, and submit TN TC-0087 from any browser — or have AI generate a custom version in seconds. No installs, no printing, no back-and-forth.
- The Request for Release Form allows heirs to ask TennCare to waive or delay recovering costs from a deceased beneficiary's estate.
- Heirs or authorized representatives of a deceased TennCare beneficiary use this form to prevent or postpone estate recovery claims.
- Applicants must submit the completed form within 60 days of the date listed on the official TennCare notice of claim.
- Valid reasons for a waiver include undue hardship or the presence of a surviving spouse, minor child, or disabled child.
- Required documentation includes a death certificate and may include wills, trust documents, birth certificates, or property deeds for the deceased.
- You can use pdfFiller to fill, edit, and share the Tennessee Request for Release Form securely from any browser.
What is TN TC-0087?
Tennessee Request for Release Form is a document used by heirs or authorized representatives to ask the state to waive or delay its claim against the estate of a deceased TennCare beneficiary. This application, also known as RFR 2021-2, is specifically designed for situations where the state seeks to recoup costs for medical services provided during the beneficiary's lifetime. By filing this request, applicants can formally demonstrate that recovery would cause undue hardship or that the deceased is survived by specific family members who qualify for an exemption.
The form requires detailed information about the deceased beneficiary and the individual submitting the request to establish a legal basis for relief. It outlines several categories for exemption, such as cases involving a surviving spouse, a child under age 21, or a child who is blind or permanently and totally disabled. Applicants must provide supporting evidence, which may include death certificates, birth certificates, or property deeds, to verify their eligibility. This medicaid recovery waiver request ensures that the recovery process considers the unique financial and familial circumstances of the heirs.
TennCare Estate Recovery Program
Who needs the TN TC-0087 — and who doesn't
Not everyone files TN TC-0087. The checklist below tells you whether it applies to your situation — and points you to the right alternative if it doesn't.
You need this TN TC-0087 if…
- you are an heir or authorized representative seeking to waive or delay a claim against the estate of a deceased TennCare beneficiary
- you wish to apply for a waiver based on criteria such as undue hardship or the presence of specific surviving heirs
- you have received a notice of claim and need to submit a formal request for release within 60 days of the notice date
You do not need this TN TC-0087 if…
- the deceased TennCare beneficiary is survived by a spouse
- the deceased beneficiary has a surviving child who is under 21 years of age
- there is a surviving child of the deceased who is blind or permanently and totally disabled
Why you need the TN TC-0087
Why people fill out TN TC-0087, and what tends to go wrong when they don't.
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Protect Estate Assets Filing this form allows heirs to request a waiver or delay of recovery claims. This process helps protect the assets of a deceased TennCare beneficiary when specific legal criteria are met.
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Identify Eligible Heirs Use the specialized sections to document the presence of a surviving spouse, minor children, or disabled dependents. This information is critical for the state to determine if the estate is exempt.
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Meet Filing Deadlines Submitting this request to the TennCare Estate Recovery Program within 60 days of a claim notice ensures your case is reviewed. It establishes a formal record of your request for relief.
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Secure Online Management You can fill and edit this form in your browser using pdfFiller. This online platform for managing PDF documents keeps your sensitive data in secure encrypted storage while you compile attachments.
What each section of TN TC-0087 means
Every section explained — what it's asking, the records you'll need on hand, and the mistakes that most often cause a rejection or follow-up request.
| Deceased Beneficiary Details | Enter details identifying the person who received TennCare benefits while alive and whose estate is now subject to the state program's recovery process. |
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| Requestor Information | Provide identifying details for the heir or authorized representative who is filing this request for a waiver or delay of the estate recovery claim. |
| Recovery Waiver Basis | Select the specific criteria for the request using checkboxes, such as undue hardship, a surviving spouse, or a surviving child who is minor or disabled. |
| Information Accuracy Certification | Complete this section to certify that the information provided in the request is accurate and true to the best of the applicant's knowledge. |
| Supporting Documentation Checklist | Review the list of required and optional documents, such as death certificates or property deeds, that must be included with the submitted request packet. |
How to fill out TN TC-0087 using pdfFiller
A walkthrough from the first field to the signature line. With your records in front of you, most people finish in under ten minutes.
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Open the form Click Get Form to open the Tennessee Request for Release Form in the pdfFiller editor to begin your application for a waiver or delay of estate recovery.
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Enter beneficiary information Select the text fields in Section I to type in the name and personal details of the deceased TennCare beneficiary whose estate is subject to the recovery claim.
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Provide applicant details Navigate to Section II and enter the contact information for the heir or authorized representative submitting the tn rfr form 2021-2 on behalf of the estate.
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Select waiver basis Use the checkbox tool in Section III to indicate the specific reason for your request, such as undue hardship or a surviving spouse, for the tenncare waiver form.
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Complete the certification Fill out Section IV by providing your signature and the current date to certify that all information provided in the request is accurate and complete.
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Check required attachments Mark the checkboxes in Section V to confirm which supporting documents, such as a death certificate or copy of the will, you are including with the submission.
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Save and share Review your document for errors, then download the finished PDF to your device or use pdfFiller to share the form via link, email, or fax.
Required disclosures & attachments
The fields TN TC-0087 won't be accepted without — and the disclosures filers most often miss.
Deadlines, key dates & penalties for TN TC-0087
When TN TC-0087 is due, what late filing actually costs, and how to request more time if you need it.
| Filing Deadline | The Request for Release must be returned within 60 days of the date on the TennCare notice of claim. |
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Recent changes to TN TC-0087
The official Request for Release Form is identified as RFR 2021-2. The current version of this document was updated by the TennCare Estate Recovery Program in October 2021, as indicated by the revision status Rev. 10/21.
Pointer: Verify that your document displays the Rev. 10/21 date to ensure you are using the most current version.
Key terms used in TN TC-0087
A one-sentence glossary of the TN TC-0087 terms and concepts you'll see throughout this guide.
- TennCare Beneficiary
- The deceased person who received medical assistance benefits through the TennCare program during their lifetime.
- Estate Recovery
- The legal process by which the state collects repayment for medical services from a deceased beneficiary's remaining assets.
- Undue Hardship
- A condition where the state waives its claim because recovery would cause extreme financial difficulty for the heirs.
- Request for Release
- The formal application used to ask TennCare to waive or delay its claim against a deceased person's estate.
- Authorized Representative
- An individual, such as an attorney or heir, legally permitted to submit the waiver request for the estate.
Frequently asked questions about TN TC-0087
Quick answers to the questions we hear most often about completing the TN TC-0087.
The Request for Release Form is a document used to ask the TennCare Estate Recovery Program to waive or delay its claim against the estate of a deceased beneficiary. This form allows heirs or representatives to demonstrate why recovery would create an undue hardship or why specific exemptions apply based on the deceased's survivors.
Heirs or authorized representatives of a deceased TennCare beneficiary should submit this form if they wish to request a waiver or delay of estate recovery. It is specifically intended for those seeking relief from the state's claim against property or assets that would otherwise be used to reimburse Medicaid expenses incurred by the beneficiary.
TennCare may waive or delay recovery if there is a surviving spouse, a child under 21, or a child who is blind or permanently and totally disabled. Additionally, heirs can request relief based on undue hardship. The form includes specific sections to check the basis for the request and provide supporting evidence for these conditions.
The completed Request for Release must be returned to the TennCare Estate Recovery Program within 60 days of the date on the official notice of claim. Timely submission is necessary to ensure the request for a waiver or delay is considered before the estate recovery process proceeds further.
Every request must include a copy of the deceased beneficiary's death certificate to be considered complete. Depending on the specific situation, you may also need to provide a copy of the will, trust documents, power of attorney, birth certificates for children, guardianship papers, or deeds to property owned by the deceased.
You can use pdfFiller to fill, edit, and manage the Tennessee Request for Release Form directly in your web browser. The platform allows you to complete all required fields, attach digital copies of supporting documents like death certificates, and share the finished PDF via email or link, making the submission process more efficient and organized.
