MedicaidAdministrativeLow impact
Resident Accounts – Death Claims
Illinois Medicaid - HFS·IL · Geriatrics·Provider Notice
Effective date
Sep 15, 2015
We identified it
Jun 20, 2026
Summary
Healthcare and Family Services has replaced the Small Estates Affidavit form with a new "Notice of Claim for Funds in Personal, Trust and Room and Board Accounts on Death of Resident" form for collecting deceased resident account balances at long-term care facilities. Facilities will receive this new form automatically when reporting a resident's death and must follow the instructions to submit account balances to the Bureau of Collections.
Action Required
Long-term care facilities should update their procedures to use the new death claim form when it is received automatically after reporting a resident's death. If needing to remit funds before receiving the form, contact Bureau of Collections by fax at 1-217-785-6121. Direct any additional account claims to the Bureau of Collections for disposition.