MedicaidAdministrativeLow impact
Resident Accounts – Death Claims
Illinois Medicaid - HFS·IL·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 resident accounts when a resident dies at supportive living facilities. Facilities will receive this form automatically when they report a resident death and must submit the decedent's account balance to the Bureau of Collections.
Action Required
Facilities managing resident funds should watch for the new Death Claim form that will be automatically sent to the 'Bookkeeper' when resident deaths are reported. Follow form instructions to submit decedent account balances to Bureau of Collections. For unreceived forms, contact BOC directly by faxing requests to 1-217-785-6121.