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4830.00.00 PAYMENT FOR BURIAL EXPENSES (MED 1) Recommendations for payment of funeral and cemetery expenses of deceased recipients of Medicaid for the Aged, Blind, and Disabled (MA A, MA B, MA D, MASI), Disabled Working (MADW), or Residential Care Assistance Program (MA R) are to be submitted for final approval to the Medicaid Medical Review Team, Office of Medicaid Policy and Planning. Any business receiving payment from the Auditor of State must have a Vendor Information Form, State Form 53788 (R2/10-09), Request for Taxpayer Identification Number and Certification, on file in the State Auditor's office. If a business has never received payment through the State Auditor's office, a State Form 53788 (R2/10-09) W-9 must be attached to each business' initial claim form. Remittance will be made directly to the claimant. Reimbursements of burial expenses are made to vendors by direct deposit in the account on file through completed vendor information form, State Form 53788 (R2/10-09). 4835.00.00 INSURANCE SETTLEMENTS (MED 1) A surviving relative of a deceased recipient may be the beneficiary of a cash settlement from a life insurance policy on the deceased. The insurance settlement is the income or resource of the surviving relative. However, if all or part of the insurance settlement is used to meet the burial expenses of the deceased recipient, the funds used for burial expenses are to be considered a contribution from a relative. If the surviving relative is also an applicant or recipient, the insurance settlement may affect the applicant’s eligibility depending on the program involved.

1 IC 12-14-17-2 2 IC 12-14-17-2(b) 3 IC 12-14-17-3 4 IC 12-14-17-2(b) 5 IC 12-14-6-2 6 IC 12-14-17-3 7 IC 12-14-17-5