Section 117.54  Claims for Reimbursement

a)         Claims for reimbursement for individuals eligible under Section 117.50(a)(1) are as follows:

1)         The Department will not reimburse funeral or burial expenses paid by a legally responsible relatives.

2)         If no person has agreed to pay the total costs of the funeral and burial or cremation charges, the Department shall pay the vendor the actual costs of the funeral and burial or cremation, or the minimum allowable amount for each service as established by the Department in Section 117.50, whichever is less, provided that the Department reduces its payments by the amount available from the following sources:

A)        The decedent's and available resources and the anticipated amount of any death benefits available to the decedent's estate; and

B)        Amounts paid or arranged to be paid by a decedent's legally responsible relatives. (305 ILCS 5/12-4.11)

3)         All funeral and burial expenses for which reimbursement is requested are to be included in one claim.

4)         Eligibility for payment of funeral/burial expenses is effective from the first day for which medical eligibility under a program listed in Section 117.50 (a)(1) is established and continues to the last day of the month in which cancellation is effective.

5)         Funeral/burial claims for an individual who is a patient in a Division of Behavioral Health and Recovery (DBHR) or Division of Developmentally  Disabled (DDD) facility, or is a patient temporarily discharged from a DBHR or DDD facility and in a community hospital at the time of death, or is a DBHR or DDD patient who is on a home visit for a brief period of time (less than two weeks) shall not be paid by the Department.

b)         Claims for reimbursement for individuals eligible under Section 117.50(a)(2) are as follows:

1)         The Department will not reimburse funeral or burial expenses paid by a legally responsible relative.

2)         All funeral and burial expenses for which reimbursement is requested are to be included in one claim.

(Source:  Amended at 50 Ill. Reg. 176, effective December 19, 2025)