Note: This message is displayed if (1) your browser is not standards-compliant or (2) you have you disabled CSS. Read our Policies for more information.
Application and Claim for Funds to Defray Burial Costs - Medicaid Aged, Blind and Disabled Recipients 35937
Completed by funeral homes to make an application to get burial costs reimbursed by the state for individuals on Medicaid due to age, being blind or disabled. Local DFR offices process these applications and claims are paid at Central Office, Financial Management.
These forms cannot be filled in online. They may be printed out and filled in by hand or typewriter.