M E M O R A N D U M

IM-62  04/05/00  FORMS MANUAL REVISION #9


SUBJECT:
NOTICE TO REPONSIBLE INDIVIDUAL (FIM13P) AND INSTRUCTIONS
 
DISCUSSION:
Benefits paid to or on behalf of an individual become a debt due the state upon the claimant's death.  The IM-1UA and IM-2 forms notify applicants that the state may file a claim against the deceased person's estate.  The Notice to Responsible Individual provides information about the effort to recover Medicaid payments. 

This form is system generated when a match occurs between active and closed Income Maintenance cases and the monthly death records from the Department of Health.  The form goes to the deceased claimant's address that is on file in the IMU5 system.  If the deceased person is a spouse who was not the payee or a child, it goes to the payee's or caretaker parent's address.  The system will also send a copy to the county office.

If you are contacted by the person who is handling the deceased person's affairs, please be as understanding as possible in answering his or her questions.  You may have to refer the individual to the Division of Medical Services, Estate Recovery Program, if he or she needs detailed information about estate recovery.
 
NECESSARY ACTION:
  • Discuss this memorandum with appropriate staff.

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  • File the form and instructions in the Forms Manual.

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  • Make pen and ink entry in the Form Manual Index to show the addition of this new form.
    • Distribution #2
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