Medicaid Assistance

The Cremation Society of Indiana does accept payment from The Indiana Medicaid Burial Assistance Program. A funeral home associate will check eligibility at the time of need. Using the form below, we will need to obtain the following information: Full name, Social Security number, date of birth and date of death for the person you are planning for.

To qualify for assistance to defray burial and cremation costs, the person who has died must have been covered by Medicaid in an eligible category including aged, blind or disabled.

If eligible, Medicaid will provide a funeral expense of $1,200 to the funeral home, and families can contribute an amount not to exceed an additional $1,750.

How soon do you need our services?
- Immediate Need
- Soon
- Planning Ahead
If You Are in Immediate Need

Call us at 317-783-3357.

If your loved one has just passed, we extend our deepest sympathies to you for your loss. Please call us first and notify us that a death has occurred. Completing this form does not notify us immediately. After you notify us, please proceed with your online arrangements.
Information about the person completing this form
Informant’s full name*
Prefix First Last
Informant’s address*
Street Address Address Line 2 City State ZIP Code
Informant’s phone number*
Informant’s email address*
Informant’s relationship to the decedent*
If other, please specify.*
Click here for an additional informant.
- Yes, I have an additional Informant.
Additional Informant 1
Informant’s full name*
Prefix First Last
Informant’s address*
Street Address Address Line 2 City State ZIP Code
Informant’s phone number*
Informant’s email address*
Informant’s relationship to the decedent*
If other, please specify.*
Click here for an additional informant.
- Yes, I have an additional Informant.
Additional Informant 2
Informant’s full name*
Prefix First Last
Informant’s address*
Street Address Address Line 2 City State ZIP Code
Informant’s phone number*
Informant’s email address*
Informant’s relationship to the decedent*
If other, please specify.*
Click here for an additional informant.
- Yes, I have an additional Informant.
Additional Informant 3
Informant’s full name*
Prefix First Last
Informant’s address*
Street Address Address Line 2 City State ZIP Code
Informant’s phone number*
Informant’s email address*
Informant’s relationship to the decedent*
If other, please specify.*
Information about the person you are planning for
Decedent Full Legal Name*
Prefix First Middle Last Suffix
Maiden Name*

If male, enter 'None'
Maiden name unknown
- Yes
Gender*
Age*
Please enter a number greater than or equal to 0.
Date of Birth*
Month
Day
Year
Date of Birth unknown
- Yes
Date of Death (if you are in immediate need)
Month
Day
Year
Decedent's Birthplace*
City State / Province / Region Country
Decedents birthplace unknown
- Yes
Decedent's Social Security Number*

If you are not comfortable including the social security number online, please call us (317) 783-3357 and fill in the field using 111-11-1111.
Ever Served in the US Armed Forces?*
- Yes
- No
- Unknown
Decedent Street Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Decedent County*
Decedent address unknown
- Yes
Marital Status*
Surviving spouses full name*
Prefix First Last
Maiden name of surviving spouse*

If male, enter 'None'
Surviving spouses full name unknown
- Yes
Decedent's Father*
Prefix First Last
Decedent's Father unknown
- Yes
Decedent's Mother*
Prefix First Last
Maiden Name*
Decedent's Mother unknown
- Yes
Occupation of the decedent?*
Occupation of the decedent unknown
- Yes
Type of business or industry?*
Type of business or industry unknown
- Yes
Level of education*
Decedent of Hispanic origin?*
- No, Not Hispanic
- Yes, Mexican, Mexican American, Chicano
- Yes, Puerto Rican
- Yes, Cuban
- Yes, Other Spanish
- Hispanic
- Latino
Race*
If other, please specify.*
There may be additional costs associated with the transportation of your loved one into our care. The cost, if applicable, is calculated based on the distance between the "Location of the Deceased" and our facility. If the location of the deceased lies outside of the service area, the cost will be calculated in your cart. If this is not an immediate need, please enter the location you anticipate for the transportation of your loved one. Please contact us with any additional questions.
Place of Death (name of facility or address)

The location MUST be selected from the Google Maps auto-complete to correctly calculate
County of Death
Place of Death (name of facility or address)

The location MUST be selected from the Google Maps auto-complete to correctly calculate
County of Death
Infectious Disease at time of death?
- Yes
- No
- Unknown
If yes, please specify.
Does the decedent have a pacemaker?
- Yes
- No
- Unknown
Approximate weight?
- Above 275lbs
- Below 275lbs
Contact Options
- Send information about pre-arrangement
- Contact me to set an appointment
- Please keep my information on file
Name
This field is for validation purposes and should be left unchanged.

If You Are in Immediate Need

Information about the person completing this form

Additional Informant 1

Additional Informant 2

Additional Informant 3

Information about the person you are planning for

Contact Options

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