The following documents are needed to complete your Medicaid application:

Click here to download our checklist

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PLEASE PROVIDE AT LEAST ONE DOCUMENT FROM EACH OF THE FOLLOWING CATEGORIES:

PROOF OF AGE
  • US Passport
  • Birth Certificate
  • Driver's License
  • Baptismal Certificate

PROOF OF CITIZENSHIP
  • US Passport
  • Birth Certificate
  • Naturalization Papers
  • Alien Registration Card
  • Final Adoption Decree
IDENTITY
  • US Passport
  • Photo License
  • School ID
  • US Military ID
  • County ID
MARITAL STATUS
  • Marriage Certificate
  • Separation Papers
  • Divorce Decree
  • Spouse's Death Certificate


PLEASE PROVIDE ALL APPLICABLE DOCUMENTS FROM THE FOLLOWING CATEGORIES:

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FINANCIAL RESOURCES

All Data Applicable to Resources owned in the last 5 years

  • Checking Account Statements
  • Savings Account Statements
  • Money Market Accounts
  • Certificates of Deposit
  • Credit Union Accounts
  • Stocks or Bonds
  • Annuities
  • IRA, 401K, 403B, Keogh Accts
  • Title to Automobile & Value
  • Deeds to Property Owned and Listing Agreement
  • Property Proceeds / HUD-1
  • Mortgages
  • Special Needs Trusts
  • Burial Plot Information
  • Prepaid Funeral Contracts
  • Life Insurance Policies with Cash Value Statement
INCOME
  • Most Recent Pay Stubs
  • Social Security Award Letter
  • Railroad Retirement Award Letter
  • Temp. Disability Check or Award Letter
  • Pension Statement
  • Unemployment Check Stub
  • VA Award Letter
  • SSI Award Letter
  • Support/Alimony Checks Or Court Order











OTHER
  • Social Security Card (front and back)
  • Medicare Card (front and back)
  • Additional Insurance Cards/RX Card
  • POA
  • Guardianship Documentation
  • Tax Returns
  • Insurance Premium Bill or Payment Coupon













SPOUSAL SCENARIOS PLEASE PROVIDE COPIES:
  • Spouse's ID & Cards
  • Electric Bills
  • Real Estate Tax Bills
  • Gas/Oil Bills
  • Mortgage Statements
  • Rent Receipts
  • Water/Sewer Bills
  • Home/Renter's Insurance
  • All Income Verifications (Social Security Award Letter, Pension Stub, Etc.)

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