MEDICAID APPLICATION DOCUMENTS

1. DRIVERS LICENSE, PHOTO ID CARD, OR PASSPORT
2. SOCIAL SECURITY CARD FOR APPLICANT, (and spouse if living)
3. RED, WHITE AND BLUE MEDICARE CARD
4. HEALTH INSURANCE CARDS, PREMIUM AMOUNT STATEMENT
5. BIRTH CERTIFICATES FOR APPLICANT (Naturalization papers for immigrants)
6. MILITARY SERVICE RECORD.
7. PROOF OF MONEY FROM OTHER SOURCES (LOANS, GIFTS, RENTAL INCOME)
8. PROPERTY: COPY OF DEED. IF PROPERTY SOLD IN LAST FIVE YEARS THEN COPY OF CLOSING PAPERS
9. TITLE AND REGISTRATION FOR ALL VEHICLES
10. ALL INDIVIDUAL AND GROUP LIFE INSURANCE POLICIES THAT HAVE CASH VALUE, AMOUNT OF CASH VALUE AND FACE VALUE
11. PROOF OF OWNERSHIP AND VALUE OF BURIAL LOTS AND PREPAID BURIAL PLANS
12. STATEMENT OF GROSS AMOUNT OF PENSIONS
13. SOCIAL SECURITY AWARD LETTER showing amount of social security for the current year
14. LAST FIVE YEARS OF INCOME TAX RETURN

Financial information needed:

1. PROVIDE ALL INVESTMENT and BANK STATEMENTS and COPIES OF CANCELED CHECKS OVER $500 FOR LAST FIVE YEARS (including accounts that were closed).
2. IF ACCOUNTS CLOSED IN FIVE YEARS, THEN PROVIDE STATEMENTS THROUGH CLOSING, PROOF OF CLOSING OF ACCOUNT, AND PROOF OF DEPOSIT INTO NEW ACCOUNT (if amounts do not match then provide explanation).
3. WRITTEN EXPLANATION FOR ANY CHECKS OR WITHDRAWALS OVER $500 DURING LAST FIVE YEARS (such as checks for cash or checks to family members).
4. ON THE FINANCIAL STATEMENTS PLEASE NOTE SOURCE OF DEPOSITS AND TRANSFERS.