Medicaid Document Checklist

What do I need to apply for Medicaid?
The following information is necessary in completing the Medicaid application.
The more documentation provided, the quicker the processing time.
print checklist

Please provide at least ONE document from each of the following categories:

  • 1. Proof of Age
  • US Passport
  • Birth Certificate
  • Driver’s License
  • Baptismal Certificate
  • 2. Proof of Citizenship
  • US Passport
  • Birth Certificate
  • Naturalization Papers
  • Alien Registration Card
  • Final Adoption Decree
  • 3. Identity
  • US Passport
  • Photo License
  • School ID
  • US Military ID
  • County ID
  • 4. Marital Status
  • Marriage Certificate
  • Separation Papers
  • Divorce Decree
  • Spouse’s Death Certificate

Please provide ALL applicable documents from the following categories:

  • 5. 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
  • Life Insurance Policies with Cash Value Statement
  • Burial Plot Information
  • Prepaid Funeral Contracts
  • 6. Income
  • Most Recent Pay Stubs
  • Social Security Award Letter
  • Railroad Retirement Award Letter
  • Temp. Disability Check Or Award Letter
  • Pension Statement
  • Unemployment Check Stubs
  • Support/Alimony Checks Or Court Order
  • VA Award Letter
  • SSI Award Letter
  • 7. Other
  • Social Security Card (front and back)
  • Medicare Card (front and back)
  • Additional Insurance Cards/RX Card
  • Insurance Premium Bill or Payment Coupon
  • POA
  • Guardianship Documentation

The following living expenses will be taken into account if the Medicaid recipient is placed in a nursing facility, but the spouse remains living in the community.

Please provide copies
  • All Income Verifications
      (Social Security Award Letter,
      Pension Stub, Etc.)
  • Spouse’s ID & Cards
  • Spouse’s ID & Cards
  • Electric Bills
  • Real Estate Tax Bills
  • Gas/Oil Bills
  • Mortgage Statements
  • Rent Receipts
  • Water/Sewer bills
  • Home/Renter’s Insurance