Medicaid Checklist

Take a look at your checklist below or click here to download a PDF version: Download PDF of Medicaid Checklist

Please note: Married individuals must provide proof for both husband and wife

  1. Birth certificate or passport
  2. Marriage certificate or Death certificate of spouse, if applicable
  3. Divorce papers, if applicable
  4. Military Discharge papers, if applicable
  5. Proof of Social Security number and income benefit. Call Social Security at (800)772-1213 to request verification of SS number and Proof of Income letter.
  6. Copy of the Medicare card and copy of the front and back of Supplemental Health Insurance cards, including prescription card. We also need the current premium statement and proof of payment.
  7. Copy of life insurance policies with a letter from the insurance company stating the face value and current cash value of policy. Also, letter from the insurance company or transfer agent stating whether or not stock is owned in the L.I. company. If so, proof of number of shares owned and current value. If this is a nursing home case, you will need a 5-year history of the stock.
  8. Copy of deeds to all property owned or shares of a co-op. Proof of residency.
  9. Copy of Power-of-Attorney and/or all Trusts.
  10. Proof of any rental income from any real estate being rented.
  11. Prepaid Irrevocable Funeral Agreement (all pages) with itemization as well as a copy of canceled check use to pay for the Agreement.
  12. Deed to Cemetery plot.
  13. If applying for Home Care/Community Medicaid or the Lombardi program, we need the current 3 months of statements for all financial accounts. Client’s assets need to be at or below the monetary limit for that year.
  14. If applying for nursing home care, we need statements for the past 5 years on all open or closed financial accounts, including Trusts, IRAs and Annuities. We will also need a copy of all annuity contracts.
  15. All deposits, other than income, must be documented (copies of deposit slips and checks deposited). All withdrawals of $2,000.00 or more must also be documented.
  16. If any money was transferred or gifted within the 5 year look-back period, we must document where that money was deposited.
  17. Income Tax Returns, including all 1099s-last 5 years for a nursing home case. Past year for Home Care. If no Return was filed, we will complete the IRS form 4506T to request Verification of Non-filing letter.
  18. Verification of all monthly income, including the Social Security Award letter and letters from Pension companies stating the gross and net benefit of the client or spouse.