Medicaid Checklist

Medicaid Checklist

CHECKLIST OF DOCUMENTS FOR
MEDICAID ELIGIBILITY DETERMINATION

Please provide copies of the following information as it applies to your situation. If you choose, you may provide originals and we will make the copies.

APPLICANT'S PERSONAL INFORMATION

  1. Driver's License or Identification card for applicant
  2. Social security card for applicant and spouse
  3. Birth Certificates for applicant if NOT receiving Social Security benefits
  4. Copies of health insurance card(s) (both front and back) for applicant

INCOME/ASSET INFORMATION

  1. Proof of ALL income, including, but not limited to: 2012 Social Security benefits notice, other retirement income, veterans' benefits, or wage statements as applicable.
  2. Statements for ALL bank or credit union accounts: savings, checking, money market, certificates of deposit, and retirement accounts, (including, but not limited to IRA's and 401(k)'s);
  3. Written verification (policy illustration) for all life insurance policies or annuities showing ownership, face value and current cash surrender value;
  4. Copies of all life insurance policies and annuity contracts, if applicable
  5. Copy of original Trust papers and any changes (if applicable)
  6. Copies of any/all United States Savings Bonds
  7. Copy of all vehicle titles
  8. Copy of Deeds for all real property
  9. Copy of Cemetery Lot Deed(s) or burial accounts
  10. Copy of Prepaid Funeral Arrangements
  11. Documentation of any prior gifts from applicant in the past 60 months e.g. gifts to another for educational expenses; transfer of assets to another, etc.
  12. Statement form the Nursing Home of any funds held for applicant (Security Deposit, Patient trust Fund, etc.)

LIABILITY INFORMATION

  1. Utility Bills - gas and electric - for current months
  2. Homeowner's or renter's insurance premium statements
  3. Health Insurance premiums (personal or company paid)
  4. Mortgage payments or lot rent receipts
  5. Property taxes for the past year (summer, winter, school tax bills as applicable)
  6. Guardianship or Conservator expenses (if applicable)

ElderCare Law

Medicaid Myths
ElderCare Checklist
MI Medicaid Reference
ElderCare Articles
Holistic Care Planning
ElderCare Questionnaire