Page 9 - Medicaid New Client Welcome Guide
P. 9
MEDICAID
Checklist
Durable Power of Attorney
Last Will and Testament or Revocable Living Trust
Prenuptial or Postnuptial Agreement
Driver License or Government Issued Identification or Passport
Social Security Card
Medicare/Health Insurance Card(s)
Proof of medical insurance premium
Proof of current gross income directly from income sources (Social Security Annual Award
Letter can be obtained online at www.ssa.gov. For VA pension please contact VA Pension
Management Center at 1-877-294-6380 for an itemized breakdown of benefits.)
Current proof of life insurance cash and face value
Proof of irrevocable burial/funeral contract
Statements for all financial accounts for the last 3 months including but not limited to checking,
savings, money market, CD's, IRA's, annuities, stocks, bonds, investments, etc. (include all pages
- even if the page is blank)
Married applicants with a spouse remaining at home may submit proof of their mortgage, rent,
homeowner’s insurance, maintenance fees, property taxes, and most recent utility bill
DD214 for Medicaid applicants receiving VA benefits
(If a DD214 is unavailable please provide the information below for the Veteran)
Name
Date of Birth
Social Security Number
Branch of Service
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