Page 7 - Family First Firm - Medicaid Welcome Kit

MEDICAID

CHECKLIST

So what exactly will you need to provide to have an application filed for Medicaid
benefits? Well, here's a preliminary list of some of the basic documents you should collect.
At times, DCF may request additional information if they find it to be necessary to
determine eligibility.
READY TO SUBMIT DOCUMENTS?
_ 1. Durable Power of Attorney EMAIL: medicaid@fff.law
_ 2. Last Will & Testament or Revocable Living Trust FAX: 407-476-1101
_ 3. Prenuptial or Postnuptial Agreement
_ 4. Drivers License or Government Issued Identification or Passport
_ 5. Social Security Card
_ 6. Medicare/Health Insurance Card(s)
_ 7. Proof of Medical Insurance Premium
_ 8. Proof of Current GROSS Monthly Income directly from income sources.

-Social Security 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 a breakdown of benefits
_ 1. Current proof of life insurance with current cash and face value

This must be on the insurance company letterhead.
_ 2. Proof of irrevocable funeral/burial contract.
_ 3. 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.

DCF requires all pages, even if the page is blank.
_ 4. Married applicants residing in the community may submit proof of their mortgage, rent,

HOA, maintenance fees, property taxes, and most recent utility bill.
_ 5. 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

Other:_______________________________________________________

***PLEASE NOTE: All requested documents are required for the applicant and the applicants spouse. Please forward these documents to
our office at your earlist convenience so we can proceed with processing the Medicaid application. If you happen to have any difficulty or
need assistance in obtaining these documents, please let us know. We are happy to assist.***