Page 13 - Digital Medicaid Workbook

MEDICAID

CHECKLIST

READY TO SUBMIT DOCUMENTS?
FAX: 407-476-1101 OR E-MAIL THEM TO
YOUR MEDICAID SPECIALIST DIRECTLY
(EMAIL DIRECTORY LISTED ON PAGE 8)

1. Durable Power of Attorney or Guardianship
2. Last Will & Testament or Revocable Living Trust

3. Drivers License or Photo Identification
4. Social Security Card

5. Health Insurance Card(s)
6. Proof of Medical Insurance Premium
Proof of Current GROSS Monthly Income (directly from income source)
7.
-Social Security Award Letter may be obtained online at: www.ssa.gov

-VA Pension Management Center may be reached at: (877) 294-6380
If receiving VA income, a "breakdown" letter specifying if the income

is pension, aid & attendance, or other form of compensation is
required.

8. Proof of life insurance with current cash and face value
This must be a current letter on insurance company letterhead.

9. Proof of pre-paid funeral/burial contract
Must be "irrevocable" but we can walk you through changing this.

10. Statements for all financial accounts for the most recent 3 months
DCF requires all pages, even if the page is blank.

11. Household expenses (Mortgage/Rent, HOA, insurance, taxes & utilities)
This only applies for a dependent spouse or dependent disabled child

Veterans & Surviving Spouses
DD 214 (Military discharge record)
1.

2. Marriage License
Death Certificate (must include the cause of death)
3.
Other:________________________________________________________________

***PLEASE NOTE: Our dedicated team will assist with gathering information. However, there's no guarantee we
will be successful in obtaining necessary documents as each institution adheres to their individual policies.
Therefore, your assistance in the document collection process may be requested.***

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