Checklist of Items Necessary for Medicaid Application

Upload one document for each category unless otherwise noted

  • Proof of Citizenship

  • Proof of Social Security Number

  • Proof of Medicare Number

  • Proof of Marital Status

  • Proof of Income (select all that apply)

  • Supplemental Health Insurance Both are required (if applicable)

  • Bank Statements

  • Other Assests (select all that are relevant)

  • Proof of Residence

  • Housing Costs (application can be submitted without this)

  • Spousal Refusal Cases Only (needed from refusing spouse)

  • Power of Attorney Form (If applicable)

  • Signed Document Required


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