The following items are necessary to apply for Medical Assistance:
_____ Copy of Social Security Card
_____ Verification of Social Security Income
_____ Copy of Medicare Card
_____ Copy of Health Insurance Card And Verification of Cost
_____ Copy of Birth, Marriage and Death Certificate of Spouse, Divorce Decree
_____ Copy of US Passport and/or Legal Status Paperwork
_____ Life Insurance Policies (confirm face, cash value, accumulated dividends, paid-up)
_____ Savings Account: owned or co-owned (with 60 months of bank statements)
_____ Checking Account: owned or co-owned (with 60 months of bank statements)
_____ Deed to Real Property owned or transferred within the last 60 months
_____ Property Tax Assessments
_____ Verification of Certificates of Deposits – 60 month history
_____ Verification of Savings Bonds – 60 month history
_____ Verification of Stock – 60 month history.
_____ Verification of IRA or Keogh Accounts – 60 month history
_____ Verification of Mutual Funds – 60 month history
_____ Verification of disposal of any resources (within 60 months) (sold, transferred or gifted)
_____ Verification of Trust funds – 60 months history and copy of trust
_____ Verification of Burial Plots – Deed
_____ Verification of Prepaid Burial Plans or Accounts including Irrevocable Contract
_____ Vehicles Title or Registration
_____ Verification of all income for both husband and wife – gross and net
_____ Power of Attorney or Guardianship Papers
_____ Community Spouse’s shelter cost
_____ Other ______________________________________________________________
_____ Other ______________________________________________________________