Medicaid Document Checklist
Submit applicable documents in person, via email (info@mazloumi.com), or fax (516-283-0250). Questions? Call 516-466-PLAN.
Proof of Age
- US Passport
- Birth Certificate
- Driver's License
- Baptismal Certificate
Proof of Citizenship
- US Passport
- Birth Certificate
- Naturalization Papers
- Alien Registration Card
- Final Adoption Decree
Identity
- US Passport
- Photo License
- School ID
- US Military ID
- County ID
Marital Status
- Marriage Certificate
- Separation Papers
- Divorce Papers
- Spouse's Death Certificate
Financial Resources
- Checking Account Statements
- Money Market Accounts
- Savings Account Statements
- Certificates of Deposit (CDs) Statement
- Brokerage Account Statement
- Stocks or Bonds
- Annuities
- IRA Statement
- 401K and 403B Statement
- Share Certificate (for Co-Ops)
- Mortgages
- Automobile: Make/Model and Value
- Deed (for personal residence, investment real estate, land, etc.)
- Life Insurance Policy (+ Cash Value)
- Burial Plot Information
- Prepaid Funeral Contracts
- Other Investments (such as LLCs, Partnerships, Corporations, etc.)
Income
- Most Recent Pay Stubs
- Social Security Award Letter
- Railroad Retirement Award Letter
- Dividend and Interest Income
- Pension Statement (incl. Foreign Pensions)
- Unemployment Check Stubs
- Support / Alimony Checks or Court Order
- RMD Statement (for IRAs)
- Unemployment Check Stubs
- Rental Income
- VA award Letter
- SSI Award Letter
- Annuity Income
- “Other” Investment Income
- Tax Return (Incl. Business Tax Return)
- W-2, K1S, 1099
Other
- Social Security Card (Front & Back)
- Medicare Card (Front & Back)
- Water Bill
- Property Tax Bill
- Supplemental Health Insurance Card (+ Premium Statement)
- Prescription Drugs Card (+ Premium Statement)
- Power of Attorney and Health Care Proxy
- Mortgage Statement
- Lease or Rent Receipt (if renting)
- Name and Contact Information of Treating Physician(s)
- Medical Records
The following living expenses will be taken into account if the medicaid recipient is placed in a nursing facility but the spouse remains living in the community. please provide copies of the following:
- All Income Verification (Social Security Award Letter, Pension Stub, Etc.)
- Spouse's ID & Cards
- Electric Bills
- Real Estate Tax Bills
- Mortgage Statement
- Rent Receipts
- Water / Sewer Bill
- Home / Renter's Insurance
MEDICAID FOR NEW YORKERS