Jay J. Sangerman, PLLC
60 East 42nd Street, Suite 2218
New York, New York 10165
Florida & New Jersey
jsangerman@sangerman.com
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© 2006
Medicaid Documentation Checklist -- Abbreviated
A More Detailed List Is Available By Clicking Here
FOR MARRIED APPLICANTS, INFORMATION NEEDS TO BE PROVIDED FOR BOTH HUSBAND AND WIFE
1. PROOF OF AGE AND CITIZENSHIP
2. VERIFICATION OF MONTHLY INCOME
3. VERIFICATION OF RENT & RELATED EXPENSES
4. HEALTH INSURANCE
5. MEDICARE
6. SOCIAL SECURITY CARD
7. PROOF OF MARITAL STATUS
8. VETERAN STATUS
9. SPOUSAL REFUSAL
FINANCIAL DOCUMENTATION AND INFORMATION
(Please note that financial documentation is needed for 36 months for a nursing home application, but only for ONE month for a homecare community application. The documentation set forth below requiring 36 months of information and transaction explanations is only for nursing home Medicaid. For married applicants, documentation must include all information, whether it pertains to the Medicaid applicant or the spouse and whether in joint name with another or sole name)
10. CHECKING, SAVINGS, CD, MONEY MARKET AND OTHER ACCOUNTS
11. STOCKS & BONDS
12. REAL PROPERTY
13. COOPERATIVE APARTMENTS
14. LIFE INSURANCE
15. IRS FEDERAL TAX FORM 1040 AND ALL RELATED SCHEDULES FOR THE PRIOR THREE YEARS (no tax returns required for homecare community application)
16. REPARATIONS
17. PROOF OF TRANSFERS OF MONEY OUT OF APPLICANT'S NAME:
(This information is not required for homecare/community applications)
JAY J. SANGERMAN, ESQ.
JAY J. SANGERMAN, PLLC
60 East 42nd Street - Suite 650
New York, New York 10165
Telephone (212) 922-0711
Facsimile (212) 922-0709
jsangerman@sangerman.com
4115 NW 60th Circle
Boca Raton, Florida 33496
561-989-9095
Jay J. Sangerman & Associates
Lanidex Executive Center
100 Misty Lane
Parsippany, New Jersey 07054
(973) 739-9055