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Assets    Documents    Who is Eligible    Denied Eligibility    Penalty Period


    Form List of Documents Required for Medicaid Application

DOCUMENTS REQUIRED FOR DETERMINATION OF ELIGIBILITY FOR MEDICAL ASSISTANCE

The following documents are required for the applicant and spouse and any minor children under the age of 21.

A.        Proof of identity and family relationships
  •     Social Security Card
  •     Birth or Baptismal Certificates
  •     Military Discharge Papers
  •     Marriage Certificate
  •     Death Certificate of Spouse

           
        For those family members not born in the U.S.A.

  •     Certificate of Naturalization

  •     Passport and/or Visa

  •     Alien registration cared

 B.        Residency and Living arrangement

  •     Rent receipt and/or lease

  •     Utility bills (most current)

  •     Mortgage statement, property and school tax bills (most current)

  •     Two letters of residence, from other than relative, stating length of time at given address

  •     Letter from person you live with verifying that they supply room and board

  •    
             

C.        Income

  •     Pay stubs for previous eight weeks

  •     Unemployment insurance book

  •     Statement of rental and/or room and board  income           

  •     Support payments divorce or separation papers

  •     Award letter and/or photocopy of check for the following benefits:

        a.     Social Security
        b.     Veterans
        c.     Union pension
        d.     Railroad retirement
        e.     Insurance endowments
        f.      N.Y.S. disability
        g.     Workers Compensation

  •      If self-employed; business book and records

  •      Tax returns for the past two years

D.         Resources

  •     Bank books (including IRA, CD and money market accounts) for past 36 months including closed accounts with copy of title page (from      through     )

  •     Checking account each statement for the past 36 months (with copies of checks over $500 for NYC and over $1000 for Nassau or Suffolk ) statements (from      through     )

  •     Title page of Life insurance policies and a letter from carrier stating the current cash value

  •     Stocks and Bonds Certificates.  If in a brokerage account, each statement for the past 36 months (from      through     )

  •     Real Estate Deeds

  •     Health and Accident insurance policies and latest premiums

  •     Medicare card

  •     Closing papers on property sale

  •     Deed to Burial Plot

E.    Medical Forms

  •     DSS 486 'Physician's Statement for Determination of Disability' (if under 65 in Nassau County )

  •     DMSB1 Long Placement Form (for Home Care in Nassau County )

  •     517 Physician's Request for Home Health Aide (for Home Care in Nassau County )

  •     M11Q Request for Home Care (Home Care for New York City )

F.    Other

  •     Spousal Refusal
             

 

 

 

Send mail to maberasturi@yahoo.com with questions or comments about this web site.
Last modified: 12/21/06
Mark G. Aberasturi, a New York elder law lawyer and estate planning attorney, focuses his law practice on Elder Law and Probate, Estates, Wills and Medicaid Trusts, Living Trusts, Supplemental Needs Trusts, Living Wills and Estate Tax.  Mr. Aberasturi provides legal advice on matters involving Medicaid, Medicare and nursing homes.  Mr. Aberasturi is a member of the National Academy of Elder Law Attorneys, The New York State Bar Association Elder Law Section, and is former chairman of the Orange County, New York Bar Association Elder Law Committee.  His practice is located in Goshen, Orange County New York.
 
Servicing the Hudson Valley area, including Monroe New York 10950, Montgomery New York 12549, Middletown New York 10940 and 10941, Newburgh New York 12550, Wallkill New York 12589, Washingtonville New York 10992, Chester New York 10916, Port Jervis New York 12771, New Windsor New York 12553, Cornwall New York 12518, Central Valley New York 10917, Highland Mills New York 10930, Florida New York 10921, Walden New York 12586, Warwick New York 10990, and Maybrook New York 12583, Tuxedo Park 10987, Blooming Grove 10914, Circleville 10919, Fort Montgomery 10922, Harriman 10926, Pine Bush 12566, New  Hampton 10958, Slate Hill 10973, as well as Ulster County, Sullivan County and Rockland County.
This web site is designed for general information only. The information presented on this site should not be construed to be formal legal advice or the formation of a lawyer/client relationship.

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