Medicaid Application Checklist

Below you will find the Medicaid application checklist. This office strives to provide the best possible service in assisting you with the Medicaid application process. This process is complex and exhaustive. In order for your application to go as smoothly as possible, we request copies of the following:

1. Proof of Age for applicant and spouse (Birth certificate, Baptismal record, or US passport).
2. Proof of citizenship for applicant and spouse (Naturalization certificate, alien registration card, or

US passport).

3. Proof of legal residence (rent receipt, apartment lease, copy of deed to real estate you or your spouse

presently own or co-own.

4. Gross amount of social security benefits for applicant and spouse, if any.
5. Gross amount of pension income (pension stub showing gross amount) for applicant and spouse, if

any.

6. Gross amount of veteran’s benefits for applicant and spouse, if any.
7. Financial statements for the last 5 years on all opened or closed accounts. This includes savings

accounts, checking accounts, CD’s, money market accounts, IRA’S, stocks, bonds, trust funds, safety

deposit boxes or any other assets where your name or spouse’s name appears as sole or joint owner.

8. Deposits and/or withdrawals over $1000.00 from all of the above accounts must be explained in

writing.

9. Previous three (3) years of federal income tax returns as well as 1099’s.
10. Life insurance policies, including policy number, owner, face value, and cash surrender value for

applicant and spouse, if any.

11. Pre-paid funeral contracts and deed to burial plot (itemized breakdown).
12. Copy of Social security card for applicant and spouse, if any.
13. Copy of Medicare card of applicant and spouse, if any.
14. Other health insurance cards as well as bill & proof of payment of monthly/quarterly premium, of

applicant and spouse, if any.

15. Closing statement and/or deed for real estate which was disposed of within the last 60 months.
16. Copy of paid nursing home bills and the corresponding cancelled checks.
17. Copy of title and registration to car.
18. Proof of Marital Status- Marriage certificate, divorce decree, death certificate.
19. Verification of military services (discharge papers).
20. Copy of Power of Attorney, if any.
21. List of household expenses specifically telephone bill, utility (heat, gas & electric) bill, homeowner’s

insurance, property tax bill, rent and/or mortgage payment.

Be aware that additional information may be requested at the time of the application. Please mail all

information to the Union office. Thank you.

Benjamin D. Eckman, Esq. concentrates his practice on Elder Law & Estate Planning. Elder law is intended to broadly assist “extended living”. An elder law practitioner provides the legal information necessary for persons whose lives will extend or have already extended beyond the time when all children are usually out of the house and when regular employment ceases. After the elder law attorney and client complete their work, legal documents have been drafted, tax considerations have been analyzed, and a plan to protect the elder’s estate has been implemented.

Benjamin D. Eckman’s practice focuses on Estate Planning & Elder Law – legal issues facing senior citizens. Benjamin D. Eckman received his Bachelor’s Degree in Business/Accounting from Touro College and his law degree from Seton Hall University School of Law. He is a member of the New York State Bar Association, the New Jersey State Bar Association, the National Academy of Elder Law Attorneys, the Elder Law Section and Real Property, Probate and Trust Section of the New Jersey State Bar Association, the Union County Bar Association, Passaic County Bar Association and the Bergen County Bar Association. He can be reached at (973) 709-0909, (908) 224-4357 or (201) 263-9161.