What You Need to Know About Applying for
Medical Assistance for the Aged, Blind and Disabled
When you apply for medical assistance you will be asked to provide documents containing information that can verify both your personal and your financial information. The more documentation you are able to provide the easier it will be to process your application. If some documents are not available, we may be able to verify information through outside sources. However, using outside sources may cause delays in processing your application. The following information explains what documents you will need to apply:
Basic Information:
In order to qualify for Medicaid you must be 65 years old or blind or disabled and either a U.S. Citizen or lawfully admitted for permanent residence (or certain eligible aliens) and a resident of New Jersey. Proof of your marital status is needed along with your spouse’s social security number and date of birth because the resources of your spouse will also be used in determining your financial eligibility. Listed in the columns below are examples of documentation that can assist in the processing of your application. Only one document from each column is needed. Be aware that some documents provide proof for more than one category. For example, a U.S. Passport will prove your age and citizenship and identity. Documents which should be included with your application include but are not limited to:
When you apply for medical assistance you will be asked to provide documents containing information that can verify both your personal and your financial information. The more documentation you are able to provide the easier it will be to process your application. If some documents are not available, we may be able to verify information through outside sources. However, using outside sources may cause delays in processing your application. The following information explains what documents you will need to apply:
Basic Information:
In order to qualify for Medicaid you must be 65 years old or blind or disabled and either a U.S. Citizen or lawfully admitted for permanent residence (or certain eligible aliens) and a resident of New Jersey. Proof of your marital status is needed along with your spouse’s social security number and date of birth because the resources of your spouse will also be used in determining your financial eligibility. Listed in the columns below are examples of documentation that can assist in the processing of your application. Only one document from each column is needed. Be aware that some documents provide proof for more than one category. For example, a U.S. Passport will prove your age and citizenship and identity. Documents which should be included with your application include but are not limited to:
Age
US Passport Birth Certificate Driver’s License Baptismal Cert. State issued I.D.
US Passport Birth Certificate Driver’s License Baptismal Cert. State issued I.D.
Citizenship*
US Passport
Birth Certificate Naturalization Papers Alien Registration Card Final Adoption Decree
US Passport
Birth Certificate Naturalization Papers Alien Registration Card Final Adoption Decree
Identity*
US Passport Photo License School I.D.
US Military I.D.
US Passport Photo License School I.D.
US Military I.D.
Marital Status
Marriage Certificate Divorce Decree Death Certificate Separation Papers
Marriage Certificate Divorce Decree Death Certificate Separation Papers
*Consult with your County Welfare Agency to obtain a more detailed list of tiered verifications
that can be accepted.
Financial Information:
You must meet certain income criteria and be resource eligible. The income can be earned, (receiving a pay check), or unearned (receiving interest from an investment account). Listed below are examples of documents that can prove how much money you receive each month. Documents showing income include but are not limited to:
Financial Information:
You must meet certain income criteria and be resource eligible. The income can be earned, (receiving a pay check), or unearned (receiving interest from an investment account). Listed below are examples of documents that can prove how much money you receive each month. Documents showing income include but are not limited to:
Copies of Recent Pay Stubs
Copy of Temporary Disability Check Copy of SSI Check or Award Letter Copy of Unemployment Check or Stub Copies of Dividend Checks
Copy of Temporary Disability Check Copy of SSI Check or Award Letter Copy of Unemployment Check or Stub Copies of Dividend Checks
Copy of Social Security Check or Award Letter
Copy of VA Benefits Check or Award Letter
Copy of Worker’s Compensation Check or Letter Copy of Support/Alimony Checks or Award Decree Income Statement from Employer.
Copy of Worker’s Compensation Check or Letter Copy of Support/Alimony Checks or Award Decree Income Statement from Employer.
Verification 11/06 ver8C – DRA Mod.
Available Resources:
You are allowed $2,000/$4,000 in resources, (more if the applicant is married). In order to present the clearest picture of your financial situation, please bring copies of any of the following items:
You are allowed $2,000/$4,000 in resources, (more if the applicant is married). In order to present the clearest picture of your financial situation, please bring copies of any of the following items:
*Checking Accounts
*Money Market Accounts
Certificates of Deposit Retirement Accounts
Life Insurance Trust Shares
Certificates of Deposit Retirement Accounts
Life Insurance Trust Shares
*Savings Accounts
*Christmas Club Accounts
Annuities
Special Needs Trusts
Annuities
Special Needs Trusts
*Credit Union Shares/Accounts
*Vacation Club Accounts
Stocks or Bonds
Copies of Life Insurance Policies with cash value
Stocks or Bonds
Copies of Life Insurance Policies with cash value
*The last 3 months of statements or passbook entries for every financial account prior to
applying for Medicaid must be provided. In addition, a sampling of 3 months worth of
statements or passbook entries for those same accounts - or any closed accounts - for the
past 4** or more years should be provided. You may be asked to provide additional
statements if there has been a large amount of money removed or transferred from your
accounts for any reason.
**The look back period has been increasing monthly from 3 to 5 years beginning March 2009 through February 2011.
Living Expenses:
If you are currently living with your spouse and one of you is applying for nursing home placement through the Medicaid Program, you will need to document your monthly living expenses. Some of the documents that you can provide to show your living expenses include, but are not limited to:
**The look back period has been increasing monthly from 3 to 5 years beginning March 2009 through February 2011.
Living Expenses:
If you are currently living with your spouse and one of you is applying for nursing home placement through the Medicaid Program, you will need to document your monthly living expenses. Some of the documents that you can provide to show your living expenses include, but are not limited to:
Copies of Rent Receipts
Copies of Telephone Bills
Copies of Water/Sewer Bills
Health Insurance Bills
Copies of Mortgage Statements Copies of Real Estate Tax Bills
Copies of Gas/Oil Bills Copies of Electric Bills
Renter Insurance Home Owner Insurance Unpaid Medical Bills Outstanding Loans
Renter Insurance Home Owner Insurance Unpaid Medical Bills Outstanding Loans
In addition to the documentation listed in the categories above please bring any documents that
show you have designated a Power of Attorney or a Third Party Signator to help you with your
finances. If you are a third party applying for an incapacitated individual, please include any
Guardianship documentation.
You may be asked to provide information in addition to that which is listed in this document. The reason additional information may be requested is to insure that the County Welfare Agency has the most complete understanding of your situation as is possible. You will be helping them to provide you with the most suitable care for your circumstances.
You may be asked to provide information in addition to that which is listed in this document. The reason additional information may be requested is to insure that the County Welfare Agency has the most complete understanding of your situation as is possible. You will be helping them to provide you with the most suitable care for your circumstances.
Verification 11/06 ver8C – DRA Mod.
Nursing Home and Community Based Waiver Programs
Check List
This is the type of information that you will need to bring with you when applying for Medicaid. The more information you are able to provide the faster your Medicaid application can be processed.
This is the type of information that you will need to bring with you when applying for Medicaid. The more information you are able to provide the faster your Medicaid application can be processed.
1. Proof of Age:
One of the following documents should be provided to verify your age:
US Passport
Birth Certificate Driver’s License Baptismal Certificate Other_____________
One of the following documents should be provided to verify your age:
US Passport
Birth Certificate Driver’s License Baptismal Certificate Other_____________
2. Proof of Citizenship:
One of the following documents should be provided to verify your citizenship:
US Passport
Birth Certificate Naturalization Papers Alien Registration Card Final Adoption Decree Other________________
One of the following documents should be provided to verify your citizenship:
US Passport
Birth Certificate Naturalization Papers Alien Registration Card Final Adoption Decree Other________________
3. Identity:
One of the following documents should be provided to verify your identity:
US Passport Photo License School I.D. US Military I.D.
One of the following documents should be provided to verify your identity:
US Passport Photo License School I.D. US Military I.D.
4. Marital Status:
One of the following documents should be provided to verify your marital status: Marriage Certificate Separation Papers Divorce Decree Spouse’s Death
Certificate Other__________
One of the following documents should be provided to verify your marital status: Marriage Certificate Separation Papers Divorce Decree Spouse’s Death
Certificate Other__________
5. Income
In order to verify your Income, please provide copies of all that are applicable:
applicable:
Most recent pay stubs
Social Security Check or Award Letter*
Railroad Retirement Check or Award Letter* Temp. Disability Check or Award Letter*
Pension Checks
Unemployment check stubs
Workers Comp.check stubs
Support/Alimony Checks or Court Order VA check or Award Letter*
Reparation Payments
Payments from Boarders
SSI Award Letter
Dividend Checks
Federal Income Tax Returns
including schedules:
Schedule C – Net Profit from Business Schedule D – Capital Gains
Schedule E – Rental Real Estate
Schedule K-1- Partner’s Share of Income
Other___________________________________ *Award Letter Preferred
In order to verify your Income, please provide copies of all that are applicable:
applicable:
Most recent pay stubs
Social Security Check or Award Letter*
Railroad Retirement Check or Award Letter* Temp. Disability Check or Award Letter*
Pension Checks
Unemployment check stubs
Workers Comp.check stubs
Support/Alimony Checks or Court Order VA check or Award Letter*
Reparation Payments
Payments from Boarders
SSI Award Letter
Dividend Checks
Federal Income Tax Returns
including schedules:
Schedule C – Net Profit from Business Schedule D – Capital Gains
Schedule E – Rental Real Estate
Schedule K-1- Partner’s Share of Income
Other___________________________________ *Award Letter Preferred
6. Financial Resources
To provide the most accurate picture of your Financial Resources, you must provide copies of all that is
To provide the most accurate picture of your Financial Resources, you must provide copies of all that is
Checking Acct. Statements
Stocks or Bonds
Amount of Cash on Hand IRA, 401K, 403B, Keogh
Accounts
Money Market Accounts
Deeds to Property Owned Mortgages
Christmas/Vacation Clubs Burial Plot Information
Amount of Cash on Hand IRA, 401K, 403B, Keogh
Accounts
Money Market Accounts
Deeds to Property Owned Mortgages
Christmas/Vacation Clubs Burial Plot Information
Savings Acct. Statements
Certificates of Deposit
List of Valuables (jewelry, Trusts or other Financial
Instruments Annuities
Property Proceeds
Prepaid Funeral Contracts Credit Union Shares
Funds set aside for Burial
List of Valuables (jewelry, Trusts or other Financial
Instruments Annuities
Property Proceeds
Prepaid Funeral Contracts Credit Union Shares
Funds set aside for Burial
Special Needs Trusts
Life Insurance Policies with Cash Value Statement Life Insurance Trust Shares
Other________________________________________
Life Insurance Policies with Cash Value Statement Life Insurance Trust Shares
Other________________________________________
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:
Mortgage Statements
Electric Bills
Telephone Bills
Outstanding Loans
Other_________________ Verification 11/06 ver8C – DRA Mod.
Electric Bills
Telephone Bills
Outstanding Loans
Other_________________ Verification 11/06 ver8C – DRA Mod.
Real Estate Tax Bills
Gas / Oil Bills
Connection Charges
Health Insurance Bills
Other_________________
Gas / Oil Bills
Connection Charges
Health Insurance Bills
Other_________________
Rent Receipts
Water / Sewer Bills
Home / Renter’s Insurance
Unpaid Medical Bills (past 3 months)
source http://www.state.nj.us/humanservices/dmahs/clients/medicaid/abd/abd_what_you_need_to_know.pdf
Water / Sewer Bills
Home / Renter’s Insurance
Unpaid Medical Bills (past 3 months)
source http://www.state.nj.us/humanservices/dmahs/clients/medicaid/abd/abd_what_you_need_to_know.pdf
