What to Bring to Your Enrollment Appointment for Medicaid or CHP+

What to Bring to Your Enrollment Appointment for Medicaid or CHP+
Proof of Identity / Lawful Presence
-Valid Drivers License or Identification Card
-US military Card or Military Dependents ID
-Native American Tribal Document (ID Card, Proof of Indian Blood, etc)
-Certificate of Naturalization (DHS forms N-550 or N570)
-Certificate of US Citizenship (DHS forms N-560 ro N-561)
-School University Photo ID Card (SMILES card not accepted for Medicaid)
-For Children under 18 Affidavit of ID acceptable if no other ID available
Proof of Citizenship / Lawful Presence / Residency Status
-US Passport
-US Birth Certificate
-Certification of Report of Birth issued by Dept of State (Form DS-1350)
-Consular report of birth aboard of US Citizen (Form DS-1350)
-Certification of birth abroad (FS-545)
-Final Adoption Degree
-Official Military Record of Service Showing US Place of Birth
Proof of Income for all Responsible Parties in Household
-Paystubs form previous/current month of work. Should have at least one month of consecutive pay stubs
-If no pay stubs are available, then bring a typed letter from your employer on company letter head
showing gross income for previous and current month, how long you have been employed there, actual
hours worked per week, pay per hour and pay frequency. (You may also ask for an employment letter to
provide income information).
-If you are self-employed, bring your business ledgers, mileage sheet(s) and business expenses for the
previous and current month.
-If you have unearned income, you must know the monthly amount. (To apply for Medicare Savings
Programs, you must bring your Social Security Notice of Award showing your monthly income amount).
Pregnancy Verification (ONLY IF PREGNANT)
-Pregnancy statement with due date from the doctor or clinic
Other Required Information (Certain of these items apply to only some programs)
-Documentation of the value of your assets i.e, bank statements. Motor Vehicle registration, and real estate
What to Bring to Your Enrollment Appointment for Medicaid or CHP+
-Health Insurance cards, including Medicaid, CHP+, and commercial insurance, for all family members, if
-One month of receipts for childcare, elderly care, child support, and alimony paid. These items may be
used as deductions
-Bills or receipts for health care costs incurred in the last year that have not been covered by insurance or a
health program. These may be used as deductions
-Divorce or separation decree or court-stamped request for divorce or separation
If you have any questions about applying for Medicaid or CHP+ please call 303-953-6600