Mass Health Checklist

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MassHealth Application Checklist

This checklist is intended for use by SHINE clients who are applying for MassHealth.  It includes some of the most common verifications requested of MassHealth applicants who are 65 years or older.  Keep in mind that MassHealth may request additional documentation, but providing as much of the following information as possible could decrease the amount of time it takes to receive a decision.

¨  For U.S. citizens: copy of U.S. passport, U.S. birth certificate, or Certificate of Naturalization (unless receiving Social Security benefits)

¨  For U.S. citizens: Copy of driver’s license, state identification card, or other government-issued photo identification (unless receiving Social Security benefits)

¨  For non-citizens:  Copy of legal permanent resident card, work authorization card, I-94 form, or visa (unless receiving Social Security benefits)

¨  Copy of Medicare Card

¨  Copy of any other medical insurance, dental insurance, or vision insurance cards (both sides)

¨  Proof of all GROSS income, such as 2 recent paystubs, pension stub, unemployment stub, etc. (not including Social Security benefits)

¨  If applicant/spouse own a rental property:

¨  Proof of rent amount, such as statement from tenant(s) or current lease

¨  12 months of mortgage statements

¨  12 months of property tax bills

¨  12 months of utility bills, if paid by landlord

¨  12 months of water/sewer bills, if paid by landlord

¨  Current homeowner’s insurance statement

¨  Copies of bills/invoices for any repairs and maintenance in past 12 mos.

¨  Verification of co-op or condo fee

¨  Copy of most recent account statements for all bank accounts, including certificate of deposits and burial accounts

¨  Copy of recent account statements for any other investment accounts

¨  Copy of deed and current tax bill for all real estate

¨  Copy of registration and proof of amount owed for all vehicles

¨  Verification of life insurance face value and current cash surrender value

¨  Copy of any pre-paid burial contracts with itemized list of goods and services purchased