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
