How to Apply to Medicaid
Content
HOW TO APPLY TO MEDICAID
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Should I apply?
•! Check 1: Check Income Limits •! Check 2: Fill out an Online Government Preliminary
Survey
•! Information you will need for Survey: •! Money in cash and bank accounts •! Money from jobs and training •! Government benefits you get now or have gotten in the past (Medicaid, Social Security, Veteran's benefits) •! How much you spend on rent, house payments, and utilities •! How much you spend for adult and child care •! Your medical facts
What Do I Need to Apply?
Copies of Information Needed to Apply to Medicaid *Need Copies of Both Sides of Documents *Only Need Information Applicable to You
!! Proof of Identity
•!
!!
Current Driver's License or Department of Public Safety ID U.S. passport, Certificate of Naturalization, U.S. birth certificate, hospital record of birth, or Medicare card If born in TX: they may be able to look up birth record Resident card (I-551), Arrival/departure form (I-94), or Papers from U.S. Citizenship and Immigration Services Power of attorney paper, guardianship order, court order, or similar court documents
!! Proof of Citizenship
•!
!!
•!
!! Immigration Status
•!
!!
!! Legal Representative
•!
!! Social Security, pension, veterans benefits,
Supplemental Security Income (SSI), workers’ compensation, unemployment, or other government benefits
•! •!
!! !!
Award letter or pay stubs Divorce decree, court order, or district clerk record showing how much is paid District clerk record or letter from the parent who pays showing how much, how often, and date usually paid; letter must have name , address, phone number, and signature of the parent who pays
!! Child support paid !! Child support received
•!
Loans, repayments, and gifts (includes someone paying bills for you) •! Loan agreement or statement from the person giving you money or paying your bills. •! Must be dated and show that person's name, address, phone number, and signature Military service •! Current Military ID (Form DD-2), military orders, or separation papers (Form DD-214) Veterans benefits, workers' compensation, or unemployment Award letter or pay stubs Proof of income from your job •! Last 3 pay stubs or paychecks, a statement from your employer, or selfemployment record Bank account •! Most current statement from all account Medical costs •! Bills or statements from health care providers from the past 3 months, only if unpaid •! Dependent care expenses receipts, canceled checks, or signed statement from person you pay; signed statement must show when and how much you pay
How Do I Apply?
•! Option 1: Online •! Step 1: Make an online account: •! Step 2: Follow online tutorial.
How Do I Apply?
Option 3: Mail-in Option •! Step 1: Print out the form:
•! English: •! Spanish: •! OR: Call toll-free 2-1-1 (or 1-877-541-7905) to get a form mailed to
you.
•! Step 2: Make copies of Information Needed to Apply to
Medicaid •! Step 3: Mail to: HHSC, PO Box 14600, Midland, TX 79711-4600
How Do I Apply?
•! Option 3: In-Person •! See if there is an office near you: •! Step 1: Call toll-free 2-1-1 (or 1-877-541-7905) to schedule an appointment. •! Step 2: Bring copies of information needed to apply to Medicaid.
SCROLL DOWN TO CONTINUE
Should I apply?
•! Check 1: Check Income Limits •! Check 2: Fill out an Online Government Preliminary
Survey
•! Information you will need for Survey: •! Money in cash and bank accounts •! Money from jobs and training •! Government benefits you get now or have gotten in the past (Medicaid, Social Security, Veteran's benefits) •! How much you spend on rent, house payments, and utilities •! How much you spend for adult and child care •! Your medical facts
What Do I Need to Apply?
Copies of Information Needed to Apply to Medicaid *Need Copies of Both Sides of Documents *Only Need Information Applicable to You
!! Proof of Identity
•!
!!
Current Driver's License or Department of Public Safety ID U.S. passport, Certificate of Naturalization, U.S. birth certificate, hospital record of birth, or Medicare card If born in TX: they may be able to look up birth record Resident card (I-551), Arrival/departure form (I-94), or Papers from U.S. Citizenship and Immigration Services Power of attorney paper, guardianship order, court order, or similar court documents
!! Proof of Citizenship
•!
!!
•!
!! Immigration Status
•!
!!
!! Legal Representative
•!
!! Social Security, pension, veterans benefits,
Supplemental Security Income (SSI), workers’ compensation, unemployment, or other government benefits
•! •!
!! !!
Award letter or pay stubs Divorce decree, court order, or district clerk record showing how much is paid District clerk record or letter from the parent who pays showing how much, how often, and date usually paid; letter must have name , address, phone number, and signature of the parent who pays
!! Child support paid !! Child support received
•!
Loans, repayments, and gifts (includes someone paying bills for you) •! Loan agreement or statement from the person giving you money or paying your bills. •! Must be dated and show that person's name, address, phone number, and signature Military service •! Current Military ID (Form DD-2), military orders, or separation papers (Form DD-214) Veterans benefits, workers' compensation, or unemployment Award letter or pay stubs Proof of income from your job •! Last 3 pay stubs or paychecks, a statement from your employer, or selfemployment record Bank account •! Most current statement from all account Medical costs •! Bills or statements from health care providers from the past 3 months, only if unpaid •! Dependent care expenses receipts, canceled checks, or signed statement from person you pay; signed statement must show when and how much you pay
How Do I Apply?
•! Option 1: Online •! Step 1: Make an online account: •! Step 2: Follow online tutorial.
How Do I Apply?
Option 3: Mail-in Option •! Step 1: Print out the form:
•! English: •! Spanish: •! OR: Call toll-free 2-1-1 (or 1-877-541-7905) to get a form mailed to
you.
•! Step 2: Make copies of Information Needed to Apply to
Medicaid •! Step 3: Mail to: HHSC, PO Box 14600, Midland, TX 79711-4600
How Do I Apply?
•! Option 3: In-Person •! See if there is an office near you: •! Step 1: Call toll-free 2-1-1 (or 1-877-541-7905) to schedule an appointment. •! Step 2: Bring copies of information needed to apply to Medicaid.
