Required Documentation for Enrollment Screening

Specific documentation is required to properly screen you and your family for health insurance programs. Without the required documents, we will not be able to complete a full screening the same day.

Proof of Identity & Lawful Presence for Connect for Health, Family Medicaid, and CHP+

U.S. Citizens are not required to provide any documentation of their identity and citizenship status, as long as this information can be verified by an electronic system. For the automated verification to occur, we need to have your full name, date of birth, and Social Security Number. Providing certain documents can be used to prove Identity or Lawful Presence and/or help us to be successful with the electronic verification. These documents include, but are not limited to, the following:

• Driver’s License or government-issued Photo ID
• US Passport
• Birth Certificate
• Certificate of Naturalization (DHS forms N-550 or N-570) 
• Certificate of US Citizenship (DHS forms N-560 or N-561)

Legal Permanent Residents must provide one of the following:

• Legal Permanent Resident Card
• Employment Authorization Car
• I-94 if a Refugee or Asylee

Proof of Income for all Responsible Parties in Household: 

Medicaid offers retroactive coverage. If you need to request retroactive coverage (up to 90 days from the date of application) you will need to provide income for those months, you are requesting retroactive coverage.

• Pay stubs from previous/current month of work. Should have at least one month of consecutive pay stubs. Talones de pago del mes de trabajo anterior/actual.
• If no pay stubs are available, then bring a typed letter from your employer on company letterhead 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. The name of the person signing the letter and the company’s phone number to verify if needed.
• If you are self-employed, bring your business ledgers, mileage sheet(s) and documentation of your business expenses for the previous month.
• If you have unearned income, you must know the monthly amount.

Other Miscellaneous Documentation if applicable:

• Commercial health insurance cards.