Financial Eligibility: List of documents

Identification of household members (all that apply will be required):

  • The head of household and spouse (if applicable) will need to provide picture identification
  • Birth certificates for children under 18 (will accept copies from hospital, courthouse or TDHS)
  • Social Security cards for everyone in household

Residency Verification

Proof of residency may include but is not limited to:

  • Current utility bill (such as water, gas or electricity)
  • Most current property tax receipt
  • Current rent receipt or lease agreement showing applicant's address
  • Driver's license or other government issued identification

Proof of Income

Proof of income will include all of the below that apply to you and your household.

  • Current check stubs
  • If applicant does not receive check stubs from employer they will be required to have employer complete an Employment Verification Form.
  • Prior Year's Income Tax Return (**preferred, if available)
  • Unemployment Benefits
  • Social Security Benefits (from SSA Office)
  • Retirement Income
  • Workers Compensation Benefits
  • Proof of Child Support (from Attorney General's Office, a Decree, or check stubs)
  • Income Producing Property
  • Royalties
  • Alimony
  • Investment Income
  • Current bank statement(s) may be required.
  • Required documentation for applicants listing zero (0) income may include but not be limited to the following:

Reporting No/Zero Income

  • Notarized In-kind letter/letters (see approval process located in policy)
  • Proof of receiving Food Stamps/TANF
  • Proof that they have applied for SSI benefits
  • Applicants having no income who are eligible to work will be required to show proof of registration with the Texas Workforce Commission
  • Proof of eligibility screening. If patient refuses to cooperate or comply with eligibility screening, they will automatically be denied coverage.

Self-employed applicants:

Applicants who are self-employed must provide the prior year's income tax return. If this is not possible the applicant must complete the self-employment form and supply us with supporting documents such as business receipts, bank statements (both individual and business,) audited financial statements, etc.