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
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
- 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.
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.