Documents

APPLICANT RESPONSIBILITIES

• Applicant Responsibilities

PROOF THAT YOU LIVE IN TRAVIS COUNTY.

Examples include:

• Current Texas driver’s license
• Utility, Cable, Medical bill printed in the last 30 days.
• Mail postmarked in the last 30 days

PROOF OF YOUR HOUSEHOLD’S INCOME RECEIVED IN THE LAST 30 DAYS.

Examples include:

• Check stubs
• Retirement or Social Security benefits letter
• Unemployment benefits letter
• Self-Employment Statement
• MAP’s Residence and/or Financial Support Statement
• Zero Income Statement
• Income with no taxes deducted

ANY PROOF OF U.S. CITIZENSHIP OR RESIDENCY FOR YOUR HOUSEHOLD MEMBERS (INDIVIDUALS WITHOUT LEGAL RESIDENCY STATUS CAN SELF-DECLARE THEIR STATUS).

Examples include:

• Birth certificate
• Legal Permanent Resident Card
• Passport
• Other USCIS documents

PICTURE ID FOR ALL ADULTS IN YOUR HOUSEHOLD.

Examples include:

• State-issued driver’s license
• Foreign ID
• USCIS document
• Passport

PROOF YOU ARE THE PARENT OR LEGAL GUARDIAN OF ALL CHILDREN IN YOUR HOUSEHOLD.

Examples include:

• Birth certificate
• Adoption papers
• Legal guardianship papers
• Court documents

PROOF OF ANY OTHER HEALTH CARE BENEFITS FOR WHICH YOU HAVE BEEN APPROVED, BEEN DENIED, OR HAVE A PENDING APPLICATION.

Examples include:

• Medicaid enrollment verification letter
• Medicare card
• Private insurance card
• Denial letter for Medicaid or CHIP
• Letter from Social Security Administration indicating pending application
• Letter indicating pending application for TANF / Medicaid

OTHER FORMS AND INFORMATION

• Central Health Authorization Form

Submit additional proof documents online