MAP Eligibility - Documents You'll Need - Central Health

MAP Eligibility - Documents You'll Need - Central Health

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

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