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FREDERICK COUNTY DEPARTMENT OF SOCIAL SERVICES Long Term Care Checklist: The following items are necessary to determine your eligibility for Nursing Home Medical Assistance. This information is necessary for both husband and wife, if applicable. Items needed: Social Security card(s)Medicare card(s) Health Insurance card(s) Health Insurance Premium payment Verification of Birth, Marriage, Death Certificate of Spouse, Divorce Decree Life Insurance policies (confirm Face Value, Cash Value, Accumulated Dividends, Paid-up Additions) Savings Account Passbook (asset verification from January 2006 to current month) Checking Account; owned or co-owned (asset verification from January 2006 to current month) Deed to Real Property owned or transferred from January 2006 to current month Deed to Property in which Life Estate is held or has been transferred from January 2006 to current month Property Tax Assessments Verification of Certificates of Deposit (January 2006 to current month) Verification of Savings Bonds (January 2006 to current month) Verification of Stock (January 2006 to current month) Verification of IRA or Keogh Accounts (January 2006 to current month Verification of Mutual Funds (January 2006 to current month) Verification of disposal of any resource from January 2006 to current month (sold, transferred or given away) Verification of Trust Funds (60 month history and copy of Trust) Verification of Burial Plots Verification of Prepaid Burial Plans or Accounts including Irrevocable Contract Vehicles (Title or Registration) Verification of ALL income for both Husband and Wife (gross and net income) Power of Attorney or Guardianship papers Verification of Annuities Income Tax Returns for prior three years Community Spouse's Shelter Costs If you have any questions please contact our Agency |