Documentation Required to Accompany MaineCare Applications

List of Asset and Income Documentation Required to Accompany MaineCare Applications

As a condition of eligibility for nursing home (long term care) or assisted living (residential care) MaineCare benefits, all assets and income of the applicant and spouse must be verified at the time of application.  The following is a list of the most common items that need verification or documentation.  Since there are several programs available, some of the items may not apply to your situation or additional information may be requested.

The "lookback period" (the financial reporting period) is 60 months (five years).

General Information:

• Social Security Card (or other proof of Social Security Number if card is lost)
• Birth Certificate
• Medicare Card
• Naturalization Certificate or Green Card, if not a citizen

Assets (going back 60 months):

• Savings account statements or copies of passbook pages
• Checking account statements, including copies of checks
• Bonds (U.S. Savings Bonds, Treasury Bonds, etc.)
• Stocks, i.e. statements
• Certificates of Deposits going
• IRA’s, 401K, Keoghs, pensions, etc.
• Annuities
• Life insurance policies and current cash surrender values of all policies
• Prepaid Burial Contracts or Mortuary Trusts
• Health insurance card(s) and latest premium statement(s)
• Guardian/Conservator documents or Durable Power of Attorney
• Deeds of ownership of any interests in land and buildings, and most recent municipal property tax bills
• Documentation of any assets transferred to others
• Form 1040 income tax returns for the past 5 years

Income - Records of Current Income From:

Veterans Benefits        Civil Service                        Workers Compensation           Rental Income

Social Security             Employee Pensions          Railroad Retirement                  Wages

Alimony                         Annuity Income                  Unemployment                         Any Other Income