General eligibility requirements that apply to all Apple Health programs

Chart of acceptable documents

Revised Date: 
April 18, 2017

Acceptable Forms of Verification Chart

The following table is a suggested list of reliable sources of verification for each eligibility factor. Any source, including verbal, written, and email statements, can be used as long as it meets the "Criteria for Evaluating Verification".

What to verify Acceptable verification
Child Support obligation
  • Court papers
  • Division of Child Support data
  • Statement from custodial parent
  • Receipt
Citizenship and identity See Citizenship and Identity Documents - Tier 1-4
Deductions for MAGI-based
  • IRS 1040 form showing allowed deduction
  • School verification showing allowable deduction
  • Verification showing moving costs, alimony paid, etc.
Dependent care expenses
  • Statement from the provider
  • Bills or receipts
  • SSPS data
Disability
  • Award letter from SSA
  • DDDS disability approval 
  • Collateral contact with SSA
  • Collateral contact with VA
  • Decision from disability program specialist (ABD cash)
Immigration status
  • Permanent Resident Card (Form I-551)
  • Refugee Travel Document (Form I-571)
  • Valid foreign passport with I-94 stamp of admission
  • Visa with I-94 stamp of admission

See National Immigration Law Center (NILC) for documents used to verify immigration status
Income
  • Pay stubs
  • Employer statement by telephone or in writing
  • Division of Child Support data
  • ACES Interfaces
  • Bank statement that shows direct deposits (as long as amount shown is gross and not net)
  • Collateral contact
  • SOLQ
  • TALX/The Work Number
  • IRS 1040 if it is accurate of current income
  • Profit and loss statement
Medical expenses
  • Bills/Receipts
  • Statement from the provider
Pregnancy
  • Accept individual's statement of pregnancy and EDD
Residency
  • Accept individual's declaration unless questionable
  • Collateral statement
  • Rental or lease agreement
  • Statement from landlord
  • Mortgage papers
  • Utility company records or bills
Resources
  • Bank statements
  • Insurance documents
  • Vehicle registration
  • Stock certificates
  • Courthouse records
  • Property tax statement
Shelter costs
  • Landlord statement
  • Current lease
  • Rent or mortgage receipt
  • Utility bills
  • Collateral contact
Social Security Number
  • Social Security card
  • Application for SSN
  • SSA printouts or documents
  • Birth document that states SSN was applied for
Tax filing status
  • Accept attestation unless questionable

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