KENTUCKY CHILDRENS HEALTH INSURANCE PROGRAM AND KENTUCKY MEDICAID

• Social Security cards
  
• Verify date of birth, Hospital Record or Birth Certificate
  
• Income:
  • Verify wages prior two months from date of application. Check stubs for each pay period during the two months or employer verification of pay from those pay periods.
• Self employment, such as farm income, construction, etc. (any income where no taxes are withheld.) Verification by federal tax returns (schedule C), or if taxes are not filed, self employment records of income and expenses for the previous year.
  
• Social Security benefits, by printout or award letter. Any income must be verified either by award letters, court orders, or receipts for child support.
  
• A written statement listing all household members by name, and the address where they reside, completed by someone outside the home.
  
• Lack of income for adults, age 18 and over, must be verified by a written statement, stating this person has no income. A non-relative must write the statement of no income.
  
• A statement must provide verification of pregnancy from a doctor or health department showing the due date.
  
• Health insurance card.
  
• Life insurance policies.
  
• Verification of any type of resources, such as savings, checking, etc. This must be a current statement with the balance.
  
• You must come into our office to complete the interview and sign the application. At this time other verification may be required.

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