What information do I need to provide to complete an application for individual and family coverage?
In order to for us to complete an application for Medicaid, for financial help paying for a private insurance plan, or for private health coverage without financial help for you and/or your family, we will need to know the information below about you and the other members of your household.
For Everyone in the Household (even those not applying): Basic information:
Date of Birth
Address (if not homeless)
Income: (Not Applicable for those applying for private health coverage without financial help)
Types of income (for example, wages and salaries, Social Security benefits, etc.)
Amounts of income and how often the person receives it
The approximate date the person started receiving each type of income
The total amount of income your household expects to receive during the year coverage would be effective
Adjustments to Income: (Not Applicable for those applying for private health coverage without financial help)
Types of adjustments (These are the adjustments to income you can take on your taxes. For example, student loan interest paid, IRA deduction, etc.)
Amount of the adjustments taken each year
The approximate date the person started taking this adjustment
For Those Applying for Coverage: Official Information:
Social Security Number (for those who have one)
o Whether or not household members are US citizens o For those who are not US citizens and want coverage, whether or not they have an eligible immigration status. You can find a list of eligible immigration statuses on the DC Health Link website. We will also need immigration document details for anyone with an eligible immigration status. This would include naturalization numbers and date of entry to the country.