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Table of Contents>>Proof/Verification Tables>>

Wisconsin ForwardHealth Programs

  Proof/Verification Tables

The following tables list what you are required to provide as proof of your answers and items you can use. If you need help getting any items of proof, call your agency and ask for help.

Proof Needed and Items You Can Use BadgerCare Plus Medicaid FoodShare

U.S. Citizenship (See note)

  • U.S. passport

  • U.S. birth certificate

  • Citizenship ID card

  • Adoption papers

  • Military record

  • Hospital record of U.S. birth

  • Insurance record with U.S. birth

  • Nursing home admission papers showing U.S. birth
Yes Yes Yes

Immigration Status — Anyone who is not a U.S. citizen can use a copy of his or her:

  • Alien Registration card

  • Naturalization certificate
Yes Yes No

Identity (See note)

  • U.S. passport

  • Military dependent ID card

  • State driver license

  • Military ID or draft record

  • School picture ID

  • Native American Tribal document

  • For children under 18 applying for health care, a signed Statement of Identity form.
Yes Yes Yes
Disability — You may be asked to provide proof of disability or blindness if the state is not able to get this information. If so, you may provide an approval letter from the State Disability Determination Bureau or award letter from the Social Security Administration. No Yes
(if disabled)
Yes 
(if disabled)

Assets

  • Bank statements

  • Deeds

  • Titles

  • Contracts
  • Life insurance policies, etc.
No Yes Yes
Health Insurance — The State of Wisconsin will check for you to see if employer health insurance is available to you and/or your family members. Yes No No

Child Support Paid or Received — You can use:

  • Court order

  • Payment record from other state
Yes Yes Yes
Pregnancy — You can use a note or letter from your health care provider that confirms the pregnancy and includes the due date. Yes Yes No

Job Income and Wages — Proof of all job income and wages for all family members who have a job.

  • Check stubs (for the last 30 days)

  • An Employer Verification of Earnings (EVF-E) form

  • A letter from the employer.

If you choose a letter, it must have the same information as the EVF-E form. Note: If you want to use an EVF-E form, ask the agency to send one to you. Your employer must complete and sign this form. Return the completed form to your agency.

Yes Yes Yes

Self-Employment Income — Proof of income for all family members who are self-employed.

Yes Yes Yes

Other Income — You must provide proof of all other income for

everyone in your home. Other income may include alimony, child support, disability or sick pay, interest or dividends, Veterans Benefits, workers compensation, unemployment insurance, etc. You can use:

  • Pension statement
  • Current award letter
Yes Yes Yes

 

Proof May be Needed and Items You Can Use, if You Want to Get the Credit BadgerCare Medicaid FoodShare

Rent or House Payments — Some items you can use:

  • Lease or rental agreement or receipt/letter from landlord

  • Mortgage payment record
No Yes No

Utility Costs — Some items you can use are:

  • Utility and/or phone bill

  • Letter from utility company

  • Firewood receipt
No Yes No

Medical Costs/Expenses (some examples are doctor visits, insurance premiums, hearing aids, transportation and lodging to see a health care provider, dentures, hearing aids, prosthetics; etc.) — Items you can use:

  • Billing statement/Itemized receipts

  • Medicare card showing Part "B" coverage

  • Health insurance policy showing premium coinsurance, copay or deductible

  • Medicine or pill bottle with price on label
Yes

Yes

Yes

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Next Section — BadgerCare Plus Standard and Benchmark Plans Enrollment Information

Previous Section — Federal Poverty Level/Income Limits

Last Revised: February 06, 2013