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NOTE: CSHCS determines financial eligibility by total gross. Income verification must be provided for everyone receiving income that is part of the household (e.g. related or not related). Include copies of all documentation used to prove income. Preferred documentation is the most recent three (3) consecutive paycheck stubs for all household members. Other acceptable documentation is an employer’s letter (on company letterhead) signed and dated, showing how much you earn and how often received. If you are self-employed and have other income that is not reflected on your paycheck stubs you must provide a copy of all household members latest federal tax form 1040 or other documents that can verify income. Additional documentation may be requested.
Restrictions on Public Benefits Form
Each participant’s family must also apply for Medicaid.
Where to Apply:
Indiana Family & Social Services Administration County Office Locations:
Office Locations(for children age 0 to 3)
Contact the Intake Coordinator listed
705 Riley Hospital Dr.
Indianapolis IN 46202