Program Approval Letter, Benefit Statement, or Verification of Coverage Letter, should contain the following basic information:

Eligibility Screenshot or printout from an online portal or website tool, should contain the following basic information:

• Name of the program or state equivalent,
• Name of the beneficiary,
• Address of the beneficiary, and
• Date of the award

• Name of the program or state equivalent,
• Name of the beneficiary
• Case number,
• Eligibility dates, OR
• Current participation status

Medicaid