Eligibility

Any medically uninsured individual or family is eligible for our services if their household income is below 200% of the Federal Poverty Guideline:

Number of Family Members
Monthly Income
Annual Income
1
 $2,082
 $24,980
2
 $2,818
 $33,820
3
 $3,555
 $42,660
4
 $4,292
 $51,500
5
 $5,028
 $60,340
6
 $5,765
 $69,180
7
 $6,502
 $78,020
8
 $7,238
 $86,860


Prior to using our services, you must sign the declaration form as verification for your eligibility. This form is available at our clinic and will be provided to you on your first visit. We strongly recommend that you bring any of the following verifying documentation to your first visit:

  • Tax return form for the previous year
  • W-2 form for the previous year
  • Pay stub for the previous 3 months
  • Social Security statements
  • Any other official documents that show your financial status such as bank statements

If you are unable to provide documentation from the above list, an in-person interview with our social worker can replace the verification process.