Eligibility
Qualifications for Service
- Resident of Marion County
- No Health Insurance
- Ages 18-64
- Household income below 200% of Federal Poverty Guidelines (see chart below)
|
Number of Persons in Household |
Total Household Income (<200% of Poverty Line) |
| 1 | $24,980 |
| 2 | $33,820 |
| 3 | $42,660 |
| 4 | $51,500 |
| 5 | $60,340 |
Application Process
Once you have gathered the required information listed below, please call the clinic to schedule a screening appointment. Within 2-3 business days, a staff member will contact you to schedule your first medical visit.
Items to Bring
- Picture ID with current Marion County address (must match bills / sample mail address)
- Social Security Card or Green Card
- Current Medicaid Denial Letter dated within one year and stampled (3300 Form)
- Any household bills in your name. (i.e.: lights, water, phone, cable, mortgage, lease or medical bills, etc.)
- If no bills: please provide a monthly sample of mail with your name of current address
- Proof of household income (i.e.: w2, last 1040 tax form, or check stubs - last 6 weeks)
- Include the following types of income that apply to you:
- Please provide print outs for current year:
- Unemployment History
- Worker's Compensation
- Child Support or Alimony
- Social Security/Disability Award Letter
- Food Stamps
- Please provide print outs for current year:
- Include the following types of income that apply to you:
Please click on the eligibility form below to see additional details.