Eligibility Requirements

If you are in need of affordable, basic health care, we would like to help.

To be sure that our resources are given to those that need it most, all new patients will need to complete a financial eligibility assessment in order to receive care and treatment. If you do not meet the eligibility criteria, we will offer information about other health care services in the community that may be appropriate for you.

Eligibility requirements:

  • No health insurance, or
  • Not currently enrolled in a state or federal insurance plan (Medicaid, Badgercare, Medicare, Veteran’s Benefits), and
  • Household income at or below 250% of the Federal Poverty Guideline

At your first visit please bring proof of income documentation such as:

  • Recent tax return or W-2
  • One month check stubs
  • Unemployment check stubs

Note: Eligibility status will be renewed periodically.

250% Federal Poverty Level (2016)
Household Size 1 2 3 4 5 6
Total Annual Pretax Household Income $29,700 $40,050 $50,400 $60,750 $71,100 $81,450

Request Appointment