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 be asked 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:

  • Household income at or below 300% of the Federal Poverty Guideline

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

  • Recent tax return or W-2
  • Two months check stubs
  • Unemployment check stubs
  • Social security income statement

Note: Eligibility status will be renewed periodically.

2018 Federal Poverty Level Table

Household (taxed filed together) income, Federal Poverty Limit Guidelines Link https://www.safetyweb.org/fpl.php

Household Size Household Income < 100% Household Income < 150% Household Income < 250% Household Income < 300%
1 $12,139 $12,140 - $18,209 $18,210 - $30,350 $30,351 - $36,420
2 $16,459 $16,460 - $24,689 $24,690 - $41,150 $40,151 - $49,380
3 $20,779 $20,780 - $31,169 $31,170 - $51,950 $51,951 - $62,340
4 $25,099 $25,100 - $37,649 $37,650 - $62,750 $62,751 - $75,300
5 $29,419 $29,420 - $44,129 $44,130 - $73,550 $73,551 - $88,260

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