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.

(920) 931-1150 (Main)
(920) 931-1158 (Fax)

Hours
Mon – Thurs • 9am – 5pm

The Hope Clinic will be closed to observe the following Holidays:

  • New Year’s Day
  • Good Friday
  • Memorial Day
  • Labor Day
  • Thanksgiving and the Day After
  • Christmas Eve and Christmas Day
  • New Year’s Eve Day

2020 Federal Poverty Level Table

Household (taxed filed together) income, Federal Poverty Limit Guidelines Link https://home.mycoverageplan.com/fpl.html

Family SizeAnnual FPL100% Monthly FPL156% Monthly FPL191% Monthly FPL200% Monthly FPL306% Monthly FPL
1$12,760$1,063$1,659$2,031$2,127$3,254
2$17,240$1,437$2,241$2,744$2,873$4,396
3$21,720$1,810$2,824$3,457$3,620$5,539
4$26,200$2,183$3,406$4,170$4,367$6,681
5$30,680$2,557$3,988$4,883$5,113$7,823
6$35,160$2,930$4,571$5,596$5,860$8,966
7$39,640$3,303$5,153$6,309$6,607$10,108
8$44,123$3,677$5,736$7,022$7,353$11,251
+1 Person$4,480$373.33$582.40$713.07$746.67$1,142.40