Eligibility Requirements

Medical Patient Eligibility

Medical patients must meet the following requirements to receive clinic services:

  1. Shenandoah County resident
  2. No medical insurance
  3. Family income at or below 200% of the federal poverty level (you may use the chart below to determine if you meet the income requirement)

 

New Patient Intake Form_English Version

Nuevo Paciente Elegibilidad_Version en EspaƱol

 

Dental Patient Eligibility

Dental patients have two options for meeting eligibility requirements.

  1. Shenandoah County resident
  2. No dental insurance
  3. Family income at or below 200% of the federal poverty level (you may use the chart below to determine if you meet the income requirement)

OR

  1. Present Medicaid card. This proves your income status and helps us know for which services you are eligible.

 

200% of the Federal Poverty Level 2017

Household Size

Gross Income

Monthly Yearly
1 $1,980 $23,760
2 $2,670 $32,040
3 $3,360 $40,320
4 $4,050 $48,600
5 $4,740 $56,880
6 $5,430 $65,160
7 $6,122 $73,460
8 $6,815 $81,780
Additional person add: $690 $8,280