Eligibility Information for Dental Clinic

Want to become an ARDC patient?

The Augusta Regional Dental Clinic charges for dental services to uninsured adults based on the patient's income level. Dental services at the ARDC require a separate eligibility screening prior to any appointment (unless you have dental insurance or Medicaid).

Qualifications for uninsured adults:

  • You must be 18 years of age or older
  • You must live in Staunton, Waynesboro, or Augusta County
  • You must be income qualified and go through an eligibility process

Effective February 1st, 2017, The Augusta Regional Dental Clinic will be scheduling eligibility appointments. All new dental eligibility appointments must be scheduled with a date and time. Eligibility appointments will be scheduled on Mondays 8am - 12pm and Fridays 8am - 1pm.

If you have a referral from an ARC Medical Provider, your primary care physician, the Emergency room, or any outside emergency service provider due to a dental emergency (abscess, infection, exudate, swelling of the face, etc.), you can receive an eligibility appointment at the first available time.

If you are a patient of the Augusta Regional Medical clinic, please contact Carrie at 540-221-6723 Ext 203. 

Please bring the following to your eligibility appointment:

  • Proof of total household income for the past four weeks (for self, spouse and blood relatives in the household)
      1. Examples: Documents showing any income sources, such as jobs, child support payments, TANF, SSI, Social Security, retirement, pensions, unemployment benefits, etc.
      2. If you do not receive a paycheck, bring a letter from your employer stating your earnings for the past four weeks.
      3. If you are self-employed, provide a recent Profit & Loss Statement (Schedule C) with your tax return.
      4. If living with another person and they are helping you financially, you must provide a letter stating who you are receiving assistance from. It must be signed, dated, and include a phone number where we can reach that person. You can obtain a form at our office if you wish to use ours but you do not have to.
  • Total number of members (including date of birth) living within the household
  • List of all medications
  • Photo ID/Valid VA Driver's License showing Staunton, Waynesboro or Augusta County address
  • $45, $60, or $75 to schedule an appointment (ARDC accepts cash, money orders, MasterCard and Visa)
***ALL APPOINTMENTS MUST BE PAID IN ADVANCE. Co-pay covers the cost of Standard Care Procedures (Fillings, Extractions and Cleanings). Additional procedures are based on the Medicaid Rate Fee Schedule. Please ask for pricing.
 
Patient Fee Schedule (determines co-pay):   
Household Size
0 -200%
$45 co-pay
201-250%
$60 co-pay
251-300%
$75 co-pay
1
$24,120.00
$30,180.00
$36,180.00
2
$32,480.00
$40,600.00
$48,720.00
3
$40,840.00
$51,050.00
$61,260.00
4
$49,200.00
$61,500.00
$73,800.00
5
$57,560.00
$71,950.00
$86,340.00
6
$65,920.00
$82,400.00
$98,880.00
7
$74,280.00
$92,850.00
$111,420.00
8
$82,640.00
$103,300.00
$123,960.00