Eligibility Information for Medical Clinic

Am I eligible for healthcare services at the Augusta Regional Clinic?

BEFORE STARTING TO OBTAIN DOCUMENTS;

1.     You must have no health insurance, including Medicaid, Medicare, Veterans’, or Private coverage.

2.     You must live in Waynesboro, Staunton, or Augusta County and present a valid Virginia driver’s license, DMV ID, or bill showing that your current address is in the area we serve.

3.     You CAN NOT be in the process of applying for or have a disability case pending. *If you have been approved for disability but have no insurance, the Clinic can provide you services until the coverage starts.

4.     Your income must fall within our guidelines.

5.     You must be between 18-64 years of age.

6.     You must provide all documents needed for the eligibility process.

THE FOLLOWING MUST BE PRESENTED AT YOUR ELIGIBILITY APPOINTMENT TO BECOME ELIGIBLE:

1.       $10.00 Eligibility fee  *Must be cash*

2.       Picture ID. --If address is different than what is on the picture ID, then we need proof of the physical address. Proof can be a Driver’s License, utility bill, lease or any official document with your name and address on it.

*A P.O. Box address is not acceptable.*

a.       If not a U.S. Citizen, we need your green card or your permanent residence card

3.       Proof of the household income (If you are married, you must provide your spouse’s income as well)

a.        The last FOUR weeks’ worth of income prior to the eligibility appointment. This must be one month’s worth of the most current paystubs. The paystubs must be consecutive.

* If you do not have one month’s worth of paystubs you may submit a letter from your employer that includes the date you started working there, number of hours you work a week, what your gross monthly income will be. This letter must be on a company letter head, with your employer’s signature, and a phone number for the company.

b.       Any additional proof of monthly income:

                                                               i.      Food stamps- letter from Social Services showing how much you receive a month

                                                              ii.      SSI- letter from Social Security stating the amount received a month for retirement or disability.

                                                            iii.      Unemployment- letter from VEC showing how much you receive a month

                                                            iv.      Child support- copy of court order

                                                              v.      Pension / retirement benefits / Widow Pension

                                                            vi.      Any other source of monthly income and/or assistance to the household

                                                           vii.      Bank statement if you are living off of savings

                                                         viii.      Proof of HUD or housing allowance

4.       If you are self-employed or a contractor you must show the last 3 months of income and expenses resulting in the amount of profit for each month.

5.       Your last Federal Income Tax form 1040. If self-employed we need a copy of your Schedule C as well. If you do not have a copy, you can request your tax transcript from the IRS or go to www.irs.gov.

*You can still be eligible if you did not file a 1040 by granting us permission to verify that you do not file with the IRS. We will need your W2’s or your 1099 form.*

6.       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 have 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.

7.       Proof of approval for Augusta Health Financial Assistance. You can obtain a copy of their form at the billing center at the hospital, our front office, or online at www.augustahealth.com

REPEAT: THE ABOVE MUST BE PRESENTED AT YOUR ELIGIBILITY APPOINTMENT TO BECOME ELIGIBLE

IF YOU HAVE ANY QUESTIONS OR NEED TO SCHEDULE AN ELIGIBILITY APPOINTMENT, YOU CAN CONTACT:

 

Carrie Durham (540) 221-6723 ext 203