Am I eligible for healthcare services at the Augusta Regional Clinic?
BEFORE STARTING TO OBTAIN DOCUMENTS;
- You must have no health insurance, including Medicaid, Medicare, Veterans’, or Private coverage.
- 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.
- 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.
- Your income must fall within our guidelines.
- You must be between 18-64 years of age.
- You must provide all documents needed for the eligibility process.
THE FOLLOWING MUST BE PRESENTED AT YOUR ELIGIBILITY APPOINTMENT TO BECOME ELIGIBLE:
- $10.00 Eligibility fee *Must be cash*
- 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.*
- If not a U.S. Citizen, we need your green card or your permanent residence card
- Proof of the household income (If you are married, you must provide your spouse’s income as well)
- 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.
- Any additional proof of monthly income:
- Food stamps- letter from Social Services showing how much you receive a month
- 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
- Child support- copy of court order
- Pension / retirement benefits / Widow Pension
- 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
- 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.
- 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.*
- 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.
- 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