OF CENTRAL VIRGINIA ELIGIBILITY
1) Beginning May 1, 2006 we raised our
household income guideline to 185% of the Federal Poverty Level with
some “judgment room” for Jane Ayers and Shannon Jarvis to enroll
some exceptional cases up to 200%.
2) Beginning somewhere between November 1, 2006 and January 1, 2007,
the Free Clinic administration hopes and plans to ask the Free
Clinic’s Board of Directors to raise this level a second time to
200% of the Federal Poverty Level for every person.
3) Patients should not have insurance, Medicare, or Medicaid for the
service(s) being provided.
SPECIALTY CLINIC GUIDELINES:
1) In the instance of a patient referred to a
Free Clinic Specialty Clinic, the patient will be asked to submit to
an eligibility screening if he/she wants other medical or dental
services through the Free Clinic.
2) When a referral is made by Johnson Health Center or the Lynchburg
Health Department and the patient has already completed an
eligibility screen with them, the financial records and medical
records will be transferred to the Free Clinic by the referring
3) When a referral is made by a private physician or the emergency
room, the patient will be asked to complete an eligibility screening
(if it is reasonably possible) before he/she is seen. If it is not
reasonably possible, the patient will be seen for one visit at the
clinic, but must complete an eligibility screen before other
services (i.e. another specialty clinic visit, general FC medical
services, general FC pharmaceutical services) are provided.
WHAT IS THE DEFINITION OF A HOUSEHOLD?
1) Two or more immediately related family
members living in one unit. If persons are non-related, an
assessment will be made on an individual basis.
2) If an individual is living with parents, but working PT or FT,
he/she will be assessed for eligibility on his/her income. If not
working, he/she will be assessed for eligibility on the basis of
his/her parent/guardian’s income. If disabled, he/she would not have
to be working; he/she might not have work related income of his/her
3) When unrelated persons share one housing unit (room, apartment,
or house), they will be considered as a family unit for eligibility.
When unrelated persons share a divided housing unit, they will be
considered as two or more family unit(s).
WHAT ARE SOME PARAMETERS FOR UNEMPLOYED
1) The following persons will be permitted up
to 90 days to obtain gainful employment (i.e. persons just released
from prison, persons just sent out from a shelter, persons just laid
off from a job, and persons just discharged after a long illness
from a health care facility). They might also be exempted upon
request from the $2-$5 administrative fees after a review of their
2) A person who has not obtained employment after this 90-day period
and is not “earning” unemployment and/or social security will be
reassessed in regard to his/her Free Clinic eligibility. Key factors
will be his/her effort made to attain employment, the feasibility of
employment for the individual, and other “uncontrollable” factors.
We do expect a reasonable effort at attaining some employment.
HOW DOES A PERSON VERIFY INCOME INFORMATION?
1) Persons must provide his/her most recent
federal and state Income Tax returns, W-2 Forms, and two most recent
pay stubs from his/her employer
(within the past thirty days are preferred). A letter from the
individual’s employer reporting this same information can be
substituted, if necessary.
2) Self-employed individuals must provide documentation of their
earnings as part of an eligibility evaluation. If this is NOT
provided during eligibility
screening, it can result in a delay in getting medications for the
patient from the pharmaceutical company(ies).
3) Individuals paid in cash (versus a check, money order or other
paper document) by his/her employer must provide a written letter
from the employer reporting income – preferably on business or
4) All persons NOT REQUIRED to file state and/or federal income
taxes for a given year must present a copy of Federal Form 4506. Or
they must fill one out, and we will send it in for them. NOTE: We
will check on federal and state taxes as well as the Form 4506 being
MISCELLANEOUS DOCUMENTATION INFORMATION
1) All Medicare and Medicaid patients will be
provided dental services ONLY. They must “update” their eligibility
on an annual basis between December and January when they receive
their new social security benefit letters and their new
2) All other patients may apply for all services, but they must
“update” their income information every 90 days to remain eligible
for services. This is necessary because their situations can change
over a period of time.
3) If an applicant received an extension for filing his/her annual
taxes beyond the normal filing date, he/she must include this form
in an eligibility screening.
4) If a patient fails to “update” his/her eligibility “on time”, it
can restrict and/or delay necessary services for the patient.
5) WARNING – If certain documentation is not provided by the patient
within 90 days of extending services, we may have to withdraw a
service or services (i.e. medications).
6) Food Stamp and TANF Letters documenting services are provided by
an individual’s local social services office.
7) If no actual rent or mortgage is being paid to someone or a
company, a person must provide a letter from the person providing
this free accommodation.
After you gather all the information listed
above pertaining to you and everyone in your household, please
contact the Free Clinic for an eligibility screening appointment. It
will normally take 7-10 days after this appointment to approve your
eligibility for services.
Your first appointment at the clinic is for paperwork processing
A dental appointment must be prepaid for at $5; you must have your
previous medical records forwarded to the clinic and medical
appointments are $2 each.