Eligibility
requirements vary depending on the service provided. Some
services are free, some are a flat fee and others have a fee based
on a sliding scale. Sliding scale means that the fee is relative
to your income. Financial eligibility is determined annually and
whenever there is a change in financial status. You must have
identification and proof of income when services are provided.
Proof of Income is required for all working adults in the household, related or unrelated. Proof of income includes all of the following that apply:
Pay Stubs - provide either the most recent
with "Year to date" income listed, or 3 most recent
W-2 Form or income tax return for most current
calendar year
Employer's written statement regarding weekly,
monthly, or yearly gross income
Unemployment notice from VEC (Virginia Employment
Commission)
Letter of Termination/Layoff notice from previous
employer
Statement of Social Security benefits or other
benefits
Military LES (leave and earning statement)
(WIC Program Only)
Foster care statement from Social Services
Food stamps - Letter of eligibility (WIC Program
Only)
TANF (WIC Program Only)
Current Medicaid card or Medicaid HMO card
Free or reduced school lunch - letter of eligibility
(WIC and Dental Programs Only)
Minors if not workingmust
provide parents incometo determine
eligibility (WIC Program Only)
Minors must provide proof of their income, if they are working, and proof of parents' income for some medical services.
Must have proof of residency (WIC, Child Health
and Maternity)
Must have proof of Identification (WIC Program
Only)
Medicaid HMO Card (WIC Program Only)
Proof of Identity
Medicaid Card/HMO Card for each person being certified
Driver's License
Birth Certificate or Crib Card
Social Security Card
Proof of Virginia Residence
Medicaid Card/HMO Card for each person being certified
Driver's License
Rent/Mortgage Receipts
Please bring Shot Records if you have them
We accept Medicaid HMO's for :
Family Planning
Maternity
