{"id":124,"date":"2016-08-08T19:28:51","date_gmt":"2016-08-08T19:28:51","guid":{"rendered":"https:\/\/www.vdh.virginia.gov\/chesterfield\/?page_id=124"},"modified":"2025-12-30T19:13:52","modified_gmt":"2025-12-30T19:13:52","slug":"service-eligibility-information","status":"publish","type":"page","link":"https:\/\/www.vdh.virginia.gov\/chesterfield\/service-eligibility-information\/","title":{"rendered":"Service Eligibility Information"},"content":{"rendered":"<p><strong>Eligibility requirements vary depending on the service provided.<\/strong> Some services 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.<\/p>\n<h3>Proof of Income \u2013 you may be required to provide one or more of the following. Requirements are different for each service.<\/h3>\n<ul>\n<li>Pay Stubs &#8211; provide either the most recent with &#8220;Year to date&#8221; income listed, or 3 most recent<\/li>\n<li>W-2 Form or income tax return for most current calendar year (up to June)<\/li>\n<li>Employer&#8217;s written statement regarding weekly, monthly, or yearly gross income<\/li>\n<li>Letter of Termination\/Layoff notice from previous employer<\/li>\n<li>Statement of Social Security benefits or other benefits<\/li>\n<li>Military LES (leave and earning statement)<\/li>\n<li>Foster care statement from Social Services<\/li>\n<li>Food stamps &#8211; Letter of eligibility<\/li>\n<li>TANF<\/li>\n<li>Medicaid card for current month<\/li>\n<li>Minors if not working must provide parent\u2019s income to determine eligibility<\/li>\n<\/ul>\n<h3>Proof of Identity<\/h3>\n<ul>\n<li>Medicaid Card\/HMO Card for each person being certified<\/li>\n<li>Driver&#8217;s License<\/li>\n<li>Birth Certificate or Crib Card<\/li>\n<li>Social Security Card<\/li>\n<\/ul>\n<h3>Proof of Virginia Residence<\/h3>\n<ul>\n<li>Medicaid Card\/HMO Card for each person being certified<\/li>\n<li>Driver&#8217;s License<\/li>\n<li>Rent\/Mortgage Receipts<\/li>\n<\/ul>\n<p><strong>Please bring Shot Records if you have them<\/strong>.<\/p>\n<p>If you have questions or need more information regarding eligibility requirements, please call 748-1750.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Eligibility requirements vary depending on the service provided. Some services 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 [&hellip;]<\/p>\n","protected":false},"author":52,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_lmt_disableupdate":"no","_lmt_disable":"","footnotes":""},"tags":[],"class_list":["post-124","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Service Eligibility Information - Chesterfield Health District<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.vdh.virginia.gov\/chesterfield\/service-eligibility-information\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Service Eligibility Information - Chesterfield Health District\" \/>\n<meta property=\"og:description\" content=\"Eligibility requirements vary depending on the service provided. 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