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Community Clinic Eligibility Guidelines

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  • Patients must reside in Allen, Barren, Butler, Edmonson, Hart, Logan, Metcalfe, Monroe, Simpson or Warren counties (exceptions may apply). Patients must meet eligibility criteria of being uninsured or underinsured.
  • Patients are required to provide current Federal Tax 1040 information on first visit and then annually. Non-filing patients must complete a federal 4506-T (provided) to qualify for eligibility and charity care discounts. 
  • Patient’s failure to keep a scheduled appointment without 24-hour notification may be dismissed from future eligibility.
  • Patients are expected to pay a fee of $10 at the time of visit. The fee may be billed, but payments are expected promptly to avoid bad debt and avoid dismissal from future visits.

Uninsured patients are those who:

  • Fall under hardship guidelines of the Affordable Care Act, as determined by Kentucky law.
  • Have chosen the option to pay an assigned penalty for remaining uninsured.
  • Cannot access health insurance by virtue of non-citizenship.
  • Are in transition between insurance plans.

Underinsured patients are those who:

  • Are covered by Medicaid but who remain without an accessible primary provider.
  • Pay a premium to participate in a health insurance plan but cannot afford to use it. Deductible exceeds 10% of family income.

All qualifying patients will attest that their family income falls at or below 250% of the national poverty guidelines. See the table below for the guidelines.

Number of Persons in Family

$10
100% - 250%

1

 $11,770 - $29,425

2

 $15,930 - $39,825

3

 $20,090 - $50,225

4

 $24,250 - $60,625

5

 $28,410 - $71,025

6

 $32,570 - $81,425

7

 $36,730 - $91,825

8

 $40,890 - $102,225

For each additional add

$4,160