Eligibility for Clinical Services is determined by proof of household income and must be determined initially, and then annually, or whenever there is a change in financial status or the approved income scale.

Proof of identification, household income, and health insurance (i.e., private insurance, Medicaid, Medicare, etc.,), must be presented at the time of service.

The following is a list of acceptable proof of household income documents to determine financial eligibility:

• A picture ID or driver’s license.
• A health insurance card (if applicable).
• Printed verification of income from members of the household, examples include:
  • Most recent pay stub(s) showing gross pay.
  • A food stamp award letter.
  • Social Security Benefits, retirement benefits, or other benefits award letter.
  • A child or spousal support award letter.
  • A current tax return or W2.
  • A Virginia Employment Commission (VEC) unemployment monetary determination letter.
  • A letter of termination or layoff notice from previous employer.
  • A statement of gross earnings signed by the employer on company letterhead.
  • A support letter from the supporting church or shelter on letterhead.
  • A support letter signed by a relative or friend (may be notarized).
  • Income of the supporting person(s) (i.e., a minor that does not work may provide parents’ income).

Proof of residency is required for Dental Services. Residency examples include a Newport News address on a picture ID, driver’s license, rental agreement, or utility bill.

The following are NOT considered household income and cannot be accepted:

• A bank loan.
• A student loan.
• A checking or savings account statement.

**Pregnancy tests are a flat fee and excluded from financial eligibility requirements.

School physicals have additional eligibility requirements:  

• The child must reside within the District, be at least 4 years old, and be entering the public school system. We do not perform day care or sports physicals.
• The child must be uninsured. Children with private health insurance, Medicaid, etc., are deemed ineligible and will be referred to a pediatrician or private physician.
• The parent (or legal guardian with legal papers) must bring a picture ID or driver’s license, a copy of the child’s birth certificate, household income verification, and a copy of any Immunizations their child has received for an eligibility prescreening, prior to scheduling the appointment.