Patient Application Requirements

COMPLETED applications must be returned with ALL

supporting documents BEFORE an appointment can be made.

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Eligibility:

• Must have NO INSURANCE

• Must live in Delaware

• Must have income at or below 300% of Federal Poverty Guidelines

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Please bring the following documents to complete your application:​

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• Photo ID

• Proof of Delaware residency

  • Utility bill, phone bill, lease agreement with your name​

  • If you live in a shelter, letter from shelter confirming you live there.

• Proof of income (1 month's worth of all income)​

  • Pay stubs, SNAP benefits, SSI benefits, unemployment benefits ​

  • If you have no income, bring your most recent federal tax return

• Medicaid denial letter​

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If you are unemployed, we will accept any of the following that applies to you:

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• Current social security benefits letter

• Retirement/pension letter

• Veterans benefit letter

• Unemployment statement

• Child support for each child

• TANF letter

• DHHS statement

• Other household income

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If you are living with someone who is taking care of your necessities, that individual must sign the last page of the application and provide a bill with his/her name and address.

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