To be a patient at the Gloucester-Mathews Care Clinic you must be:
√ A resident of gloucester county or mathews county
√ at least 18 years of age and not medicare-eligible
√ At or below 250% of the Federal Poverty Level
√ Patient must not have any insurance to include Medicare, Private insurance or be eligible for Veteran’s assistance
What to bring to Screening Appointment?
At your screening you must provide income documentation for everyone listed on your tax returns:
1. Last two months worth of pay stubs.
2. Most recent 1040 tax return and:
~ A copy of any W-2s, or 1099's
~ If you are self employed your schedule C
~ If you did not file, you need to fill out a form 4506 T at your screening.
3. Proof of all other forms of income:
~ Unemployment Checks/Letter of Determination
~ Child Support/Alimony Checks or Court Decree
~ Social Security/Disability/Widow/ Widowers Benefits Letter
If unemployed, and not receiving unemployment benefits, you will need a friend or family member to complete the GMCC Letter of Support Form, stating you are unemployed with no income and how expenses are being met; GMCC Letter of Support Form is available at the Clinic or the Administration Office.
~ Food Stamps Benefits Letter
~ TANF Determination Letter
4. Copy of driver’s license or state ID
5. PROOF OF RESIDENCE (UTILITY BILL, VEHICLE TITLE)