Looking for Help?
If you’re uninsured, you’re not alone. More than 1.1 million Virginians are in the same situation. But, fortunately, there’s help available if you can’t afford care.
What kind of help? Depending on where you live and what your income is, you may be able to receive medical care, see a dentist, get help with mental health issues and even receive prescription medications for free. And your children may qualify for free health insurance from a state-sponsored program — insurance that can help them receive medical and dental care when they need it.
Who can get help?
Some of the services provided are available to anyone, with the cost for care determined by your family’s income (Community Health Centers, for example, have sliding fee schedules). Most of the others require that you have a household income at or below a set percent of the Federal Poverty Level (FPL).
If my income qualifies, can I automatically get care?
In terms of child health insurance, the process is very speedy and children quickly can be eligible to receive care.
However, because there are so many uninsured and low income Virginians, it can be difficult to get an adult medical appointment at some of the free clinics or to receive dental or mental health care. Many of the clinics and health centers are overwhelmed with people just like you and have had to set up waiting lists. But all of them are working hard to expand their ability to care for as many people as possible.
Is there a “cut off” point that applies to all of these programs?
The thing to remember is that different types of services — and different clinics — have different “cut off” levels. Your family income might be too high to receive adult care at the local free clinic, but your children may still qualify for state-supported health insurance. It’s important to check.
How do I know what percentage of the Federal Poverty Level we are?
The FPL depends on two things: how many people are in a “household” and how much combined income those household members bring in.
Before you can know what percent of the FPL your household is, you first must know the total year’s income of all household members combined. With that information in hand, look at the chart at the bottom of this page, find the row that matches the number of people in your household and follow the chart to the right until you find your total household income. Look to the top of that column to find your household’s percentage of FPL.
As an example, if your “household” includes one parent, one grandparent and two children, you have four household members. In a household like that, if the combined income of all the four people in the house was $43,000, it would be considered below 200 percent of the FPL.
What is a “household”?
A household is a group of people who live together who are officially connected in some way, either by marriage, by a “blood” relationship (such as a child, parent or grandparent, brother or sister, niece or nephew or in-law), or through adoption or fostering.
People who live in the same place but are not officially connected in one of the ways listed above are not considered a “household.” That means that three friends sharing an apartment, for example, are three separate households.
Why does the percent of FPL matter?
Many of the clinics require patients to have a household income that is at or below a set percent of the FPL. For example, some Virginia free clinics accept patients whose household income is at or less than 200% of the FPL, while others limit income eligibility to 100%, 125% or 150%. Virginia Community Health Centers offer services on a sliding fee scale. And prescription medication assistance may be available to those with up to 300% of the FPL.
It is important to check with the clinic or service to determine whether a certain percentage of FPL is required for eligibility.
Figuring out the percentages
Qualifying for a program that limits services to 100% of the FPL or below means that only those whose total household incomes were at or less than the level listed for their household size would be eligible for care.
Before tax or after tax?
Usually, the household income is determined by gross income (before tax income), although it is important to check with the service or provider.
For more information on poverty guidelines, visit the U.S. Department of Health & Human Services web page on poverty levels.