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To Qualify, You Must:

  • Be a resident of Lowndes County;

  • Be employed: but if not, be able to show that you are actively seeking employment; 

  •  Have NO health insurance, AFFORDABLE HEALTH CARE, nor receive MEDICAID, MEDICARE, OR SOCIAL SECURITY benefits which provide coverage for medical care.

 

Screening takes about 45 minutes. You MUST bring ALL of the following documents in order to be screened: 

(They will be copied and returned to you.)

 

1) Proof of residency in Lowndes County, Mississippi. This may be a current utility bill, gas bill, light bill or phone bill.

 

2) If the utility bill is not in your name, the clinic will need a letter from the person you are renting from - dated, signed and a contact phone number. Also, please give us either your car tag receipt or your voter's card.

 

3) Social Security Card of applicant and Social Security Cards of all members of the household.

 

4) Paycheck stubs of applicant for the past 2 pay periods and all members of the household who work.

       If unemployed, a letter from a prospective employer proving efforts to secure employment.

       If self-employed, letters confirming your employment and earnings.

 

5) Your last year's income tax return and W-2. If you did not file an income tax return for last year, please go to the IRS office and complete Form 4506-T. If anyone in your household filed income tax separately, their W-2 and income tax return for last year must also be submitted. Income tax form must show SIGNATURE, DATE, DAYTIME PHONE NUMBER, and OCCUPATION.

 

6) Written proof if you, or any member of your household, receive SSI, Social Security, Food Stamps, Utility or Housing Assistance, School Grant, Alimony, Child Support, VA benefits, or Unemployment benefits.

 

7) If you have ever applied for Social Security Disability Benefits and been denied, you need to bring your Letter of Denial when you come to be screened.

 

8) Mississippi Driver's License or picture ID with current address which must match address of item #1 above.

 

If you have any questions, please call the Clinic at 662-244-0044  

 

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