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Eligibility for Health Department Services


Eligibility requirements vary depending on the service.  Some services are free.  Some are provided at a flat fee.  Other services have a fee based on a sliding scale: the fee varies based on individual or household income.  A few services (dental clinic and chronic disease clinic) are available only to residents of the Peninsula Health District.

Identification, proof of residency, proof of income and/or financial status, and any health insurance cards (private, Medicaid, Medicare) should be presented at the time of service. 

Financial eligibility, if required, is determined initially and then annually, or whenever there is a change in a person’s financial status or the approved income scale.  Acceptable verification of income and/or financial status may include:

  • Pay stubs: most recent 4 to 6 week period or (if applicable) most recent stub with year to date earnings
  • Federal tax return: most recent year with supporting documentation (W2s, Form 1099s, schedules, etc.)
  • Employer's written statement regarding gross earnings
  • Notice of Action letters (food stamps, state and local hospitalization, general relief, TANF, etc.) from the Department of Social Services
  • Social Security and other retirement benefits: current year award letters and/or Form 1099s for previous year totals
  • Unemployment compensation: monetary determination letter or payment history from Employment Commission
  • Child/spousal support payments: support court order, check stubs/copies or letter of support
  • Letter of termination or layoff notice from most recent employer
  • Letter of referral (Healthcare for the Homeless, Youth Challenge, Community Service Board, etc.)
  • Zero Income Self-Declaration in certain limited conditions

Eligibility Services can also provide information, assessment and referral for financial and other medical resources in the community. 

Pharmaceutical assistance programs:  The Peninsula Health District works with prescription assistance programs to obtain medication for our patients in the Chronic Disease Clinic.  These programs offered by pharmaceutical companies may require additional personal information or income verification for eligibility determinations.

Call Eligibility Services at (757) 594-7405 with any questions on eligibility for services or on the necessary documents for eligibility determinations.


Contact the WIC program with any questions on eligibility for WIC services.


Last Updated: 08-04-2011

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