Eligibility &
Requirements
If you are a Polk County resident who has little or no-income and are without health coverage or insurance, or are waiting to qualify for Medicaid, then the Polk HealthCare Plan may be for you.
QUALIFYING FOR MEMBERSHIP
The Polk HealthCare Plan was created as a last resort for residents with no other option for healthcare coverage. Having any healthcare coverage will automatically make you ineligible for the plan.
To qualify for membership in the Polk HealthCare Plan you must:
- Be a full-time resident of Polk County
- Have no health insurance coverage or medical coverage
- Have no or low-household income
- Provide a Social Security number
- Provide a valid Florida-issued driver license or ID card
- Provide two proofs of residency and proof of income
Federal Poverty Level Income guidelines for PHP effective October 1, 2023, based on 200% of Federal Poverty Guidelines | Persons In Family/Household | Maximum $ Income/Month | Maximum $ Income/Year |
|---|
| 1 | $2,510 | $30,120 |
| 2 | $3,407 | $40,880 |
| 3 | $4,303 | $51,640 |
| 4 | $5,200 | $62,400 |
| 5 | $6,097 | $73,160 |
| 6 | $6,993 | $83,920 |
| 7 | $7,890 | $94,680 |
| 8 | $8,787 | $105,440 |
2024 Federal Poverty Level as published in the Federal Register Notice, effective Jan. 12, 2024. For families/households with more than eight persons, add $5,380 annually for each additional person.
What documents do I need to apply?
Any one of the following documents will meet the requirement for proof of income:
- Court-ordered child support or alimony payments
- Expense records (bank/credit statement, profit and loss statement)
- Pay stub(s) (one month of pay stubs)
- PELL Grant Award Letter
- Pension documents
- Proof of rental income
- Self-employment Tax Form
- Social Security Award Letter
- Tax Return
- Unemployment Award Letter
- Verification of Earnings Form
- Workers’ Compensation
Any two of the following documents will meet the requirement for proof of residency:
- Driver License / State Identification Card
- Federal or State agency Award Letter / Check
- Lexis Nexis Report
- Proof of employment (Ex: Pay stub with home address listed)
- Property tax statement
- Proof of homestead ownership / purchase
- Rental verification completed by landlord
- Rent receipt / lease agreement
- Shelter/Residential Facility Letter
- Utility Bill (electric, water, gas bill)
- Vehicle Registration
- Verification of homelessness from Polk County Court Services Office
- Voter Registration Card
Funded by the voter-approved, half-cent sales surtax for indigent healthcare, the Polk Health Care Plan is administered by the Community Health Care section of Polk County’s Health and Human Services Division.
2135 Marshall Edwards Dr.
Bartow, FL 33830
(863) 533-1111
Mon-Fri: 8 a.m. to 5 p.m.
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