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Eligibility and Requirements

The Polk HealthCare Plan was created as last resort for residents with no other option for healthcare coverage. 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’s license or ID card
  • Provide two proofs of residency and proof of income
Federal Poverty Level Income guidelines Effective January 19, 2023
Based on 168% of Federal Poverty Guidelines
Persons in Family/Household

Maximum $ Income/Month

Maximum $ Income/Year
For families/households with more than 8 persons, add $8,635 annually for each additional person. 2023 Federal Poverty Level as published in the Federal Register Notice, effective January 19, 2023. 


What documents do I need to apply?

Accepted examples for Proof of Income:

  • Certification of Zero Income Form
  • Court Ordered Child Support or Alimony Payments
  • Expense Records (bank/credit statement, profit and loss statement)
  • Pay Stubs (4wks)
  • PELL Grant Award Letter
  • Pension
  • Proof of Rental Income
  • Self-Employment Tax Form
  • Social Security Award Letter
  • Tax Return
  • Unemployment Award Letter
  • Verification of Earnings Form
  • Worker's Compensation

Accepted examples of Proof of Residency:

  • Award Letter / Check from Federal or State Agency
  • Declaration of Domicile / Verification of Support
  • Driver's License / State Identification Card
  • Electric / Water / Gas Bill
  • Lexis Nexis Report
  • Proof of Employment
  • Proof of Homestead Ownership / Purchase
  • Rental Verification completed by Landlord
  • Rent Receipt / Lease Agreement
  • Shelter/Residential Facility Letter + Declaration of Domicile
  • Vehicle Registration
  • Verification from Polk County Probation Office of homeless status
  • Voter Registration