Mercy Health Clinic accepts Medicaid!
Mercy Health Clinic is now accepting Medicaid with the following Managed Care Organizations (MCOS):
Mercy will see NEW patients who are likely to be eligible for the Montgomery Cares program (see criteria below).
The application for Montgomery Cares:
• Applications can also be mailed to OESS attn: Barbara Kauffman, 401 Hungerford, 4th floor, Rockville MD 20850
• Patients can contact OESS contact information of OESS.MoCo@montgomerycountymd.
For uninsured patients without a Social Security Number (SSN):
You may be eligible to receive medical services at Mercy Health Clinic. First, you are required to visit the Clinic for an interview to determine that you meet the following eligibility criteria:
- 18 years of age or older
- resident of Montgomery County
- no health insurance
- low or no income (total annual income of 250% or less of the poverty level – see below for more details)
New and current patients of Mercy Health Clinic MUST re-qualify every year.
Below are the income eligibility requirements of Mercy Health Clinic. These represent 250% of the Federal Poverty Guidelines for 2018.
Please note that the federal Poverty Guidelines are determined each year by the U.S. Department of Health and Human Services and are published in the Federal Register; they are not determined by Mercy Health Clinic.
# of persons annual income at Federal Poverty Guidelines
in the family 250% of poverty level 2018 poverty level
1 person: $30,350 or less $12,140 or less
Family of 2: $41,150 or less $16,460 or less
Family of 3: $51,950 or less $20,780 or less
Family of 4: $62,750 or less $25,100 or less
Family of 5: $73,550 or less $29,420 or less
Family of 6: $84,350 or less $33,740 or less
For each additional $10,450 $4,180
Eligibility Application Forms:
Suggested documentation to bring to the eligibility interview:
- proof of residency in Montgomery County. This could include one (1) of the following: utility bill with name and address, mortgage or lease, property tax bill, school records, driver’s license with current address, Maryland State ID Card, signed federal tax return / W2 (current year), recent pay stubs with name and address, written statement on letterhead from homeless shelter, official County or State correspondence on letterhead, letter from landlord/third party host with host’s proof of residency.
- proof of age, if possible. Picture ID is preferred. Driver’s license, birth certificate or passport will be accepted as proof of age.
- proof of income. This could include one (1) of the following:
- most recent pay stubs, most recent signed federal tax return. * For January – April 2020: Bring the 4 most recent paystubs for each member of the household OR your 2020 tax return, when completed.
- letter from employer on company letterhead stating gross income per week or per month
- disability statement/unemployment statement
- social security/SSI award letter
- court statements about alimony or child support
- letter from a relative or friend that states the amount of support provided to the patient – letter must be signed with the address and phone number of the person writing the letter.
- If the applicant has no income: please bring a signed letter from the applicant, family member, professional or other that states the person has no income; or bring a letter from employer indicating termination of employment.