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Home / Services / Indigent Health Care / Polk HealthCare Plan / Eligibility and Requirements

Eligibility and Requirements

The Polk HealthCare Plan was created as a 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 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/HouseholdMaximum $ Income/MonthMaximum $ Income/Year

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

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 (four weeks)
  • 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
  • Workers’ Compensation

Accepted examples of Proof of Residency:

  • Award Letter / Check from federal or state agency
  • Declaration of Domicile / Verification of Support
  • Driver 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 and Declaration of Domicile
  • Vehicle Registration
  • Verification of homelessness from Polk County Court Services Office
  • Voter Registration