• You must be a Brunswick County resident.
  • You must be age 18 or older.
  • You must be uninsured and ineligible for Medicaid, Medicare or VA Benefits. (May be required to provide proof of ineligibility or termination of benefits)
  • Your total gross household income must be at or below 150% of Federal Poverty Guidelines.
  • You must complete an application and turn in documents to determine your eligibility before your first visit and each year.
  • You must apply for all benefits to which you may be entitled (e.g. SSI, Unemployment, VA, etc.)
  • Boiling Spring Lakes: Mondays & Thursday 9:00 am – 4:00 pm
  • Shallotte: Wednesdays 1:00 pm – 4:00 pm
  • Call for other times or a phone interview, if needed



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  1. Proof of who you are and that you live in Brunswick County – Bring in a document from two categories:
    • A Driver License or State-Issued Identification Card from North Carolina Division of Motor Vehicles, another state, Puerto Rico, or a U.S. Territory; a U.S. Passport; Work Visa; Green Card; or Correctional System ID with photo
    • A current North Carolina Motor Vehicle Registration Card in the applicant’s name and showing the applicant’s current Brunswick County address.
    • A current rent, lease or mortgage payment receipt; two bank statements; or current utility bill or hospital bill – in the name of the applicant showing a Brunswick County address.
    • A document from an employer or the Employment Security Commission verifying that the applicant has been employed in Brunswick County within the most recent six months, with a Brunswick County residence address listed
    • The Tax records of the applicant showing a current Brunswick County address (Ex. Form 1040, W-2, 1099, letter from IRS, property tax receipt)
    • A document showing that the applicant has registered with a public or private employment service in Brunswick County.
    • A document showing that the applicant has enrolled his/her children in a public or private school or a child care facility location in Brunswick County.
    • A document showing that the applicant is receiving public assistance (such as food stamps) or other services which require proof of residency in Brunswick County.
    • Records from a Health Department of other health care provider located in Brunswick County which show the applicant’s current Brunswick County address.
    • A written declaration from an organization that has first-hand knowledge of the applicant’s intent to live in Brunswick County permanently, for an indefinite period of time, or residing in Brunswick County in order to seek employment or with a job commitment.
    • A current Voter Registration Card with a Brunswick County address.
    • Official North Carolina school records, signed by school officials, showing current enrollment with a Brunswick County address (including secondary schools, colleges, universities, or community colleges).
    • A document issued by the Mexican consular or other foreign consulate verifying the applicant’s intent to live in Brunswick County permanently, or for an indefinite period of time, or that the applicant is residing in Brunswick County to seek employment or has a job commitment.
    • New Hope Clinic (NHC) has the authority to determine what is considered satisfactory proof, and retains the right to deny eligibility and/or declare that the documents provided are unacceptable.  If NHC believes that the documentation is false, or otherwise find the documentation to be unsatisfactory, NHC can require the provision of additional supporting documentation.
  2. Proof of Income – Provide all of the following documents that apply to your household situation:
    • Last year’s Tax Return (e.g. Form 1040, 1040A)
    • Current Social Security Benefits Award Letter
    • Current Disability Benefits Award Letter
    • Unemployment Benefits Award Letter, wage history
    • Recent paystubs (at least one month, preferably two months)
    • A wage form or written statement from employer indicating monthly income
    • If self employed, Income Tax Form 1040 & Schedule C.  If no tax return, business records (income and expenses) for prior 6 months.
    • Written statement from absent parent/spouse or Clerk of Court showing child support/alimony paid or received for 6 months
    • Documents showing any other income
    • If no income, letter of support for person or organization supporting you

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Incomplete Applications

Incomplete applications are held for four (4) weeks if necessary documentation is not provided at the time of eligibility interview.  It is the patient’s responsibility to follow these guidelines.

Change of Status

Patients are responsible to notify the Clinic of changes to status. They must immediately contact NHC if:

  • They become covered by Medicare, Medicaid, private insurance or other health insurance or medical benefits
  • Their household income changes
  • They move out of Brunswick County
  • Their household situation changes

Ineligible Applicants

If an individual is found to be ineligible for clinic services for any reason:

A file will be created and application documents will be retained by the clinic with explanation of ineligibility.

If their financial, household, or insurance status changes, they will be eligible to re-apply for clinic services no sooner than ninety (90) days from original application.

Eligibility Renewal

All patients’ eligibility status will end one (1) year from the original date of enrollment by NHC (or earlier if other benefits were pending at the time of enrollment).

Patients are notified when it is time to renew their eligibility to the clinic and given thirty (30) days to complete the re-eligibility process.

Failure to re-certify on time will result in discharge from the clinic.

If a patient is discharged from the clinic due to failure to re-certify, they will be eligible to re-apply for clinic services no sooner than twelve (12) months from the discharge date.