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South Broward Community Health Services Application and Eligibility Guidelines

Here are step-by-step instructions to apply for — or renew — a South Broward Community Health Services (SBCHS) membership, followed by a list of documents required to determine eligibility.

To schedule an appointment for eligibility for SBCHS membership please contact our Scheduling Department at 954-276-5500. You must bring ALL required documents to your appointment. If you do not bring all of your documents your appointment may be rescheduled.

You MUST be uninsured, not eligible for any other government medical program, and live in the South Broward Hospital District to be eligible for membership with the South Broward Community Health Services Program of Memorial Healthcare System.

You can also be a member with the South Broward Community Health Services if you are a resident of the South Broward Hospital District and are enrolled in one of our contracted health plans.


Documents Required

Copies of the following documents must be presented to determine eligibility. A South Broward Community Health Services membership cannot be issued until eligibility is established.

Proof of Medicaid/Medicare/ACA Application:

  • Must provide a Department of Children and Families access number (see Medicaid section below)
    • If you are a citizen or legal resident, receiving disability, or have children under 18 living in your home you will need to apply for Medicaid
  • All applicants 65 years or older or disabled must apply for Medicare in addition to applying for Medicaid
  • All applicants must provide proof that they are not eligible for subsidies with the Affordable Care Act on the Health Insurance Exchange through www.healthcare.gov

Identification

  • Current Florida ID or Drivers License showing your current address
  • Social Security Card with proof of citizenship or immigration status for each member of the household
  • If you do not have a Florida ID or Social Security card, you must provide your Passport with Visa and current I-94

Proof of Address (please provide one of the following):

  • Current utility bill showing service address in the name of you or your spouse (i.e.: FPL, Home telephone, Gas, Water or Cable)
  • If you DO NOT have a utility bill in your name, provide a lease, mortgage statement, property tax bill or similar document in your name or your spouses name.
  • Proof of residence in a South District homeless shelter

Proof of Income for all members of the household:

  • Paycheck stubs showing your gross income for the last 6 weeks for you and your spouse
  • All unearned income must be provided
    • AFDC, Alimony, Child Support, Disability Income, Social Security Income, Unemployment Compensation, Pensions, Dividend income, Annuities, Workers Comp, etc.

If you are being supported by another person, provide a notarized Letter of Support from the person who is helping you with a copy of the supporters photo I.D. (Letter CANNOT be older than 30 days). Letter of support must be accompanied by proof that you are the child, parent, or sibling of the supporter or that the supporter claims you for federal income tax purposes.

Bank Statements

  • Last 3 consecutive statements for ALL personal (checking, savings, IRAs, CDs, money market, and bonds) AND business bank accounts for you, your spouse and dependents
    • If you do not have a bank account you must provide proof of payment for all monthly expenses for the last 3 months (i.e.: money orders, cash receipts, cancelled checks)

Current Income Tax Return — if filing separate, both Tax Returns must be provided

  • Personal and Business income tax returns for you and all members of the household All pages must be provided including 1040 forms, W-2 forms, 1099s and all schedules

Proof of Legal Guardianship (if applicable):

  • If you are a legal guardian, you must provide us with the proper custody or legal documents


Please allow 60 days for processing and review.

Additional information and or documentation may be requested to complete your application. All information is subject to verification. Providing false information may result in the denial of any type of financial assistance through the South Broward Hospital District d.b.a. Memorial Healthcare System.

MAP