NEW DENTAL PATIENT ELIGIBILITY

Before you apply to receive treatment at Marian Clinic Dental, you should know:

Marian Clinic Dental is not a free clinic. Once you have established eligibility there will be a fee associated with each appointment and procedure. Those fees are based on a sliding scale.

Marian Clinic Dental accepts some walk-in emergencies. Emergencies are accepted in the order they arrive. They are worked in between daily scheduled appointments with no guarantee an opening will be available.

Marian Clinic Dental does not accept private insurance. Insurance such as Healthwave and Medicaid are accepted and the "Benefit Plan" determines if there is any coverage. Any procedures not covered will need to be paid out-of-pocket. Medicare patients, who meet the income guidelines, are eligible for services on a sliding scale basis.

Marian Clinic Dental treats children and adults beginning at age 3

Find Out if You Qualify

Only an Eligibility Screener can determine eligibility for you or a family member. Here's how the process works:

1. Click below to print out and complete the Dental Eligibility Application Forms:

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Or, pick one up at the Dental Clinic, 3164 SE 6th (map). Don't forget to sign and date the form(s). Failure to answer all questions or to provide/attach complete information and proof of eligibility will delay your processing and delay you receiving an appointment.

2. You MUST provide proof of income. Attach copies of your proof of eligibility as follows. Eligibility is based on federal income guidelines. Proof would include:

a. Employed – You must provide a full month's proof of income, which would include one month's gross income for you and your spouse (if applicable), i.e., most recent pay stubs, child support, alimony, disability, SSI, unemployment award letter, Social Security and last year's tax return and Medicaid award letter.

b. Self-Employed – You must provide a full month's proof of income, which would include one month's gross income for you and your spouse (if applicable), i.e., most recent pay stubs, child support, alimony, disability, SSI, unemployment award letter, Social Security and last year's tax return along with Schedule C.

c. Unemployed – You must submit "award letter" from unemployment, Medicaid "award letter," SSI, Social Security, child support, alimony, etc. If unemployed and not receiving unemployment compensation, you must provide a letter of support from the person/organization that is supporting you, along with a copy of your own tax returns from the past year.

3. Applications can be mailed to 3164 SE 6th Ave., Topeka, KS 66607 or brought into this same address during business hours Monday – Thursday, 7:00 a.m. to 5:00 p.m.

4. An Eligibility Screener will review your information. If your application lacks proof of income, it will not be accepted. If your information is not complete or if we have questions about your application, we may call you on the phone. You may be asked to answer additional questions or to bring in additional proof of eligibility. Please make sure your phone allows incoming calls.

5. Once your application has been approved we will contact you by phone to schedule an appointment.

For questions regarding dental eligibility, please call
(785) 233-2800.

Existing Dental Patient Recertification

1. If you are already a Marian Clinic dental patient, you must re-apply every year on your anniversary date.

2. Click below to download Recertification forms:

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3. Please submit Recertification forms one month prior to your anniversary date to be eligible to continue to receive services and to avoid delays in scheduling your appointments!

4. Forms should be returned to the Marian Clinic Dental at 3164 SE 6th Ave, Topeka, KS 66607.