St. Nick’s program is for WORKING adults. At least one adult in the household MUST be working 15 hours or more per week. (No exceptions.) Eligibility for St. Nicholas Healthcare Payment Assistance Program is based on employment status, insurance status, household size, income, and geographic location of home and/or job. KY service counties are Ballard, Carlisle, Fulton, Graves, Hickman, Livingston, Marshall, McCracken, or Massac (IL).
Please note: working adults who have Medicaid insurance are NOT eligible for assistance in the areas of primary care, pharmacy or dental care. However, these individuals may apply for help with prescription eyeglasses or hearing aids in order to remain employed.
Disabled working adults under age 65 on Disability Medicaid/Medicare insurance who do not have dental insurance may apply for dental assistance.
Working adults over age 65 who are on Medicare but who do not have dental insurance may apply for dental assistance.
Any other working adult whose insurance does not pay for prescription eyeglasses or hearing aids may apply for assistance.
St. Nicholas Healthcare Payment Assistance Program offers partial payment assistance for a wide range of healthcare services provided by our approved provider partners. St. Nicholas does NOT provide assistance for existing medical bills or services received from non-approved partners.
St. Nicholas Healthcare Payment Assistance Program is NOT insurance – we are a 501c3 public charity. If you are worried about the tax penalty for being uninsured, you should ask your tax preparer for information on IRS Form 8965 (Hardship Exemption). Filing Form 8965 with your tax return may help you avoid having to pay the tax penalty for being uninsured. The form and its instructions are available for download from the IRS website, www.irs.gov. (Please note: IRS Form 8965 is different from the marketplace exemption.)
Application review and approval can take up to two weeks. An in-office appointment is required as part of the review process. Once your application is reviewed, you may receive a letter or phone call requesting further information. Once the application process is complete, we will notify you (usually by mail) of your eligibility status and what you need to do to schedule an appointment with our provider partners.
Please remember, St. Nicholas is an assistance program – NOT an urgent care provider. Though it is sometimes possible to expedite the application review process for those with pressing healthcare needs, it is not guaranteed. If you are experiencing an emergency or urgent health care issue, you should seek assistance from a hospital emergency department or an urgent care clinic.
Clients are required to pay their portion of the fees up front to our provider partner at time of appointment in order to receive services. This means you should not receive a bill during your eligibility period. (However, you may later receive a statement from the provider partner showing you paid your portion.) The only reason you should receive a bill is if you do not pay your portion up front due to an error by the provider partner or if your eligibility status changes. NOTE: As a St. Nick client, it is YOUR responsibility to pay your portion at the time it is due. Failure to do can result in you being dropped from the program.
KEEP ALL RECEIPTS, BILLS, AND/OR STATEMENTS YOU RECEIVE. If you do receive a bill and you believe you have received it in error, please contact us immediately and send us a copy of the bill in question.
If something happens which causes you to lose your eligibility status as a St. Nick client (i.e., changes in household, income, uninsured status, etc.), please contact us and we will be glad to refer you to other agencies who can help.
Eligibility for the St. Nicholas Healthcare Payment Assistance expires 6 months from the date of approval or if you obtain insurance coverage in the area of need. After six months, a client may reapply for clinic and pharmacy assistance. After 2 years, a client may reapply for dental assistance. After 3-5 years, a client may reapply for vision assistance. After 8-10 years, a client may reapply for hearing aid assistance.
Approved clients receive a St. Nick ID card which shows name, expiration date, and client fees to be paid. Fees are based on a sliding scale of household income. The ID card must be shown to the Partner Provider at check-in and the client fee portion must be paid before any services are rendered.
To apply for St. Nicholas assistance, download, print, and complete the application below and return to us using the contact info shown at the top of the application. Once we have received and reviewed your application, we will contact you and let you know what documentation we need to finish processing your application.
IMPORTANT: Applicants must provide proof of employment and total household income* for ALL working adults in the household for the previous 30 days.
Consecutive paycheck stubs (the part showing deductions) from the previous 4 weeks are the primary documents used. However, if you are self-employed, work in exchange for room & board, or are paid by an individual who uses personal checks, please use the Verification of Employment & Earnings Form. (Use a separate form for each employer.) Please note: if you submit pay stubs, you do NOT need to submit the Verification of Employment & Earnings Form.
*Household income includes: wages, retirement/pension, unemployment, disability, social security, child support, spousal support, food stamps/SNAP, rent assistance, utilities assistance, etc., received by the legal adult household members. (i.e., spouses, co-habitating couples, adult child and parent.)