Patient Eligibility

The Ben Massell Dental Clinic offers comprehensive oral health services at no cost to patients for adults (age 18 years and older) who qualify based on income (at or below 125% FPL), residence (metro Atlanta) and lack of insurance for dental services. The services are provided by local dentists who volunteer their time. Based on this unique model, we do not offer urgent care, emergency or walk-in services.

We offer cleanings, fillings, and extractions. In addition, we are able to help some patients with specialty services including treatment for the gums, root canals, as well as dentures and partials. We do not provide implants or bridges.


Services

o Hygiene/Deep cleanings

o Exams and X-Rays

o Extractions/Oral Surgery

Fillings

o Root Canals

o Gum Surgery

o Dentures and Partials

o Orthodontics for minors

Eligibility Guidelines

If you are uninsured (dental coverage), a resident of metro Atlanta (Butts, Cherokee, Clayton, Cobb, Coweta, DeKalb, Douglas, Fayette, Fulton, Gwinnett, Henry, Paulding, Rockdale) and have a household income that is at or below 125% of the Federal Poverty Level, then you may be eligible for services at the BMDC.

For persons with Medicaid or Medicare, please call your dental health plan administrator to confirm covered services.

If you are unemployed, please complete a DOL Wage Inquiry form and submit it to the Department of Labor, as instructed on the form.

Low Cost and Sliding Scale Fees

If you are NOT eligible based on the above criteria (age, lack of insurance, residence and income), please review these resources for a list of low cost or sliding fee resources for dental services in the community:

Oral Healthcare Resources

General Dentistry

Denture Resources

Other Resources

Patient Application and Documentation

Before we can get you scheduled for an appointment, we will need some additional information and documents to confirm your eligibility for services. You can submit this information and documentation by email to renew@jfcsatl.org. You may also send these documents via fax at 404-885-7581, or by mail to 700 Fourteenth St NW, Atlanta GA, 30318.

Please do not present your application and paperwork in person at the clinic. Please email, mail or fax your paperwork and application for review.

Note: We cannot schedule you for an appointment until we have received these documents.

Please be advised that a review of your application may take up to four weeks. We will contact you if we need further information to process your application. We appreciate your patience.

Provide ONE document from each category below.


I. Proof of Identity – the name must match your Proof of Residency documents**

· Current GA Driver’s License

· GA Identification Card

· U.S. Passport

II. Proof of Residence 1

· Rent: Current rental agreement

· Own: Current mortgage statement/deed

· Live with someone: A notarized letter written by the person with whom you reside: the letter needs to state the name & address of whom you live with and how long you have lived there. The person who writes the letter needs to have it notarized. The letter cannot be written by you.

· Homeless: A Homeless Verification Letter from a shelter and the letter must be printed on the Shelter’s letterhead paper. The shelter will know what this letter is.

III. Proof of Residence 2 (Must match the address on the first Proof of Residence document)

· Utility bill from the past 30 days

· Bank statement from the past 30 days

· Phone bill from the past 30 days

· Any piece of official mail from the past 30 days. We cannot accept mailed advertisements.

IV. Proof of Income or Documentation of No Income – must be provided for all adults in household

· Employed : 30 days’ worth of paystubs from the date of submission

· Self-Employed: previous year’s tax return

· No Income: Dept of Labor Wage Inquiry statement (please let us know if you need a wage inquiry statement and we will send the application form to you.)

· Receiving Unemployment : Award letter

· Receiving Child Support: legal document stating payment information

· Receiving Social Security: Award letter/including any household minors receiving benefits