Dental Assistance

Vouchers for Dental Emergencies

Provides vouchers for Kosciusko County residents experiencing a dental emergency such as pain and/or swelling.

Check out the Eligibility Information or Client Information Checklist for details on how to qualify for Dental Assistance.

Download Client Information Checklist

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Eligibility Information

To qualify for the program, you must bring:

  • Picture ID
  • Proof of living address
  • Proof of family income
  • $10 Application fee (cash only)

To be eligible, you must:

  • Be a Kosciusko County resident
  • Be income eligible, at or below 250% Federal Poverty Level
  • Have a dental emergency (pain or swelling)

Income documentation includes, but is not limited to:

  • Most recent tax return
  • Most recent paycheck stub
  • Child support docket
  • Unemployment statement
  • Social Security/Disability award letter or benefit statement

Frequently Asked Questions

Dental Assistance

How many Dental Assistance vouchers can I receive?

Individuals who qualify for the program may receive one (1) Dental Voucher per calendar year. Minors (ages 17 and younger) can receive two (2) Dental Vouchers per calendar year.

What if there are additional needs that the voucher does not cover?

The dentist will complete a treatment plan to meet the emergency dental needs of the patient. Any other needs or services completed at the time of treatment or scheduled thereafter could be the responsibility of the patient.

Do you help with routine dental care, preventative services, or dentures?

At this time, Medication & Dental Assistance is limited to covering emergency treatment services such as extractions, fillings, and root canals. We understand that routine, professional dental cleanings are an important part of your oral health; however, we are unable to help pay for these services. Similarly, Medication & Dental Assistance does not fund fluoride treatments, sealants, caps/crowns, orthodontics, or dentures due to program limitations of treating only the emergency or immediate needs.

How do I know if I qualify for Dental Assistance?

To qualify for Dental Assistance you must:

  • Be a resident of Kosciusko County
  • Be income eligible, at or below 250% Federal Poverty Level
  • Have an emergency dental need (pain and/or swelling)
What does the Dental Voucher cover?

The Dental Voucher covers the cost for the evaluation and services needed to resolve the emergency situation.

The voucher can pay for up to four (4) extractions, or four (4) fillings, or one (1) root canal; however, the treatment completed is up to the dentist and is limited only to the emergency need.

General Questions

Can I request assistance over the phone?

Medication Assistance (Medication vouchers, medical supply vouchers, long term prescription assistance):

  • Yes, if you are already qualified for the program, we can provide assistance over the phone, including faxing vouchers to the pharmacy

Dental Assistance

  • No, you must be in-person to receive a dental voucher
Who is Eligible?

To have accurate information for each specific program, please visit the program tab and look at the Eligibility Information. Generally, individuals who are Kosciusko County residents and have family income at or below 250% Federal Poverty Guidelines may be eligible for Medication & Dental Assistance programs. For any questions, call or visit our office to speak with a staff member to help determine if you may be eligible for one or more of our programs.

What proves residency?

A picture ID with current living address will provide the proof we require. If your picture ID does not have your current living address, please bring a piece of mail, bill, or other professional document with such information.

What is family income?

Family size is determined by the number of individuals the client would claim if filing a federal tax return. Documentation of income is needed for any family member over the age of 18.

What is used for proof of income?

Income documentation includes, but is not limited to:

  • Most recent tax return
  • Most recent paycheck stub
  • Child support docket
  • Unemployment statement
  • Social security award letter
What if I have no income?

For verification of no income, a form is completed with our staff to document how you are financially supported.

What is 250% of the Federal Poverty Level?

All of our programs use the income guidelines established by the government to determine eligibility for assistance. Guidelines are based on gross annual income, which means deductions, wage garnishments, and monthly expenses are not taken into account. At 250% of the poverty line for 2023, monthly and yearly income looks like this:

  • Family of 1: $3,038 monthly or $36,450 yearly
  • Family of 2: $4,108 monthly or $49,300 yearly
  • Family of 3: $5,179 monthly or $62,150 yearly
  • Family of 4: $6,250 monthly or $75,000 yearly
  • Family of 5: $7,321 monthly or $87,850 yearly
I have insurance, can you help?

Yes. Our program can help with medication, medical supplies, or emergency dental assistance even if you have insurance coverage. As long as you qualify based on income (250% of the Federal Poverty Level) and live in Kosciusko County, we should be able to help.

How are you funded?

Medication & Dental Assistance is fully funded through donations and private organizations. The K21 Health Foundation is the primary funder of the agency’s programs and operations. Medication & Dental Assistance is not a program of the government and does not receive any governmental funding.