Primary Adult Care (PAC) Program
PAC: Health Care for Single Adults

Program Benefits

Birth control Check-ups Family planning Healthcare Provider Visits Mental health

Other benefits vary by provider Prescriptions Substance abuse Vision, glasses, foot care for diabetics only X-rays and labs (some)

Does not cover:

Durable medical equipment ER care Specialists

Surgery Transport

Qualifications (Income Guidelines Effective March 1, 2012)

Family Size	Yearly Income Limit
1	$12,958
2	$17,551

Must also:

• Be 19-64 years old
• Be a Maryland Resident
• Be a US citizen or legal resident for 5 years
• Have assets of $4000 or less for family of one, $6000 or less for family of two or more
• Have no dependent children

How to Apply

• Call toll-free at (800) 226-2142. Ask for a PAC application form; or
• Print a PAC application

                    In English
                    En Espanol

• Make sure to put your phone number on your form so someone can contact you if they have questions.
• Mail in your completed application form to:
  • PAC Program Application
    P.O.Box 386
    Baltimore, MD 21203-0386
• You will get a letter stating if you qualify for PAC, and you must reapply each year

Information needed to Apply

• Proof of US citizenship or residence (Birth certificate; passport; naturalization papers; affidavits)
• State-issued photo identity card (Driver's license or MVA ID)
• Applicable Verification forms
  • Marital status
  • Proof of employment
  • Affidavit of no income
• Sources and amount of income
• List and proof of assets (cash and savings)
• Names, birth dates, social security numbers of all members in household

For more help with PAC, contact the Community Action Agency of Frederick County at (301) 600-1506.

I don't qualify for PAC, what other resources are available to me?

•  www.healthcare.gov

For more information, visit the Maryland Department of Health and Mental Hygiene website or call The DHMH PAC office at (800) 226-2142