Sliding Fee Scale
Individuals/Families applying for discounted fees are expected to provide the following:
- Photo Identification
- Any current insurance (Medicaid, Medicare, or private insurance) if applicable.
- Proof of income for 30 days of total household income; proof can be in the form of paycheck stubs, W-2 tax forms, disability benefits, child support, social security, and/or retirement income.
Patients stating they have no income will have to complete a zero-income affidavit form. Patients refusing to provide income documentation are responsible for full charges.
The Sliding Fee Scale is based upon the most recent Federal Poverty Level (FPL) guidelines and will be approved annually by the Community Health Center Governance Board.
Any changes to a patient's Sliding Fee Scale Plan resulting from Governance Board approval of newly published FPL guidelines will be effective at the patient's next scheduled visit.
