As a Federally Qualified Health Center, we offer sliding fee scale based on family size and income. Proof of income and family members are required by law to complete the application process.
The following documents are required:
- Photo ID and address verification – one of the following
- Current photo ID with address
- Current photo ID with any utility bill
- Other business documents that verified your place of residency
- Proof of income
- Prior year tax return, recent pay stubs, pensions, social security benefits, disability, veteran’s benefits, unemployment compensation, retirement, child support or alimony payments, letter with balance on Electronic Benefit Transfer (EBT) card, or reference letter
- If income is paid in cash, please provide a letter from employer to include the current date, date hired, employee’s name and address, employer’s name/address/phone number, wages per hour and how many hours of work per week, and frequency of pay period. The letter must be signed and dated by the employee and employer.
- Household member information, including names, social security number, and date of birth
- Insurance card(s), including Medicaid and Medicare, if applicable
Sliding fee scale is calculated based on family size and income:
|Family Income per Poverty Guidelines||Sliding Fee Discount|
|100% and below||75%|
|Above 200%||No discount|