Patient Assistance

How We Help You

As a Federally Qualified Health Center, we offer sliding fee scale based on family size and income. Proof of income and family member names are required by law to complete the application process.

CFHC Sliding Scale Fee for Download (pdf)

SLIDING FEE APPLICATION

The following documents are required:

  1. 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
  2. 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
    • Household member information, including names, social security number, and date of birth
    • Insurance card(s), including Medicaid and Medicare, if applicable

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.

    • Sliding fee scale is calculated based on family size and income:
      Family Income Per Poverty Guidelines Sliding Fee Discount
      100% and Below nominal fee
      101-125% 75%
      125-150% 50%
      151-200% 25%
      Over 200% No Discount

      Federal Poverty Guidelines

      https://aspe.hhs.gov/poverty-guidelines

As a medical home, we provide comprehensive care beyond medicine to include social services, transportation assistance for RW and HCH patients, and translator to facilitate your care.

Our Social services include:

Medication assistance for patients without prescription coverage who meet income guidelines from pharmaceutical companies.

Specialist referrals for uninsured patients who need specialty care or procedures. A payment plan may be available via local specialists.

Transportation assistance may be available for patients who have no transportation between home and our local health centers.

To inquire more about our Social Services please call 228.374.4991 ext. 1222