Financial Assistance

CHC offers a sliding-fee scale financial assistance program. Eligible patients have household incomes at or below 200% of poverty. Patients enrolled in Medicaid, Medicare and with high deductible plans are also eligible for assistance.

The Sliding-Fee Scale Financial Assistance Program can be used for all in-scope CHC programs and services. Download the Sliding-Fee Scale Application (available in seven different languages) here.

↓ Jump to Current Household Income Guidelines

What counts toward total household income?

Total household income is the total combined income of all household members. This includes money from:

• Jobs
• Self-employment (net income)
• Rent
• Pensions, dividends, interest
• Social Security or unemployment benefits
• Stipends or any other monetary income received by members of the household

Which documents can I use to verify my income?

There are many documents we can accept to verify your household income when applying for our Sliding-Fee Scale. Some of the most common are:

• 2 consecutive paystubs from the last 30 days
• Social Security, disability or pension benefits statements
• IRS Form W-2 or 1099
• FAFSA form
• Most recently filed tax return
• Unemployment benefits statement

If you have no income, you may submit a written self-declaration form detailing how you support yourself financially, but you will only be eligible for benefits for 90 days. Remember, eligibility for our Sliding-Fee Scale is based on the total household income; therefore documents will be required for each person. If you have questions about whether you have the required documentation to verify your income, please call us before you come to apply.

Who is considered to be a household member?

We generally base the household members on tax household. Roommates who share mutual living expenses are not considered to be members of the same household.

Current Household Income Guidelines