Making healthcare more affordable

The program is based on your current family size and income, and it can cover you for up to 12 months. You need to apply each year, or whenever your family size or income changes.

After you’re approved for the Sliding Fee Discount Program, you’ll receive an ID card. Do not confuse this with an insurance card. It’s only for use at Mosaic Health facilities.

Common Questions About the Sliding Fee Scale

Who is considered a family member when determining family size?

Individuals of a household, both traditional and non-traditional, are considered family. Families are tied together financially.

Who in the household is eligible for the Sliding Fee Discount Program once family size is determined?

Any member of the household listed on the application as legally binding and 19 years of age and older (any child 18 years and younger may be eligible for Medicaid and Child Health Plus) would be eligible to receive the Sliding Fee discounts if eligibility requirements are met.

How often do I need to apply for the Sliding Fee Discount Program?

You must re-apply every year or if there is a change in your current family size or income.

If I do not want to share financial information, am I still eligible for the Sliding Fee Discount Program?

Your financial situation largely determines your eligibility for the SFDP. If you choose not to provide your local Community Health Center with this information, you will be selected as “Self Pay” status. You will be responsible for total charges for all services during any visit to Mosaic Health.

If I am eligible for Medicare, but unable to afford the cost of Medicare, am I eligible for the SFDP?

Yes. Patients insured by Medicare are eligible for sliding fee discounts on their copayments and deductibles.

If I am self-employed or earn income from a business, how is my income determined, and what forms of documentation do I need to submit to apply for the SFDP?

If you are self‐employed or own a business, proper documentation would include your State and Federal tax return. The line on the tax return labeled “Adjusted Gross Income” is used to determine income. We would also ask for all supporting schedules.

If I am self-employed or own my own business and my Sliding Fee Discount Program is set to expire before April 15th of the year and/or if I will be filing for an extension on my tax return, what do I need provide for documentation to apply for my SFDP?

• If you are due to have your income verified between January 1st and April 15th and have not yet completed your tax return, we will ask you to sign a declaration of income that you will report on your tax return. A declaration of income is a form where you document what you get paid, how you get paid, how often, and who your employer is.
• We will extend your Sliding Fee Discount Program eligibility until April 15th and you will submit your tax return to Mosaic Health once it is completed.
• If the amount you reported in your declaration of estimated income is different from the tax return you submitted to the IRS, you will be responsible to pay for any differences in that change—or you will be credited if we overcharged you.
• If it is after April 15th and you are filing for an extension on your tax return, you will also be required to submit a copy of the extension form filed with the IRS.
• We will extend your SFDP eligibility for 30 days based on your declaration of income and you must provide documentation within those 30 days to remain eligible.
• If the amount you reported in your declaration of estimated income is different from your tax return submitted to the IRS, you will be responsible to pay for any differences in that change—or you will be credited if we overcharged you.