Sliding Fee Discount Program

HCHC offers affordable health, dental, behavioral and women’s health care through the use of the sliding fee discount program to uninsured and under insured qualified individuals and families.  Eligibility is based on family size and family income.  The Sliding Fee Discount Program Scale is based on the annual definition of federal poverty provided by the Department of Health and Human Services, and is divided into four categories:  A, B, C, and D.

For patients eligible for sliding fee discounts, there is no charge for lab visits regardless of the number of tests completed at that visit, unless the patient also has commercial insurance. The insurance will be billed by the lab processing vendor for those patients and any unpaid balance will not be the patient’s responsibility.

Sliding Fee Rate Chart (Click to Enlarge)

The Sliding Fee Discount application needs to be renewed every year, and for those who provide a letter of support the application will need to be renewed every 6 months.  Members of the family are defined as the head of household, any spouse, custodial parent(s) and all financial dependents.  Dependents are those individuals the applicant is legally obligated to support.

Applicants must provide proof of all sources of income that apply for the last 30 days.

Accepted Proof of Income:
  • 1040 Tax Forms (no W2s)
  • Social Security/Disability Letter
  • Unemployment Benefit Letter (no bank statements)
  • Letter of Support
  • Employers Letter (if paid in cash)
  • Pension Benefit Letter
  • Inheritance
  • Trust Funds
  • Veterans Benefits
  • Wages (4 pay stubs if paid weekly, 2 pay stubs if paid bi-weekly)
Application Forms