Sliding Fee Scale Policy Summary:

As a Federally Qualified Health Center (FQHC), Goshen Medical Center, Inc. is required to provide a sliding fee scale discount to patients who meet the eligibility guidelines.  Sliding fee scale patients are those with household incomes that fall at 100% and below poverty up to 200% of federal poverty.  The eligibility requirements are based on the federal poverty guidelines published annually by the U.S. Department of Health and Human Services. 
Figure 1 – 2015 Household Size and Income Table      


Persons in Family/Household

Annual Household Income for 100% of Poverty

Annual Household Income for 200% of Poverty

1

$11,770

$23,540

2

$15,930

$31,860

3

$20,090

$40,180

4

$24,250

$48,500

5

$28,410

$56,820

6

$32,570

$65,500

7

$36,730

$73,460

8

$40,890

$81,780

Families with more than 8 persons in the household add $4,060 for each additional person.


Data Source: http://aspe.hhs.gov/poverty/15poverty.cfm.  This table is updated by April 30th of every year.

Goshen Medical Center has established a schedule(s) of sliding fee scale discounts based on Figure 1 above.  The schedule of discounts is available for patients at the medical or dental site where the patient will receive services.   The schedule of discounts varies based on service type, i.e. medical or dental, and procedure type, for example a cosmetic dental procedure does not qualify for the sliding fee scale.
The sliding fee scale discounts can range from 20% to 100% off of the charges for the date of service.  If the patient is able to demonstrate that total household size and income results in 100% discount, there is however a nominal fee of $25 for medical services.  If the patient is verifiably homeless, presently a resident of a homeless shelter, transitional, doubling up or truly living on the street, then they are only required to pay $1.00 for services at any of our locations. 

You are encouraged to download a copy of the sliding fee application and complete to the best of your ability, bring the form with you along with your proof of income and household size. A patient representative will be happy to assist you in determining if you are eligible for a discount.  The sliding fee application is used to determine eligibility for the slide scale and to assess the level of discount assigned to the patient.

 

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