Covenant House Incorporated is a Federally Qualified Health Center (FQHC) and receives federal funding to help offset the cost of providing care to patients on a sliding fee scale. Eligibility for the sliding fee discount is determined by documented annual income and family/household size. Patients with a documented annual income below the federal poverty level (FPL) are eligible for a sliding fee discount on all services we provide.

Patients with income at or below 100% of the federal poverty level (FPL) are charged a nominal fee; however, no established patient will be refused services due to inability to pay. Patients unable to pay the discounted fee at the time of service will be required to sign a payment plan agreement.

Determining your eligibility for the sliding fee discount requires verification of your income. This information must be updated at least annually to continue your participation in the program. This information is only used to calculate your discount and is kept completely confidential.

Sliding fee discounts for essential services are offered based upon family size and income. Proof of income is required. You may apply for sliding-fee discount at the front desk.

How do I qualify?

If you wish to apply for the Sliding Fee Discount you MUST show proof of gross annual income for all immediate family members living in your household. Gross income is ALL income from ALL sources before taxes.

Acceptable Income Documentation for Sliding Fee Application Includes:

• Paycheck Stubs (Your household’s paycheck stubs for the most recent three (3) weeks.)
• Notarized Document from Employer (stating work frequency, salary per hour/week and number of hours worked.)
• Unemployment Benefit Summary Letter (if applicable)