What is the Sliding Fee Scale Program at Community Clinical Services?
All Federally Qualified Health Centers (FQHCs) offer a Sliding Fee Scale to patients that qualify based on income guidelines. The program allows patients that have no insurance or that are underinsured to access any of our medical, dental or behavioral health services at a free or reduced cost (sliding fee).
To be eligible for our Sliding Fee Scale, patients will fill out an income verification application and return the form to the front office staff at any of our practice locations or you may mail the application to:
Community Clinical Services FQHC
Patient Rep/Billing Office
PO Box 291
Lewiston, ME 04243-9971
Once your application is received, a patient rep will contact you to go over your application and request any income verification documentation that may be required.
Sliding Fee Scale Application and Cover letter:
2021 HHS Federal Poverty Level Guidelines
|TAX HOUSEHOLD SIZE||INCOME UP TO 100% OF FPL||INCOME BETWEEN 101-125% OF FPL||INCOME BETWEEN 126-150% OF FPL||INCOME BETWEEN 151-175% FPL||INCOME BETWEEN 176-200% OF FPL||INCOME GREATER THAN 200% OF FPL|
|1 PERSON H/H||$12,880||$16,100||$19,320||$22,540||$25,760||$25,761|
|2 PERSON H/H||$17,420||$21,775||$26,130||$30,485||$34,840||$34,841|
|3 PERSON H/H||$21,960||$27,450||$32,940||$38,430||$43,920||$43,921|
|4 PERSON H/H||$26,500||$33,125||$39,750||$46,375||$53,000||$53,001|
|5 PERSON H/H||$31,040||$38,800||$46,560||$54,320||$62,080||$62,081|
|6 PERSON H/H||$35,580||$44,475||$53,370||$62,265||$71,160||$71,161|
|7 PERSON H/H||$40,120||$50,150||$60,180||$70,210||$80,240||$80,241|
|8 PERSON H/H||$44,660||$55,825||$66,990||$78,155||$89,320||$89,321|
*For families with more than 8 persons, add $4,540 per person
Below is a chart that shows what our Sliding Fee is based on the above Federal Poverty Level Income Guidelines:
|CCS Sliding Fee Discount Scale approved by CCS Board of Directors effective 1/1/21|
|SERVICE||INCOME UP TO 100% OF FPL||INCOME BETWEEN 101-125% OF FPL||INCOME BETWEEN 126-150% OF FPL||INCOME BETWEEN 151-175% FPL||INCOME BETWEEN 176-200% OF FPL||INCOME GREATER THAN 200% OF FPL|
|PRIMARY CARE AND PEDIATRICS||$0.00||$5.00||$10.00||$15.00||$20.00||FULL FEE|
Please call patient financial services with any questions you may have about our Sliding Fee Scale Program: 207-777-8208
We partner with the St. Mary’s Health System and they have a Free Care program for lab work and other medically necessary services such as imaging. Our application allows you to apply for both (our Sliding Fee Scale and their Free Care Program) at the same time.
(Note that the hospital requires proof of residency and in many cases proof that you have been denied Medicaid insurance. CCS does NOT require that you have been denied Medicaid. Although we hope you will apply for Medicaid as it is an insurance that allows you to access many services, you do not have to apply and be denied to apply for our Sliding Fee Discount.)
What else do I need to know?
- Our sliding fee discount (or the hospital’s Free Care program) is not health insurance. You have to re-apply at least every 6 months and the discounts are only valid at our locations.