Sliding Scale

CFMWellness staff is available to assist clients in determining if they are eligible for our Sliding Fee Options. Clients MUST show most recent proof of income for all family members/individuals living in your household; examples of accepted documents include:

  • Previous year’s 1040 tax form
  • One month of pay stubs
  • 1 unemployment stub
  • Food Stamp Award Letter
  • Copy of Social Security or Disability Check
  • Letter from an employer that states your salary or wages.

Discount levels for patients who qualify are shown below.

2020 Sliding Fee Schedule-Annual Income

Fed. Poverty
Guideline
At or Below 100%101% – 125%126% – 150%151% – 200%Above 200%
      
Family Size

Nominal Fee

($10)

Level 1

Charge $20

Level 2

Charge $30

Level 3

Charge $40

No Discount
1

$0- $12,760

$12,761- $15,950

$15,951- $19,140

$19,141- $25,520

$25,521+
2

$0- $17,240

$17,241- $21,550

$21,551- $25,860

$25,861- $34,480

$34,481+
3

$0- $21,720

$21,721- $27,150

$27,151- $32,580

$32,581- $43,440

$43,441+
4

$0- $26,200

$26,201- $32,750

$32,751- $39,300

$39,301- $52,400

$52,401+
5

$0- $30,680

$30,681- $38,350

$38,351- $46,020

$46,021- $61,360

$61,361+
6

$0- $35,160

$35,161- $43,950

$43,951- $52,740

$52,741- $70,320

$70,321+
7

$0- $39,640

$39,641- $49,550

$49,551- $59,460

$59,461- $79,280$79,281+
8

$0- $44,120

$44,121- $55,150

$55,151- $66,180

$66,181- $88,240

$88,241+
      
      
 

Nominal

Fee-$10

 

Level 1

$20 Charge

 

Level 2

$30 Charge

 

Level 3

$40 Charge

 

NO Discount

*Based on 2020 Federal Poverty Guidelines published in the Federal RegisterJanuary 17, 2020

For families/households with more than 8 persons add $4,480 for each additional person.

Discounted charge includes all services performed by the center during the visit.


2020 Sliding Fee Schedule-Monthly Income

Fed. Poverty GuidelineAt or Below 100%101% – 125%126% – 150%151% – 200%Above 200%
      
Family Size

Nominal Fee

($10)

Level 1

Charge $20

Level 2

Charge $30

Level 3

Charge $40

No Discount
1

$0- $1,063

$1,064- $1,329

$1,330-  $1,595

$1,596- $2,126

$2,127
2

$0- $1,437

$1,438 $1,796

$1,797- $2,156

$2,157- $2,874

$2,875
3

$0- $1,810

$1,811- $2,263

$2,264- $2,715

$2,716- $3,620

$3,621
4

$0- $2,183

$2,184- $2,729

$2,730- $3,275

$3,276- $4,366

$4,367
5

$0- $2,557

$2,558- $3,196

$3,197- $3,836

$3,837- $5,114

$5,115
6

$0- $2,930

$2,931- $3,663

$3,664- $4,395

$4,396- $5,860

$5,861
7

$0- $3,303

$3,304- $4,129

$4,130- $4,955

$4,956- $6,606$6,607
8

$0- $3,677

$3,678- $4,596

$4,597- $5,516

$5,517- $7,354

$7,355
      
      
 

Nominal

Fee-$10

 

Level 1

$20 Charge

 

Level 2

$30 Charge

 

Level 3

$40 Charge  

 

NO Discount

*Based on 2020 Federal Poverty Guidelines published in the Federal RegisterJanuary 17, 2020

For families/households with more than 8 persons add $373 for each additional person.

Discounted charge includes all services performed by the center during the visit.


Click HERE to submit a Sliding Scale Application.

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