Sliding Fee Program
As a Federally Qualified Health Center, Grand Peaks offers a Sliding Fee Program to our patients based on income and family size according to the federal poverty level guidelines. This program is available to those who qualify regardless of insured status.
To apply for our Sliding Fee Program, please complete the New Patient Registration Packet. The information on this application must also be verified, and proof of income must be submitted to our facility within three days of your appointment. Otherwise, full fees will be charged.
If you are an established patient and would like to apply for the Sliding Fee Program, please bring your proof of income to your next appointment.
Proof of income options
- Medicaid Patients – Please complete our Sliding Fee Application, however due to eligibility requirements you have already met, no proof of income is needed.
- Medicare Patients – Proof of income is needed to verify the level of program eligibility.
Patients who wish to apply for the Sliding Fee Program are required to provide proof of gross income for all members of the family/household.
- What is Gross Income? All income before taxes and deductions are withheld. Gross income also includes all types of Social Security income.
- What does the family/household cover? This will include the tax filer, their spouse or significant other, dependents living in the household, as well as dependents defined by the IRS.
Grand Peaks accepts a variety of proof of income, you can bring or attach to your application any of the following:
- 2 most recent pay-stubs for all members of the household who are working
- Previous year’s tax documents
- Social Security or Disability income statements
- If you have no verifiable income, a letter from someone close to you (may not be a family member) that can verify your income and financial situation. This letter must be signed and dated, and a phone number to reach this person is required.
- If you have recently started a new job, the employer may either write a letter, or you may have them complete our Income Verification form. This form must be signed and dated.
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