Sliding Fee Program

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The Commonwealth Health Care Corporation offers the sliding-fee scale to all income eligible uninsured or under-insured patients based on annual household income for most of our services. Income guidelines and acceptable verification for the sliding-fee scale are as listed below.

How do I qualify?

If you wish to qualify for the Sliding Fee 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. Applicants should provide a copy of either two consecutive pay stubs, or the previous years income tax return or W-2 form.

Acceptable Income Verification 

  • Recent Federal tax return  
  • IRS form W-2 or 1099  
  • (2) Current paystubs
How do I get started?

To begin the Sliding-Fee application process simply download the appropriate form below and take it with you to your next scheduled visit.

Sliding Fee Application

Sliding Fee Checklist

If you have any additional questions, feel free to contact Shirley A. Ada at our Care and Resources Office for more information at 234-8950 ext 3502.