Income Verification: Applicants must provide one of the following: Last year’s income tax return, prior year W2, two most recent pay stubs, letter from employer, or Form 4506-T   (if W-2 not filed). Adequate information must be made available to determine eligibility for the program.

Discounts: Those with incomes at or below 100% of poverty will receive a full 100% discount with a nominal fee. Those with incomes above 100% of poverty, but at or below 200% of poverty, will be charged according to the attached sliding fee schedule. The sliding fee schedule will be updated during the first quarter of every calendar year with the latest Federal Poverty Guidelines.

Nominal Fee: Patients should be made aware that there are minimums which will be required from them such as clinic visits $10.00 and $10.00 for hospital/emergency room visits, even if they qualify for the maximum discount possible. However, patients will not be denied services due to an inability to pay. All KCHD collection rules shall apply. In certain situations, patients may not be able to pay the minimum fee. Waiving of charges may only be used in special circumstances and must be approved by the CEO, CFO, or their designee.

Notification: The CFO will determine if the patient qualifies and will notify the patient and clinic and hospital. At this time a detailed charge list will be generated with all the charges. This information will be gone over with the patient, so they have a clear understanding of what they owe. If they are not able to pay, a payment plan should be set up. This payment plan should be no less than $10.00 per month.