Charitable Care Program
All patients have the opportunity to apply for North Coast Health’s Charitable Care Program. Our Charitable Care Program is meant to make affordable care available to all who come to us in need. The program is dependent on income, family size and coverage. The program is offered to both those without health insurance and those who are “underinsured” – i.e., those whose coverage is inadequate for them to receive the care they need due to out-of-pocket expense requirements they cannot meet.
We believe that individuals share in the responsibility for their health, as a partner with their clinical care team in developing and carrying out care plans and as a contributor to the cost of their care to the degree they are able. We have two sliding fee scales available for which patients can qualify.
Sliding Fee Scale A
| Federal Poverty Level | Co-Pay Amount |
| 0 – 138% | $0 |
| 139 – 250% | $0 |
| 251 – 400% | $0 |
| Above 400% | Full Charges |
Who is eligible for Sliding Fee Scale A?
- Uninsured individuals with exemptions obtained through the Health Insurance Marketplace:
- Unaffordable Coverage Exemption: The lowest-cost bronze plan available through the Marketplace exceeds 8% of your income.
- Hardship Exemptions – includes any of the following situations:
- You are homeless.
- You were evicted in the past 6 months or were facing eviction or foreclosure.
- You received a shut-off notice from a utility company.
- You recently experience domestic violence.
- You recently experienced the death of a close family member.
- You experienced a fire, flood, or other natural human-caused disaster that caused substantial damage to your property.
- You filed for bankruptcy in the last 6 months.
- You had medical expenses you couldn’t pay in the last 24 months.
- You experienced unexpected increases in necessary expenses due to caring for an ill, disabled or aging family member.
- You expect to claim a child as a tax dependent who’s been denied coverage in Medicaid and another person is required by court order to give medical support to the child.
- As a result of an eligibility appeals decision, you’re eligible either for: 1) enrollment in a qualified health plan (QHP) through the Marketplace, 2) lower costs on your monthly premiums, 3) cost-sharing reductions for a time period when you weren’t enrolled in a QHP through the Marketplace.
- You received a notice saying that your current health insurance plan is being cancelled, and you consider the other plans available unaffordable.
- You experienced another hardship in obtaining health insurance coverage.
- Exemption for American Indians and others who are eligible for services from an Indian health care provider.
- Exemption for individuals who are/were incarcerated within the calendar year.
- Individuals must apply for these exemptions through the Health Insurance Marketplace (www.healthcare.gov) and provide North Coast Health with their Exemption Certificate Number to qualify for Sliding Fee Scale A. At this time, these exemptions can be obtained only by printing out the appropriate application from www.healthcare.gov and mailing the completed application with the supporting documentation required. North Coast Health has trained assisters available on-site to assist you with this process if needed.
- Uninsured individuals not eligible for Marketplace plans because they are not legally present in the U.S.
- Uninsured individuals who have been legal residents of the U.S. for 5 years or less who fall below 138% of the federal poverty level and are ineligible for Medicaid
- Under-insured individuals – Those with insurance coverage that is inadequate for them to receive the care they need due to out-of-pocket expenses required by their policies that they cannot afford (e.g., high-deductibles, high co-pays, coverage riders, etc.). This category includes individuals with Medicare but do not have Medicare Part B or Medicare Part D.
Sliding Fee Scale B
Sliding Fee Scale B has been established for uninsured patients that do not have the above exemptions from coverage:
| Federal Poverty Level | Co-Pay Amount |
| 0 – 138% | $20 |
| 139 – 250% | $30 |
| 251 – 400% | $40 |
| Above 400% | Full Charges |
The above co-pays represent significant discounts from the actual cost of care provided in an office visit, as it is our goal to provide access to care to as many individuals in need as possible.
Patients are expected to pay their required co-payments at the time of service.
- If the patient cannot pay the co-payment at the time of the visit they will be expected to pay that co-payment at the next visit, but they will not be denied service.
- If the patient has not made any payment after three visits, patient will be referred to intake staff to establish a mutually acceptable payment arrangement.
- If at any time the patient owes an amount equal to the co-payments of six visits or greater, no further visits will be scheduled. The intake staff will continue to work with the patient to get the balance paid down.
- There may be patients where it is obvious they will not be able to make payments of any size. These patients will be set up as charity care as approved by the Executive Director.
Patients may be responsible for the visit co-payment if they do not show up for a scheduled appointment or do not provide 24-hour notice of a cancellation.