Sliding Fee Scale

RPCN Sliding Fee Scale Discount Program (SFS)

RPCN offers access to quality health care for patients who don’t have insurance or don’t have enough insurance through a sliding fee discount program, with discounts available, based on your current household size and income. The Program can cover you for up to 12 months—a new application is required yearly or when your household size and income changes, whichever is sooner.

This program allows you to see Doctors and Dentists at RPCN Community Health Centers and offers access to lab, x-ray and prescriptions at a discount. If you receive medical or dental services from someone other than your RPCN provider, you may be responsible for the full cost of that visit.

If you have been approved for our RPCN Sliding Fee Scale Discount Program, you are currently a patient at one of our health centers, and you’re still struggling to afford your prescription medications, you might be eligible for our Prescription Assistance Program.

Once you are approved under the Sliding Fee Scale Discount Program, you’ll be issued an ID Card stating that you are a patient of RPCN. This is not an insurance card and it cannot be presented as such to outside of the RPCN Network.

Call your local RPCN Community Health Center to see if you qualify:

Livingston CHC: 585-243-7840

Rushville CHC: 585-554-4400

Utica CHC: 315-793-7600

Wayne CHC: 877-554-6805

What documents* do I need to bring to my appointment?

Wages and Salary

  • Paycheck Stub (4 Consecutive Pay Periods)
  • Current Income Tax Return

Self-Employed

  • Signed and Dated Federal & NYS  Income Tax Return and All Schedules
  • Records of Earnings and Expenses

Social Security

  • Award Letter
  • Benefit Letter

Insurance Status

  • A NY State Medicaid, Family Health Plus or Child Health Plus determination, if applicable.

Unemployment Benefits

  • Award Letter
  • Benefit Check

Child Support/ Alimony

  • Letter from Court
  • Child Support/ Alimony Check Stub

Workers Compensation

  • Award Letter
  • Check Stub

*No documentation will be returned unless specifically requested.

Common Questions About the Sliding Fee Scale

Who is considered a household member for determining household size?

All persons living in one household are considered household members.

Who in the household is eligible for Sliding Fee Scale once Household Size is determined?

Any member of the household listed on the application as legally binding and 19 years of age and older (any child 18 years and younger should be eligible for Medicaid) would be eligible to receive the Sliding Fee Scale discounts if eligibility requirements are met. 

How often do I need to apply for the Sliding Fee Scale?

You must re-apply every year or if there is a change in your current household size or income.

If I do not want to share financial information, am I still eligible for Sliding Fee Scale?

Eligibility for the Sliding Fee Scale is largely determined by your financial situation. If you choose not to provide your local RPCN Community Health Center with this information, you will be selected as “Self Pay” status and will be responsible for charges in total for all services during any visit to RPCN.

If I am eligible for Medicare, but unable to afford the cost of Medicare, am I eligible for Sliding Fee Scale?

No, patients eligible for Medicare are not eligible for the RPCN Sliding Fee Scale because RPCN is a payer of last resort, which means that RPCN will pay last where other insurance is present. If you are having difficulty affording the cost of Medicare, we can refer you to a member of our Care Management Team who can assist you with an agency that may be able to help with your individual situation.

If I am self-employed or have income from a business how is my income determined and what forms of documentation do I need to submit to apply for Sliding Fee Scale?

If you are self‐employed or own a business, proper documentation would include your State and Federal tax return. The line on the tax return labeled as “Adjusted Gross Income” is used to determine income. We would also ask for all supporting schedules as well.

If I am self-employed or own my own business and my Sliding Fee Scale is set to expire before April 15th of the year and/or if I will be filing for an extension on my tax return, what do I need provide for documentation to apply for my Sliding Fee Scale?

  • If you are due to have your income verified between January 1st and April 15th and have not yet completed your tax return, we will ask you to sign a declaration of income that you will report on your tax return. A declaration of income is a form where you document what you get paid, how you get paid, how often, and who your employer is.
  • We will extend your Sliding Fee Scale eligibility until April 15th and you will submit your tax return to RPCN once it is completed.
  • If the amount you reported in your declaration of estimated income is different from the tax return you submitted to the IRS, you will be responsible to pay for any differences in that change—or you will be credited if we overcharged you.
  • If it is after April 15th and you are filing for an extension on your tax return, you will also be required to submit a copy of the extension form filed with the IRS.
  • We will extend your Sliding Fee Scale eligibility for 30 days based on your declaration of income and you must provide documentation within those 30 days to remain eligible.
  • If the amount you reported in your declaration of estimated income is different from your tax return submitted to the IRS, you will be responsible to pay for any differences in that change—or you will be credited if we overcharged you.