SLIDING FEE SCALE
As a Federally Qualified Health Center Look-Alike, Land of Goshen Treatment Center, Inc. offers discounted services to clients who are uninsured and/or meet the below income thresholds. We also provide discounted substance abuse counseling for clients with low income who have medical insurance that does not cover behavioral health services. The amount a client pays is based on the federal poverty levels, income, and number of dependents. Each year the federal government sets a Federal Poverty Line (FPL) and new income levels that qualify clients for discounted care. The income levels are based on a client’s gross income (how much money you make each year before taxes are taken)
How do I qualify?
To qualify for the Land of Goshen Treatment Center Sliding Fee Scale, you must bring proof of your “household” gross annual income. A “household” includes legal children, a civil union partner or married spouse, and legal dependents. Annual gross income includes salary, unemployment benefits, disability or social security benefits, investment income or other sources of income that support the household. You should bring proof of all of the household income for yourself and everyone in your household. Applicants must provide one of the following: prior year W-2, two most recent pay stubs, letter from employer, or Form 4506-T (if W-2 not filed). Self-employed individuals will be required to submit detail of the most recent three months of income and expenses for the business. Adequate information must be made available to determine eligibility for the program. Self-declaration of Income may only be used in special circumstances. Specific examples include participants who are homeless. Clients who are unable to provide written verification must provide a signed statement of income, and why (she/he) is unable to provide independent verification. This statement will be presented to Business Office Manager or his/her designee for review and final determination as to the sliding fee percentage. Self-declared clients will be responsible for 100% of their charges until management determines the appropriate category
How do I apply?
To qualify, complete the Land of Goshen Treatment Center Fee Application 2019 and bring it with you to your next appointment or ask for a copy of the application at the registration desk of any Land of Goshen Treatment Center locations. The Business Office Manager will guide you through the process and determine your eligibility. If you have questions about the Sliding Fee Scale, please contact the registration desk of your outpatient location:
- Reflections Counseling- Ironton (740)442-7758
- New Hope Creation Center-Malta (740)651-5021