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 Income Based


Myrtle Hilliard Davis offers a sliding fee program to help reduce barriers to access to healthcare services for our patients. The sliding fee scale applies to patients without health insurance who also do not qualify for Medicaid. The
sliding fee scale is based on household size and the poverty guidelines set by the U.S. Department of Health and Human Services. Patients are required to meet the income eligibility by submitting one or a combination of the
following for proof of household income:


  • Two or more of your most recent check stubs for all members of the household
  • A Letter from employer stating annual income
  • W-2 forms for all family members for the previous year
  • Federal Tax return from the previous year
  • Social security/entitlement statement from previous month
  • Letter from Division of Employment Security


Click here for the Sliding Fee Scale 2018

The annual income for the household must be calculated and documented in order to receive a discount as mandated by federal rules governing Federally Qualified Health Centers. Patients must complete paperwork provided by Registration Services before being seen under the sliding fee program. For additional information contact Registration Services at the site nearest you.

Acceptable Forms of Proof of Income:

  • State-issued identification or passport
  • Proof of residency
  • Last TWO consecutive paycheck stubs
  • Most recent unemployment compensation letter showing full weekly benefits
  • Current award letter for everyone in the household receiving Social Security disability, retirement, survivor benefits and/or SSI.

Our social workers can help manage your conditions and treatments by working with your primary care provider. They can also offer counseling support and can help connect you with the resources you may need. To work with a social worker, please give us a call!