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Health First Community Health Center

Serving patients in western Kentucky

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Patient Assistance Programs

Sliding Fee Scale Discount Program

Health First provides services to all patients, regardless of their ability to pay.  To assist patients who may have difficulty paying, Health First offers a sliding scale discount program for our uninsured and under-insured patients who meet the federal eligibility guidelines. Fees are determined based on income and household size as shown in the chart below.

Please use the buttons below to fill out the Sliding Fee Application online or to download the application.

After clicking the button to fill out the online application, enter your name and email address and click Begin Signing.

Online Sliding Fee Application

Download and Print Application

¿Hablas español? Por favor, utilice este enlace para llenar el formulario en español.

Solicitud en Línea

Descargar e imprimir la solicitud

 

Proof of Income

Proof of income is required for all household members over the age of 18 to determine which sliding fee scale will be assigned to each patient.

You must provide at least one of the following:

  • Prior year W-2
  • Two most recent pay stubs.
  • Letter from employer stating patient’s income. Health First would prefer document be on letterhead and must include employer’s name, address and phone number.
  • Form 4506-T (if W-2 not filed)
  • Form 1040 or 1040A
  • Social security letter for fixed incomes such as social security, disability, pension, etc.
  • Free lunch school form, which must include household size and income.
  • Most recent unemployment compensation documentation.
  • Letter of reference on letterhead from any 501(c) non-profit organizations such as homeless shelters or churches.
  • Letter from the patient’s medical provider stating patient is unable to work due to health condition, surgery, etc.
  • Self-employed are required to submit detail of the most recent 3 months of income and expenses for the business.

If approved, Health First will send you a card identifying your assigned slide class. Please show the slide card to the receptionist at each visit. The outreach specialist(s) will work with medical staff, pharmaceutical companies and local community resources to help provide medical and social needs (as needed). Outreach specialist(s) may utilize information from your application and income verification for enrollment in additional assistance programs. We will contact you in writing if you are denied for any reason.

Medication Assistance

Are you struggling to afford your medications? Health First may be able to help. We partner with community pharmacies and pharmaceutical companies to offer medication assistance to eligible patients. To see if you qualify or for more information contact the Outreach Department at 1-877-667-7017.

Text Us

Patients may text proof of income documents to our outreach department at 270-873-4162 from their mobile device.

Awards and Accreditations

Our Mission

To provide high quality, affordable health care and improve the well-being of our communities.

1-877-667-7017 Toll Free

Need Assistance? Text Us 270-873-4162

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This health center receives Health and Human Services (HHS) funding and has federal Public Health Service (PHS) deemed status with respect to certain health or health-related claims, including medical malpractice claims, for itself and its covered individuals." For more information, please see http://www.bphc.hrsa.gov/ftca/ [Regulations: 42 U.S.C. 254b and 42 U.S.C. 233(g)-(n)]


Este Centro de Salud recibe fondos de los Servicios Humanos y de Salud (Health and Human Services -HHS) y cuenta con el estatus de Servicio Público de Salud (Public Health Service -PHS) federal, con respecto a ciertas reclamaciones de salud o relacionadas con la salud, incluyendo malas prácticas médicas, para la institución misma y los individuos cubiertos”. Para más información, por favor consulte http://www.bphc.hrsa.gov/ftca/