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CABARRUS COUNTY HEALTH DEPARTMENT
<br />MATERNAL HEALTH PROGRAM FEE SCALE (GROSS INCOME)
<br />
<br />Family N__9o 20% 40% 60% 80% Full
<br />Size Pay Pay Pay Pay Pay ~
<br />
<br /> 1
<br /> 2
<br /> 3
<br /> 4
<br /> 5
<br /> 6
<br /> 7
<br /> 8
<br /> 9
<br />10
<br />
<br />$0- 5 979
<br />$0- 8~019
<br />$0-10 o59
<br />$0-12 099
<br />$0-14 139
<br />$0-16 179
<br />$0-18 219
<br />$0-20 259
<br />$0-22 299
<br />$0-24 339
<br />
<br />$ 5,980-$ 7 474
<br />$ 8,020-$10 O24
<br />$10,060-$12 574
<br />$12,100-$15 124
<br />$14,140-$17 674
<br />$16,180-$20 224
<br />$18,220-$22 774
<br />$20,260-$25 324
<br />$22,300-$27 874
<br />$24,340-$30 424
<br />
<br />$ 7,475-$ 8 969
<br />$10,025-$12 O29
<br />$12,575-$15 089
<br />$15 125-$18 149
<br />$17 675-$21 209
<br />$20 225-$24 269
<br />$22 775-$27 329
<br />$25 325-$30 389
<br />$27 875-$33 449
<br />$30 425-$36 509
<br />
<br />$ 8,970-$10,464
<br />$12,030-$14,034
<br />$15,090-$17,604
<br />$18,150-$21,174
<br />$21,210-$24,744
<br />$24,270-$28,314
<br />$27,330-$31,884
<br />$30,390-$35,454
<br />$33,450-$39,024
<br />$36,510-$42,594
<br />
<br />$10,465-$11,959
<br />$14,035-$16,039
<br />$17,605-$20,119
<br />$21,175-$24,199
<br />$24,745-$28,279
<br />$28,315-$32,359
<br />$31,885-$36,439
<br />$35,455-$40,519
<br />$39,025-$44,599
<br />$42,595-$48,679
<br />
<br />$11,960+
<br />$16,040+
<br />$20,120+
<br />$24,200+
<br />$28,280+
<br />$32,360+
<br />$36,440+
<br />$40,520+
<br />$44,600+
<br />$48,680+
<br />
<br />For family units with more than 10 members, add $2,040 for each additional member.
<br />
<br />Complete (initial visit)
<br />Revisit (subsequent visit)
<br />Rhogam (for Rh negative patients)
<br />
<br />$10.00 $20.00 $30.00 $40.00 $50.00
<br />$ 7.00 $14.00 $22.00 $29.00 $36.00
<br />$ 7.00 $14.00 $21.00 $28.00 $35.00
<br />
<br /> Eligibility will be determined with each pregnancy. Income will be determined by declaration of income by patient; however, verification
<br />can be requested at the discretion of the eligibility specialist. Patients will be expected to pay according to the above fee scale.
<br /> Patients on sliding fee scale who fail to pay during a pregnancy and return to the health department for care with subsequent pregnancy
<br />will be referred to the program supervisor or nursing director prior to acceptance for care.
<br /> Patients with hospital insurance and excessive income will be referred to private care. If the patient is unable to obtain medical care
<br />within Cabarrus County (i.e., lack of up-front funds, owes doctor for previous services, doctors' appointments filled) patient can receive care
<br />at the Cabarrus County Health Department. Eligibility specialist will verify/document (using special form) that "patient is unable to receive
<br />care."
<br /> Insurance patients will be placed in the full pay category regardless of income. Insurance will be filed by the health department.
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