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CABARRUS COUNTY HEALTH DEPARTMENT
<br />MATERNAL HEALTH PROGRAM FEE SCALE - (GROSS INCOME)
<br />
<br />Family No 20% 40% 60% 80% Full
<br />S iz e Pay Pay Pay Pay Pay Pay
<br />
<br />1 $0- 5,979
<br />2 $0- 8,019
<br />3 $0-10,059
<br />4 $0-12,099
<br />5 $0-14,139
<br />6 $0-16,179
<br />7 $0-18,219
<br />8 $0-20,259
<br />9 $0-22,299
<br />10 $0-24,339
<br />
<br />$ 5 980-$ 7 474
<br />$ 8 020-$10 024
<br />$10 060-$12,574
<br />$12 100-$15,i24
<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-$12 029
<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 />Non-Stress Fetal/Test
<br />
<br />$10.00 $20.00 $30.00 $40.00 $5o.00
<br />$ 7.00 $14.00 $22.00 $29.00 .$36.00
<br />$ 7.00 $14.00 $21.00 $28.00 $35.00
<br />$ 5.00 $10.00 $15.00 $20.00 $25.00
<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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