Patient Payment

DHC accepts  Medicaid, Medicare MSCAN, CHIPS, most private insurances and other third party payer sources..

Payment is expected at the time of service.  However, a medical provider will see you regardless of your ability to pay.  Cash, personal checks, money orders, and credit cards are acceptable forms of payment.  

NOTE: If you are a new patient, please arrive 15 minutes early.

Delta Health Center | Pediatric Care | Mississippi Delta

Sliding Fee Scale

If you do not have insurance and/or have low income, you may qualify for sliding fee discounts.  Eligibility for discount is determined using the Department of Health and Human Services’ Poverty Guidelines.  While you may sign a self-declaration of income upon your first visit, you must bring in proof of income before your second visit or you will be assessed the full charges for services.

Proof of income must be shown by:

  • Current pay stubs

  • Tax forms W-2 or 1099

  • Most recent profit and loss statements, if self-employed

  • Letter from your employer

  • Documents showing income from unemployment, social security disability or death benefits, alimony, child support, public assistance, pension, adoption assistance, divorce decree, separation agreement, or other court filed agreement with amount and length of agreement.

 

  0% 20% 40% 60% 80% 100%
  100% of FPL 100.01 – 120% of FPL 121.01 – 140% of FPL 141.01 – 160% of
FPL
161.01 – 180% of
FPL
 181.01 – 200% of
FPL
Family Size From To  From To  From To  From To  From To  From To 
1 $0 $12,140 $12,141 $14,568 $14,569 $16,996 $16,997 $19,424 $19,425 $21,852 $21,853 $24,280
2 $0 $16,460 $16,461 $19,752 $19,753 $23,044 $23,045 $26,336 $26,337 $29,628 $29,629 $32,920
3 $0 $20,780 $20,781 $24,936 $24,937 $29,092 $29,093 $33,248 $33,249 $37,404 $37,405 $41,560
4 $0 $25,100 $25,101 $30,120 $30,121 $35,140 $35,141 $40,160 $40,161 $45,180 $45,181 $50,200
5 $0 $29,420 $29,421 $35,304 $35,305 $41,188 $41,189 $47,072 $47,073 $52,956 $52,957 $58,840
6 $0 $33,740 $33,741 $40,488 $40,489 $47,236 $47,237 $53,984 $53,985 $60,732 $60,733 $67,480
7 $0 $38,060 $38,061 $45,672 $45,673 $53,284 $53,285 $60,896 $60,897 $68,508 $68,509 $76,120
8 $0 $42,380 $42,381 $50,856 $50,857 $59,332 $59,333 $67,808 $67,809 $76,284 $76,285 $84,760
9 $0 $46,700 $46,701 $56,040 $56,041 $65,380 $65,381 $74,720 $74,721 $84,060 $84,061 $93,400
10 $0 $51,020 $51,021 $61,224 $61,225 $71,428 $71,429 $81,632 $81,633 $91,836 $91,837 $102,040
11 $0 $55,340 $55,341 $66,408 $66,409 $77,476 $77,477 $88,544 $88,545 $99,612 $99,613 $110,680
12 $0 $59,660 $59,661 $71,592 $71,593 $83,524 $83,525 $95,456 $95,457 $107,388 $107,389 $119,320


Sliding Fee Scale