Sliding Fee Discount Program

SEMO Health Network (SEMOHN) provides comprehensive medical and dental care to all patients regardless of their ability to pay.  To ensure the care is affordable for all patients, SEMOHN offers a sliding fee discount program.  Any patient, whether insured or uninsured, may apply for the sliding fee discount program as outlined by the U.S. Department of Health & Human Services.  The program allows a patient to receive a discount on services based on their family size and annual income compared to the Federal Poverty Guidelines.

In order to qualify for the sliding fee discount program, patients must complete the sliding fee discount program application paperwork and provide the appropriate proof of income. Patients cannot be seen on the sliding fee discount program until they have completed their sliding fee paperwork and have been approved by a SEMOHN employee. Enrollment must be renewed annually.

Acceptable proofs of income are as follows:

  1. Most recent tax return – PREFERRED
  2. Most recent W-2 or 1099
  3. Most recent check stub for patient’s working full-time (40 hours a week)
  4. Last three consecutive check stubs for patients working part-time (less than 40 hours a week) or seasonally
  5. Statement from employer
  6. Most recent unemployment check stub or benefits letter
  7. Pension, retirement, disability, or social security award letter Temporary Assistance to Needy Families Letter from Division of Family Services
  8. Court order settlements (example: child support)
  9. Any other written verifiable income statement – self-employment income needs to be verified by accounting records from the business.


Proof of income includes all persons living in the household.  Any household members determined to potentially qualify for Medicaid coverage are strongly encouraged to apply for Medicaid. Our staff is available to assist you with this process.  If the necessary paperwork is not provided, the appointment can either be rescheduled or standard charges will apply.

Below are charts detailing the net amount owed for Medical and Dental Services after the Sliding Fee Discount has been applied.

Sliding Fee Schedules

Medical Sliding Fee
sliding fee dental