Phone: 402-451-3553 Home About Us Medical Dental Behavioral Health Pharmacy Community PCMH Give COVID-19 Contact Us Sliding Fee Scale Sliding Fee Discount Program To qualify for the Charles Drew Health Center, Inc. (CDHC) Sliding Fee Discount Program, you must fill out a Financial Assistance Application, reporting household size and gross annual income for household. Your family size includes: Patient applying Spouse/Partner Any children being supported in your household Anyone who is included on patient’s federal income tax return Bring in one of the following to report gross annual income: Pay stubs (from the past 60 days) W-2 form Unemployment statement Disability/Social Security papers Letter from employer Proof of No Income Worksheet All fees are due at the time of your visit. If you are not able to pay your fee at the time of your medical visit, you will need to speak with a Patient Financial Services Advocate to make arrangements for payment. If you are unable to pay your fee at the time of your dental visit, you will be asked to reschedule your appointment for a later date. Annual Income Range Family Size 1 $0 - $12,490 $12,491 - 15,613 $15,614 - 18,735 $18,736 - 21,858 $21,859 - 24,980 Over $24,981 2 $0 - $16,910 $16,911 - 21,138 $21,139 - 25,365 $25,366 - 29,593 $29,594 - 33,820 Over $33,821 3 $0 - $21,330 $21,331 - 26,663 $26,664 - 31,995 $31,996 - 37,328 $37,329 - 42,660 Over $42,661 4 $0 - $25,750 $25,751 - 32,188 $32,189 - 38,625 $38,626 -45,063 $45,064 - 51,500 Over $51,501 5 $0 - $30,170 $30,171 - 37,713 $37,714 - 45,255 $45,256 - 52,798 $52,799 - 60,340 Over $60,341 6 $0 - $34,590 $34,591 - 43,238 $43,239 - 51,885 $51,886 - 60,533 $60,534 - 69,180 Over $69,181 7 $0 - $39,010 $39,011 - 48,763 $48,764 - 58,515 $58,516 - 68,268 $68,269 - 78,020 Over $78,021 8 $0 - $43,430 $43,431 - 54,288 $54,289 - 65,145 $65,146 - 76,003 $76,004 - 86,860 Over $86,861 Charles Drew Health Center, Inc. is a FTCA deemed facility. Malpractice coverage is provided under the Federal Tort Claims Act (FTCA) pursuant to 42 u.s.c. 233(g)-(n). The Joint Commission • Email: CLICK HERE • Call: 800-994-6610 • Fax: 630-792-5636 • Online Form: CLICK HERE • Mail: The Office of Quality and Patient Safety, The Joint Commission, One Renaissance Boulevard, Oakbrook Terrace, Illinois, 60181. Quality Care For comments and concerns about patient safety and quality of care, please contact: Charles Drew Hotline: 402-216-9111 For a copy of our Patients Rights and Responsibilities PDF booklet, CLICK HERE! Quick Links Locations Make a Donation Sliding Fee Discount Program Careers Volunteer 2018 Annual Report Charles Drew Health Center, Inc. 2915 Grant Street Omaha, Nebraska 68111 Main Number: (402) 451-3553 WIC: (402) 451-3130 Copyright © 2018 | Charles Drew Health Center, Inc. | Privacy