We welcome everyone at CommuniCare+OLE. You don’t need health insurance to be a patient at CommuniCare+OLE. We never turn anyone away because they cannot pay.
For the sliding fee scale, please fill out the affidavit of income form and bring your proof of income for the current or prior month with you to your appointment. Proof of income can include your most recent pay stub or a signed statement of your income from your employer if you get paid in cash.
Sliding Fee Scale Attestation | Declaración Jurada de Ingresos
Application for Sliding Fee Scale
Sliding Fee Scale
- Sliding Fee Scale Attestation – English
- Sliding Fee Scale Application – English
- Declaración Jurada de Ingresos – en Español
- Programa de Escala de Descuento – en Español
List of acceptable documents
EARNED INCOME FROM EMPLOYER (PERMANENT OR TEMPORARY):
➢ One Pay Stub:
- Must show gross earnings and number of hours worked (Copy of the actual check is not acceptable because it doesn’t show gross income).
- Must be dated for current or prior month.
OR:
➢ Letter from Employer:
- Must show gross earnings, number of hours and dated from current or prior month.
- Must be signed by employer with contact information.
OR:
➢ Most recent W2 or Income Tax return (pay stubs preferred, may be more current).
SELF-EMPLOYED:
➢ Most recent Income Tax return.
OR:
➢ If no tax return has been filed, Extension Form.
UNEMPLOYMENT OR DISABILITY:
➢ One Check Stub must be dated from current or prior month.
OR:
➢ Award letter must be dated from current calendar year.
PUBLIC ASSISTANCE:
➢ Napa County Health & Human Services Agency “Passport to Services” with most current data.
OR:
➢ Recent Public Assistance application including financial information. MEDI-CAL (applied but not yet approved): ➢ Recent application including financial information.
CommuniCare+OLE accepts most health insurance plans and coverage including (but not limited to) Medi-Cal, Partnership Health Plan, Medicare, and County Medical Services Program (CMSP).
Billing
Payment is due at the time of service, but patients will not be turned away because they are unable to pay. If you don’t have insurance, we offer payment plans in addition to a sliding fee scale, which means we will work with you to find an amount you can afford.
Enrollment Services
We know that enrolling in health insurance can be confusing, overwhelming, or both. Our enrollment specialists can help you find and sign up for health coverage, regardless of employment or immigration status.
CommuniCare+OLE has a team of enrollment specialists who help community members, even if they are not CommuniCare+OLE patients, get connected to additional support and resources such as Medi-Cal, County Medical Services Program (CMSP), and CalFresh.
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