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Download the Sliding Scale Application
Complete, sign, and date the application.
You have several options for returning the completed application and all required documentation for review.
In Person: Return the completed application and documentation to any Mosaic location.
Mail: Mosaic PO Box 6679, Portland, Or 97228-66793
Fax: 541-383-1883
If your application is approved, we request that you report any changes of income, address, and/or contact information within 10 days of the change to Mosaic’s billing department by calling 541-617-5369.
Frequently Asked Questions
Who can apply?
Mosaic offers a Sliding Scale discount program to all patients regardless if they are insured, uninsured, or under-insured patients. Eligibility is determined by household income at or below 200 percent of the Federal Poverty Guidelines.
What does this program cover?
Our Sliding Scale discount program applies to all programs and services at Mosaic, including medical, dental and mental health. Different programs may have different fee schedules. Patients who are eligible for the Sliding Scale discount program will pay fees based on their eligibility category.
The Sliding Scale discount program remains in place for one year.
How much will the sliding scale payments cost?
Fees range from $0-20 depending on your income and household size.
What is required to apply?
To apply, you will be asked to provide current proof of household gross income (total pay before taxes) for anyone living in the household that is over the age of 18.
Acceptable forms of proof include:
- Paycheck stubs
- Tax return
- Social Security statements
- Income from self-employment, alimony and/or child support, public assistance
Please note that proof of income is not a requirement to be seen in our clinics. However, in order to apply for our Sliding Scale Discount Program or OHP you must have proof of income at your first appointment.
I don't know if I will be eligible. Should I still apply?
Even if you think you won’t qualify for the sliding scale program, you are encouraged to apply. Completing the application may open up other opportunities within Mosaic to financially support your care.
When will I find out if my application has been approved?
The process to review and approve an application normally takes around five days.
Will Mosaic's sliding scale plan be valid at other health care providers?
No. Our sliding scale plan is valid for Mosaic services only.
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