How the Sliding-Fee Scale Works (and How to Qualify)
A sliding-fee scale is a discount on your bill based on what you earn. Every community health center (also called an FQHC — Federally Qualified Health Center) is required by federal law to offer one. The less money you make, the more the discount covers — and if your income is at or below the federal poverty line, you pay only a small nominal fee. No one is turned away for being unable to pay.
How the discount is set
Health centers use the federal poverty guidelines — the same income chart the government updates every January — to decide your discount. The scale works in tiers:
- At or below 100% of the poverty level: you pay only a small, fixed nominal fee per visit.
- Between 100% and 200% of the poverty level: you get a partial discount that shrinks as your income rises.
- Above 200% of the poverty level: you're charged the clinic's standard fee, which is still often lower than a private office.
Your family size matters too. The more people in your household, the higher the income cutoff for each discount tier. You can check where your household falls on the official federal poverty guidelines.
How to qualify — what to bring
To set your rate, the clinic needs to see your income and household size. Bring what you can:
- A recent pay stub, last year's tax return, or an award letter (SSI, unemployment, Social Security)
- A photo ID, if you have one
- How many people live in and share income in your home
If you have no documents — or no income — go anyway. Staff can walk you through it, and a signed self-declaration is often enough. You do not need insurance, a Social Security number, or citizenship. See the full first-visit checklist →
A quick example
Say you're uninsured, single, and working part-time near the poverty line. At most private clinics a basic visit might run well over $100. At a community health center on the sliding scale, that same visit could cost only a nominal fee — often around the price of a copay — because the discount covers the rest. The exact amount depends on the clinic and your paperwork, so call ahead to ask.
Already on SNAP (food stamps), Medicaid, or TANF? You almost certainly qualify for the deepest sliding-fee discount — bring proof of that benefit. If you're not sure whether you qualify for food help too, our sister site AcceptsEBT.com covers SNAP.
Frequently Asked Questions
What is a sliding-fee scale?
A sliding-fee scale is a discount on your medical bill based on your income and family size. Community health centers are required by federal law to offer one. The less you earn, the bigger the discount — and at or below the federal poverty level you pay only a small nominal fee.
Do I have to have insurance to get the discount?
No. The sliding-fee discount is for everyone, insured or not. If you have no insurance, the discount applies to your whole bill. If you have insurance, it can help with copays and amounts you still owe.
How do I qualify for the sliding-fee scale?
You qualify by showing your income and household size. Bring a recent pay stub, tax return, or a letter, plus a photo ID if you have one. The clinic uses the federal poverty guidelines to set your discount. If you have no documents, go anyway — staff can help you apply.
What if I have no income at all?
You still get care. With income at or below the federal poverty level, you pay only a small nominal fee per visit, and no one is turned away for being unable to pay. Ask the front desk how to document zero income — a signed statement is often enough.
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Sources: HRSA Health Center Program sliding-fee discount requirements (Section 330, Public Health Service Act); HHS federal poverty guidelines. This is directory and program information, not medical or financial advice. Last reviewed July 2026.