Sliding Fee Discount Program
As a Community Health Center, we offer a Sliding Fee Discount Program to all our patients based on household income and family size, which reduces the amount you pay for healthcare services. If you qualify you may pay 20-80% of the cost of most services.
To download the application click on the link below:
Sliding Fee Discount Program Application – English
Sliding Fee Discount Program Application – Spanish
Discounts are based on the annual guidelines provided by the federal government.
Sliding Fee Scale below:
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PAYMENT OBLIGATION |
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Slide A 0-100% FPG |
Slide B 101-125% FPG |
Slide C 126-150% FPG |
Slide D 151-175% FPG |
Slide E 176-200% FPG |
Slide F Over 200% FPG |
|
Medical** |
Patient Pays $20.00 Nominal |
Patient Pays $25.00 |
Patient Pays $30.00 |
Patient Pays $35.00 |
Patient Pays $40.00 |
No Discount |
|
Behavioral**
Dental Preventive** |
Same as medical |
Same as medical |
Same as medical |
Same as medical |
Same as medical |
Same as medical |
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$30.00 Nominal |
$35.00 |
$40.00 |
$45.00 |
$50.00 |
No Discount |
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FAMILY SIZE* |
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ANNUAL INCOME |
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1 |
$0 – $15,060 |
$15,601- $18,225 |
$18,226 – $22,590 |
$22,591 – $26,355 |
$26,356 – $30,119 |
$30,120 – ↑ |
|
2 |
$0 – $20,440 |
$20,441 – $25,550 |
$25,551 – $30,660 |
$30,661 – $35,770 |
$35,771 – $40,879 |
$40,880- ↑ |
|
3 |
$0 – $25,820 |
$25,821 – $32,275 |
$32,276 – $38,730 |
$38,731 – $45,185 |
$45,186 – $51,639 |
$51,640 – ↑ |
|
4 |
$0 – $31,200 |
$31,201 – $39,000 |
$39,001 – $46,800 |
$46,801 – $54,600 |
$54,601 – $62,399 |
$62,400 – ↑ |
|
5 |
$0 – $36,580 |
$36,581 – $45,725 |
$45,726 – $54,870 |
$54,871 – $64,015 |
$64,016 – $73,159 |
$73,160 – ↑ |
|
6 |
$0 – $41,960 |
$41,961 – $52,450 |
$52,451 – $62,940 |
$62,941 – $73,430 |
$73,431 – $83,919 |
$83,920 – ↑ |
|
7 |
$0 – $47,340 |
$47,341 – $59,175 |
$59,176 – $71,010 |
$71,011 – $82,845 |
$82,846 – $94,679 |
$94,680 – ↑ |
|
8 |
$0 – $52,720 |
$52,721 – $65,900 |
$65,901 – $79,080 |
$79,081 – $92,260 |
$92,261 – $105,439 |
$105,440 – ↑ |
Add the following Amounts for each additional family member per respective slide category: Slide A $5,380 | Slide B $6,725 | Slide C $8,070 | Slide D $9,415 | Slide E $10,760
*Example: Family of 9: Slide A – Family Size 9 = $52,720+ $5,380= $58,100 | Slide B – Family Size 9 = $65,900+ $6,725= $72,625 | Slide C – Family Size 9 = $79,080+ $8,070= $87,150
**When applicable, patient is responsible for all outside lab costs.
**The copay for behavioral visit will be waived if the patient comes in for both a Medical and Behavioral visit on the same day.