Sliding Fee Scale (Sliding Fee Discount Schedule)

The Sliding Fee Discount Schedule (SFDS) is based upon services rendered and has four-discount pay classes between 100% and 200% or less of the Federal Poverty Guidelines (FPG).

Our clinic provides a full discount for services included in the primary care standards of care to patients at or below 100% of the FPG. The SFDS utilizes three discount pay classes for individuals and families with incomes above 100% FPG and up to 200% FPG. In addition, individuals and families with income over 200% FPG do not qualify for sliding fee discounts.

  • 0-100% FPG – $20 nominal fee is requested based upon service
  • 101.01-132.99%FPG – 75% discount of charges
  • 133-165.99% FPG – 50% discount of charges
  • 166-200% FPG – 25% discount of charges
  • Over 201% FPG – no discount of charges

Frequently asked questions about the Sliding Fee Scale Program.

What is a Federally Qualified Health Center (FQHC)?

Federally Qualified Health Centers are community-based health care providers that receive funds from the HRSA Health Center Program to provide primary care services in underserved areas.

What is a sliding fee program?

A program designed to reduce the cost of primary care for those who meet income requirements. These discounts are available to patients based on the guidelines provided annually by the federal government.

How would I benefit from the sliding fee program?

If you qualify, medical services provided in-house may be substantially discounted depending on eligibility.

What is covered under the sliding fee scale?

Not all services are covered under the sliding fee program. Medical services provided “in-house” are eligible for a sliding fee discount. “In-house” refers to medical services provided at the clinic such as labs, x-rays, EKG’s, immunizations and office visits. Any specialty visits or diagnostics sent to reference labs or hospitals are not covered under the sliding fee program. For example, pathology specimens are not processed in house so you will be billed directly for those services.

I would like more information on your sliding fee program. How do I apply?

You will need to submit an application and provide proof of total household income. We have applications available on site or on Rural Health Care’s website:

What are acceptable forms of proof of income?

Acceptable forms of income include your most recent income tax return, copy of your W-2, or 2 recent pay stubs (from all working members of the household.)

My income has changed recently. Can I reapply for the sliding fee program?

Yes, we ask that you reapply anytime there is a change in your household income.

It appears that I will qualify for a sliding fee but I have insurance. Can I still apply?

Yes. Patients may apply whether or not they have other insurance coverage. If you are approved, the program can help with any remaining balance after insurance has been applied.

I do not have a Medicare supplement. Would I be eligible for a sliding fee?

Yes, you may be eligible for a sliding fee. You will need to fill out an application and provide proof of income to be considered for the program.

Do I have to include all members of my household on the application?

Yes. All members living in the same household need to be listed on the application, whether related or not.

I have a 19 year old child living in my house with no source of income. Do I need to include him on the sliding fee application?

Yes, anyone over the age of 18 claiming “zero income” must sign a Zero Income Attestation.

My only source of income is social security but it is directly deposited in my bank. How can I show proof of income?

A copy of your social security award letter or a copy of your bank deposit statement are
acceptable forms of proof of income.

I am unable to pay the nominal fee today. Do I need to reschedule?

No, it is not necessary to reschedule. As a FQHC, we see patients regardless of their ability to pay. You will still be responsible for the nominal fee but we are able to bill that to you for today’s visit.

I may qualify for a sliding fee discount. If I complete the sliding fee application, will it cover my visit today?

Yes, as long as the application is received at the administrative office within 30 days of today’s visit. Discounts will be applied retroactively for a 30 day period.

I have completed the application and provided proof of income. Now what?

You can mail the completed application to the address listed on the form or drop if off at the clinic. Typically, applications are reviewed within 3-5 days of receipt. You will receive a letter and welcome packet in the mail informing you of your discount, if applicable.

I received a letter stating I qualified for a sliding fee discount. How long is this effective?

The application is approved on a yearly basis. You will need to reapply each year in order to utilize the program.

Since I qualified for a sliding fee discount last year, do I still need to go through the application process again?

Yes, enrollment expires every year and a new application is required at that time.

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