Resources / Cost & Payment
Cost & Payment: The Sliding Fee Scale Explained
How FQHCs determine what you pay — and what to do if you can't afford anything.
How the Sliding Fee Scale Works
FQHCs are federally required to charge fees based on patients' ability to pay using a sliding fee discount schedule. Your fee is determined by two things: your household income and your family size, measured against the federal poverty level (FPL).
2025 Federal Poverty Levels (Reference)
| Family Size | 100% FPL | 150% FPL | 200% FPL |
|---|
| 1 | $15,650 | $23,475 | $31,300 |
| 2 | $21,150 | $31,725 | $42,300 |
| 4 | $32,150 | $48,225 | $64,300 |
| 6 | $43,150 | $64,725 | $86,300 |
Typical Fee Tiers
Tier 1 (≤100% FPL)— Nominal fee — may be $0
$0–$20 per visitTier 2 (101–150% FPL)— Reduced fee
$20–$40 per visitTier 3 (151–200% FPL)— Discounted fee
$40–$80 per visitTier 4 (>200% FPL)— Insurance billed; uninsured pay full rate
Full cost or insuranceFees vary by clinic. This is a general range — always confirm with the specific clinic.
Proof of Income: What to Bring
Most FQHCs accept any of the following:
- Recent pay stubs (last 30–60 days)
- Most recent federal income tax return (1040)
- Social Security, disability, or pension award letters
- Unemployment benefit statements
- Self-written income statement (self-attestation)
No income? Write a brief statement saying so. FQHCs are accustomed to this and will typically charge $0 or a minimal nominal fee.
What Counts as "Household Income"?
Household income includes all income received by everyone in your household:
- Wages, salaries, tips
- Self-employment income
- Social Security, disability, pension
- Unemployment benefits
- Child support or alimony received
- Rental income
What If I Can't Afford the Fee?
Tell the front desk. FQHCs cannot legally deny care for inability to pay a sliding fee. Options include:
- Fee waiver for hardship cases
- Payment plans
- Deferred payment
- Referral to an even lower-cost clinic or charity care program