What is a medical sliding scale? How to find a lower-cost clinic

A sliding fee scale is a set of reduced prices based on a person's income and family size. In simple terms, a person with less income may be charged less for an eligible service.

This guide focuses on sliding-fee discount programs at health centers supported by HRSA. It does not describe every private clinic, hospital, dental office, or assistance program. Their policies may use different rules.

How to find a sliding-scale clinic

Begin with HRSA's official Find a Health Center directory. Search by address, city, or ZIP code, then call the individual center. HRSA reports that its funded network includes about 1,400 health centers operating more than 16,200 service sites.

The directory identifies health centers, but it does not guarantee that a particular location offers the service, appointment, or price you need. Confirm those details directly.

It is a discount—not health insurance

A sliding-fee program changes what an eligible patient is charged at that health center. It does not create an insurance plan, and it does not guarantee that every service, test, medication, referral, or outside provider will be discounted.

Ask which services use the sliding fee schedule and which may follow a different schedule. Medical, dental, pharmacy, and other services may not all have the same charge.

Who can ask for it?

HRSA says anyone may use a community health center, whether or not they have insurance. For the HRSA sliding-fee program, eligibility is based on income and family size—not simply on whether someone is insured.

This means an uninsured person can apply, and an insured person may also be assessed for a discount on eligible out-of-pocket costs. Insurance contracts or other legal requirements can affect how a discount is applied.

How the income levels work

HRSA-funded health centers use the current Federal Poverty Guidelines when building their sliding-fee schedules:

• At or below 100% of the guidelines: the health center provides a full discount or may charge a small nominal amount.
• Above 100% and at or below 200%: the center provides partial discounts through several income levels.
• Above 200%: the federal sliding-fee schedule does not require a discount, although the center may have other assistance or payment options.

The dollar amounts change with family size and when the federal guidelines are updated. The health center—not a general website—must place an applicant in the correct category under its current policy.

“Nominal charge” does not always mean free

A health center may choose to charge a small flat amount to people at or below 100% of the Federal Poverty Guidelines. HRSA describes this as a nominal charge rather than a copay or minimum fee. The center sets the amount under federal requirements.

Ask for the actual amount before the visit and whether laboratory work, imaging, medication, dental work, referrals, or other services could create separate charges.

What information may be requested?

The health center decides how it will document income and family size. It may ask for items such as recent pay information, a tax return, benefit statements, or another form of income verification. Requirements vary, so request the clinic's current written application before gathering documents.

If you do not have the usual document, ask what alternative information the policy permits. Do not send income records, identification numbers, insurance cards, tax documents, or medical information to The Health Question.

Use this script when you call

“I would like to apply for your sliding-fee discount program. Is eligibility based on income and family size? Please tell me what documents you need, what I may be charged, and which services are not included.”

• Can you send me the current policy and application?
• How do you define family or household size?
• Which income period and documents do you use?
• Is there a nominal charge?
• Do medical, dental, laboratory, and pharmacy services use different schedules?
• When must I apply or renew?
• What happens if I cannot provide the usual income document?

Do not confuse it with hospital charity care

A health center sliding-fee program and a hospital Financial Assistance Policy are related ideas, but they are not the same program. A hospital may use different income limits, household definitions, deadlines, and documentation rules.

If your question concerns a hospital bill, begin with our guide to hospital financial assistance. If you need a place to receive care, use our guide to finding lower-cost care without insurance.

Costs that may not be included

HRSA explains that a health center may use separate discount schedules for different services, such as medical and dental care. Prescription drugs, dentures, and eyeglasses are not automatically subject to the same federal sliding-fee requirements as the related clinical service. Ask about each cost separately.

What to do today

1. Find a nearby HRSA health center.
2. Ask whether it offers the service you need.
3. Request the sliding-fee policy and application.
4. Confirm how income and family size are defined.
5. Gather only the documents the center requests.
6. Ask what you will be charged and what is separate.
7. Keep a copy of the application and decision.

Official starting points

• HRSA: Who can use a health center?
• HRSA: Find a Health Center
• HRSA Health Center Program: Sliding Fee Discount Program
• HRSA: Health Center Program compliance FAQs

Sources last checked September 8, 2026. Federal Poverty Guidelines, clinic policies, required documents, services, locations, and charges can change. Verify the current policy directly with the health center.

This article provides general U.S. educational information. It does not determine eligibility, calculate a personal discount, estimate a specific charge, or provide medical, insurance, legal, or financial advice.