What a sliding scale clinic is
A sliding scale clinic is a clinic whose fee depends on your household income and size, so the same visit costs less for a family with less money. The largest group are the federally funded community health centers (often called FQHCs), which by law cannot turn anyone away for inability to pay and must discount their fees according to income.[3]
Health centers offer primary care, and the law lists preventive dental services among the primary care they must provide; behavioral health care is listed as an additional service a center may offer.[3] In 2025, 1,356 health center grantees served 32.7 million patients; 17.2% of them were uninsured and about 90% of patients with a known income were at or below 200% of the poverty guideline.[5] Free clinics, some hospital clinics, dental schools and community mental health centers may also use sliding fees, but each sets its own rules.
Income limits for a sliding scale clinic in 2026
Health centers measure your income against the federal poverty guidelines, which HHS updates every January. The 2026 guideline is $15,960 for a single person and $33,000 for a family of four in the 48 contiguous states and DC.[4]
| Household size | 100%: full discount | 150% | 200%: top of the scale |
|---|---|---|---|
| 1 | $15,960 | $23,940 | $31,920 |
| 2 | $21,640 | $32,460 | $43,280 |
| 3 | $27,320 | $40,980 | $54,640 |
| 4 | $33,000 | $49,500 | $66,000 |
| 5 | $38,680 | $58,020 | $77,360 |
| 6 | $44,360 | $66,540 | $88,720 |
| 7 | $50,040 | $75,060 | $100,080 |
| 8 | $55,720 | $83,580 | $111,440 |
Alaska and Hawaii have their own, higher guidelines: $19,950 and $18,360 for one person, plus $7,100 and $6,530 per additional person.[4] The calculator above uses the right table when you pick your state.
How health center discounts work
Federally funded health centers must give a full discount at or below 100% of the guideline, partial discounts in at least three income bands between 101% and 200%, and no required discount above 200%.[1][2] The full-discount group may still be asked for a nominal fee.[2]
| Your income | What the rule requires | What you typically pay |
|---|---|---|
| At or below 100% of the guideline | Full discount | Nothing, or a small nominal fee per visit |
| 101% to 200% | Partial discount in at least 3 bands | A share of the full fee that rises with income |
| Above 200% | No discount required | The center's full fee; ask about a payment plan |
In the example in the calculator, a household of two earning $35,000 is at 162% of its guideline, inside the partial-discount band. The exact fee in each band is set by each center, so call and ask for its sliding fee schedule before the visit.[1]
What the full fee looks like before the discount
Health centers base their full fees on locally prevailing rates and their own costs, so the undiscounted fee is close to an ordinary self-pay price.[3] The discount comes off that.
| Service | Low | Typical | High |
|---|---|---|---|
| Doctor visit, new patient | $110 | $170 | $280 |
| Dental checkup: exam, bitewing X-rays, cleaning | $150 | $230 | $360 |
| Therapy session, 45 minutes | $110 | $160 | $260 |
| Routine blood work panel | $75 | $200 | $510 |
Medical prices are based on 2027 Medicare rates; dental fees are in 2026 dollars. For more detail see the doctor visit cost, therapy without insurance and blood work cost pages.
What affects what you pay at a sliding scale clinic
| Factor | Effect | Why |
|---|---|---|
| Household income | Lower income, lower fee | The discount band is set by income as a share of the poverty guideline |
| Household size | Larger household, lower band | Each added person raises the guideline |
| Where you live | Higher limits in Alaska and Hawaii | They have separate poverty guidelines |
| Type of clinic | Rules differ | Only federally funded health centers must follow the tiers above |
| Services outside the visit | Can add cost | Lab tests, imaging, drugs and specialist referrals may be billed by someone else |
Ways to pay less at a clinic
- Find a health center near you with HRSA's Find a Health Center search, which covers every federally funded site.[6]
- Ask the center which proof of income and household size it accepts, and bring it to the first visit, since the discount depends on both.
- For dental care, ask the health center first, then a dental school: see sliding scale dentists and dental schools.
- If a hospital bill follows a referral, apply for the hospital's financial assistance and use the steps in how to negotiate medical bills.
- If your income is low enough for a full discount, check whether you also qualify for Medicaid: see health insurance without a job.
In a crisis, do not wait for a clinic appointment.For a medical emergency call 911 or go to the nearest emergency room; hospitals must screen and stabilize you regardless of ability to pay.[7] For a mental health crisis, call or text 988.[8]
Frequently asked questions
What is a sliding scale clinic?
It is a clinic that charges less as your household income falls. Federally funded health centers must use a sliding fee scale based on the poverty guidelines, with a full discount at or below 100% and partial discounts up to 200%.[1]
Can a sliding scale clinic turn me away if I can't pay?
A federally funded health center cannot: the law requires that no patient be denied services because of inability to pay.[3] Free clinics and private practices set their own policies.
Do health centers offer dental care on a sliding scale?
Preventive dental care is one of the services federally funded health centers are required to provide, and their sliding fee covers the services they provide.[3] See dentists and dental schools with reduced fees for other options.
What income counts for a sliding fee?
Health centers compare your household's annual income before taxes with the poverty guideline for your household size, $15,960 for one person and $33,000 for four in 2026.[4] Ask the center which documents it accepts.
Sources
- Health Center Program Compliance Manual, Chapter 9: Sliding Fee Discount Program
- 42 CFR 51c.303: Project elements (health center sliding fee schedule)
- 42 U.S.C. 254b: Health centers (no patient denied care for inability to pay)
- 2026 Poverty Guidelines
- Health Center Program Uniform Data System (UDS) Data Overview, national, 2025
- Find a Health Center
- Emergency Medical Treatment & Labor Act (EMTALA)
- 988 Suicide & Crisis Lifeline