Sliding Fee Scale Program

Providing Affordable, Quality Care for All

At Hope, we believe that everyone deserves access to excellent, compassionate healthcare that is affordable. As a Federally Qualified Health Center (FQHC) , we provide high-quality care to everyone, regardless of their ability to pay. We understand that managing health conditions and seeking medical care can be stressful and overwhelming. We strive to make the process as easy, stress-free, and culturally inclusive as possible. Our team of dedicated healthcare professionals and encompassing staff are here to support you and provide the care and resources you need to improve your health and well-being. We are committed to serving our community and providing the highest level of care to everyone who comes through our doors.

How it Works

To provide affordable care to all of our patients, we offer a Sliding Fee Scale that allows us to reduce or “slide” fees based on income level, family size, and the Federal Poverty Guidelines. Patients living at 100% of the Federal Poverty Level receive a full discount and pay only a nominal fee of $40 for services. Patients between 101-200% of the Federal Poverty Level receive partial discounts, and patients above 201% of the Federal Poverty Level do not receive a discount and pay the full charge amount ($200 per visit).

Any patient can apply for the Sliding Fee Scale (SFS) Program, regardless of whether they are uninsured, underinsured, or have commercial insurance. If an insured patient qualifies for our SFS program and is determined to be living at 100% or lower of the Federal Poverty Level, they will receive a full Sliding Fee Scale discount. If their insurance requires a copay, they will pay the lesser of the two amounts.

To apply for our SFS program, please bring proof of income such as a prior year W2, two most recent pay stubs, a letter from your employer, or Form 4506-T (if a W-2 was not filed). Self-employed individuals will need to provide information on the last three months of income and expenses for their business. The verification process only takes a few minutes and can be completed in our office. Our Insurance & SFS Eligibility Coordinator works with each patient/ family applying and assists them with the application. Stop by our office today and fill out an application! 

The sliding fee fee scale discount program utilizes your household size and income level to determine what slide you qualify for. 
 
First identify how many people live in your household. 
 
Next, find the income level for your household in the row that corresponds to the number of individuals in your household. Once identified, look at the Slide letter & percentage in the same column. The sliding fee scale amount is listed in the same column. 
 
Examples: A one (1) person household with an annual income of $14,580 or lower would be eligible for Slide A. This means the ‘slide’ and the out of pocket cost the patient is responsible for would be $40. 
 
 A three (3) person household with an annual income between $33,064.01 – $41,268 would be eligible for Slide C. This means the ‘slide’ and the out of pocket cost the patient is responsible for would be $60. 
 
 A six (6) person household with an annual income between $40,280.01 – $53,572 would be eligible for Slide B. This means the ‘slide’ and the out of pocket cost the patient is responsible for would be $50.
Persons in Family/Household
Poverty Guideline
1
$15,060
2
$20,440
3
$25,820
4
$31,200
5
$36,580
6
$41,960
7
$47,340
8
$52,720

Sliding Fee Scale Program Application

Sliding Fee Scale Application

Form to Complete

Solicitud de Escala de Tarifa Deslizante

Form to Complete

We are committed to serving our community and providing the highest level of care to everyone who comes through our doors.