How sliding-scale fees work at community health centers

Community health centers charge patients according to income and household size. This guide explains how that sliding fee scale works, who qualifies, what documents to bring, and what is usually not discounted.

The short answer. Health centers funded by the federal Health Center Program must offer a sliding fee discount to patients with household incomes at or below 200% of the federal poverty guidelines, and patients at or below 100% may be charged only a nominal fee. The discount depends only on income and household size, and you will need to show proof of both.

What the rule says

Health centers that receive Health Center Program funding from HRSA, and the look-alikes that follow the same rules, must have a sliding fee discount programme. The essentials:

Patients with household income at or below 100% of the federal poverty guidelines receive a full discount, though the center may charge a small nominal fee.
Patients between 101% and 200% receive a partial discount that shrinks as income rises, in steps the center sets.
Above 200%, a center is not required to discount, though some do.
The discount is based only on income and household size, and the same schedule applies to every patient who qualifies.
A center may not refuse service because a patient is unable to pay.

Each center writes its own fee schedule within those rules, so the price of a filling at one center can differ from the next one across town.

Do you qualify? The 2025 poverty guidelines

The guidelines are published by the Department of Health and Human Services each January. These are the 2025 figures for the 48 contiguous states; Alaska and Hawaii are higher. Check the current year's figures with the center, because they move every year.

Household size	100%	200% (top of the sliding scale)
1	$15,650	$31,300
2	$21,150	$42,300
3	$26,650	$53,300
4	$32,150	$64,300
5	$37,650	$75,300
Each extra person	+$5,500	+$11,000

A household earning under the 200% column is inside the sliding scale. Income is usually gross income — before tax — over the past year or projected from recent pay.

What to bring

Proof of income: recent pay stubs, last year's tax return, a benefits award letter (Social Security, unemployment, SNAP), or a letter from an employer. If you have no income, ask what the center accepts instead — many take a signed statement.
Proof of household size: often the same tax return, or the names and birth dates of the people you support.
Photo ID and proof of address, which some centers ask for to confirm you live in their service area.
Any insurance card, including Medicaid. Being insured does not stop you from using the sliding scale for what insurance does not cover.

Ask when you book whether the paperwork has to be done before the first appointment. Without it, many centers charge the full fee until it is complete.

What is usually not discounted

Some costs fall outside the scale or are discounted less. The common ones in dentistry:

Lab fees for dentures, crowns and bridges, which the center pays to an outside laboratory and often passes on.
Specialist work the center refers out, such as an oral surgeon or a root canal specialist. The outside practice sets its own fees.
Services the center does not offer. Many health center dental programmes focus on exams, cleanings, fillings and extractions.

Ask for the cost in writing before treatment starts. It is a normal request and a health center is used to it.

Getting an appointment

Demand is high, and waits for a routine first appointment can be weeks. Most centers hold some same-day or emergency slots for pain and swelling, usually released first thing in the morning — call as they open. Ask whether there is a waiting list for cancellations. And confirm that the site you are calling has a dental clinic: a health center with a dental programme may run it at only some of its addresses.

This guide is general information, not dental, medical or insurance advice. Rules and fees change; confirm with the clinic or agency concerned. See our disclaimer and how we build this directory.