Sliding Fee Discount Program

Key facts

Required by

Section 330(k)(3)(G) of the Public Health Service Act

Regulations

42 CFR 51c.303 and 42 CFR 56.303

Full discount

Income at or below 100 percent of the Federal Poverty Guidelines

Partial discounts

Income above 100 and up to 200 percent of the Federal Poverty Guidelines

Applies to

Health Center Program awardees and look-alikes; also required at NHSC sites

What is a sliding fee discount program?

Health centers funded or designated under the Health Center Program must make sure no patient is denied service because of inability to pay. The sliding fee discount program is how they do it: a written set of policies, a discount schedule and procedures for checking income and family size.

The program is defined in Chapter 9 of the Health Resources and Services Administration (HRSA) Health Center Program Compliance Manual. National Health Service Corps sites must also offer a sliding fee discount to low-income patients.

How the discount schedule works

A compliant sliding fee discount schedule follows this structure:

• At or below 100 percent of the Federal Poverty Guidelines (FPG): full discount, although a nominal charge may be collected.
• Above 100 and up to 200 percent of the FPG: partial discounts in several pay classes based on income and family size.
• Above 200 percent of the FPG: no sliding fee discount is required.
• The schedule is updated when the federal poverty guidelines change and is approved by the health center board.

Why sliding fee programs matter

Sliding fee discounts make health centers the default care option for uninsured and underinsured people, which shapes their payer mix and the revenue data reported in the Uniform Data System. For patient assistance and market access teams, the discount structure explains why uninsured patients concentrate at health centers. For compliance teams and consultants, the program is one of the requirements HRSA checks during operational site visits.

Common misconceptions about sliding fees

A nominal charge is not a minimum fee or a copay: HRSA expects it to be a small, flat amount that does not create a barrier to care. Sliding fee discounts are also not limited to uninsured patients. Insured patients who qualify by income can receive discounts on out-of-pocket costs, as long as the discount is consistent with the terms of their insurance contracts.