Sliding Fee Discount

Northeastern Rural Health Clinics provides a sliding-fee discount for uninsured and underinsured patients to ensure that quality health care is readily accessible to everyone.

What is the Sliding Fee Discount?

Northeastern Rural Health Clinics offers a Sliding Fee Discount Program to uninsured and underinsured patients, per HRSA/PBHC guidelines.

This program is applicable to all individuals and families with an annual income at or below 200% of the Federal Poverty Guidelines. Patients above 200% do not qualify for the Sliding Fee Discount Program.

Dental Sliding Fee Schedule Medical Sliding Fee Schedule Federal Poverty Guidelines 2022

To Those Who Qualify:

  • Your discounted amount is to be paid at the time of service.
  • You are obligated to contact Northeastern Rural Health Clinics if there are changes to your income level or family size.

How to Apply

Ask one of our Patient Support Coordinators for a Sliding Fee Discount Program Application to find out if you qualify or fill out the application below and bring it to your next appointment.

On your application you must provide the following:

  • Family Size – Persons related by birth, marriage or adoption only. Dependents must be under the age of 18.
  • Proof of Income – Two of your most recent pay stubs, monthly bank statements, the prior years income tax return or the prior years  W-2 forms.

If no income is reported, a note explaining your living situation and how your monthly expenses are being met must be written on the back of the application.

Fillable Sliding Fee Application

Per the Census Bureau, income is defined as the amount of money income received in the preceding calendar year before payments for personal income taxes, social security, union dues, Medicare deductions, etc.

Per the Census Bureau, family is defined as a  group of two people or more (one of whom is the householder) related by birth, marriage, or adoptions and residing together. All such people (including related subfamily members) are considered as members of one family. For purposes of the Sliding Fee Discount Program, however, family may include a single individual who is counted as one person for “family size”.