Sliding Fee Discount
Grace Health serves all patients regardless of their insurance or financial status. We are a federally funded Health Center; as such, we are able to offer discounted medical services through a sliding fee schedule to patients who qualify based on household size and gross income.
Grace Health staff is available to assist patients in determining if they are eligible for our Sliding Fee Options. Patients MUST show the most recent proof of income for all family members/individuals living in your household; examples of accepted documents include:
- Previous year’s 1040 tax form
- One month of pay stubs
- One unemployment stub
- Food Stamp Award Letter
- Social Security or Disability Letter
- Letter from an employer that states your salary or wages.
Discount levels for patients who qualify are shown below.
2025 Sliding Fee Schedule - Annual Income
| Fed. Poverty Guideline | At or Below 100% | 101% – 125% | 126% – 150% | 151% – 200% | Above 200% |
| Family Size | Nominal Fee ($10) | Level 1 Charge $20 | Level 2 Charge $30 | Level 3 Charge $40 | No Discount |
| 1 | $0- | $15,650.01 – 19,562.50 | $19,562.51 – 23,475 | $23,475.01 – 31,300 | $31,300.01 + |
| 2 | $0- | $21,150.01 – 26,437.50 | $26,437.51 – 31,725 | $31,725.01 – 42,300 | $42,300.01 + |
| 3 | $0- | $26,650.01 – 33,312.50 | $33,312.51 – 39,975 | $39,975.01 – 53,300 | $53,300.01 + |
| 4 | $0- | $32,150.01 – 40,187.50 | $40,187.51 – 48,225 | $48,225.01 – 64,300 | $64,300.01 + |
| 5 | $0- | $37,650.01 – 47,062.50 | $47,062.51 – 56,475 | $56,475.01 – 75,300 | $75,300.01 + |
| 6 | $0- | $43,150.01 – 53,937.50 | $53,937.51 – 64,725 | $64,725.01 – 86,300 | $86,300.01 + |
| 7 | $0- | $48,650.01 – 60,812.50 | $60,812.51 – 72,975 | $72,975.01 – 97,300 | $97,300.01 + |
| 8 | $0- | $54,150.01 – 67,687.50 | $67,687.51 – 81,225 | $81,225.01 – 108,300 | $108,300.01 + |
Nominal Fee ($10) | Level 1 $20 Charge | Level 2 $30 Charge | Level 3 $40 Charge | No Discount |
*Based on 2025 Federal Poverty Guidelines published in the Federal Register January 15, 2025
For families/households with more than 8 persons, add $5,500 for each additional person.
Discounted charge includes all services performed by the center during the visit (i.e. in-house labs, x-rays, injections, labs performed by Lab Corp and any non-face to face visits associated f/u instructions initiated during the face to face visit.)
2025 Sliding Fee Schedule-Monthly Income
| Fed. Poverty Guideline | At or Below 100% | 101% – 125% | 126% – 150% | 151% – 200% | Above 200% |
| Family Size | Nominal Fee ($10) | Level 1 Charge $20 | Level 2 Charge $30 | Level 3 Charge $40 | No Discount |
| 1 | $0 – 1,304.17 | $1,304.18 – 1,630.21 | $1,630.22 – 1,956.25 | $1,956.26 – 2,608.33 | $2,608.34 + |
| 2 | $0 – 1,762.50 | $1,762.51 – 2,203.13 | $2,203.14 – 2,643.75 | $2,643.76 – 3,525.00 | $3,525.01 + |
| 3 | $0 – 2,220.83 | $2,220.84 – 2,776.04 | $2,776.05 – 3,331.25 | $3,331.26 – 4,441.67 | $4,441.68 + |
| 4 | $0 – 2,679.17 | $2,679.18 – 3,348.96 | $3,348.97 – 4,018.75 | $4,018.76 – 5,358.33 | $5,358.34 + |
| 5 | $0 – 3,137.50 | $3,137.51 – 3,921.88 | $3,921.89 – 4,706.25 | $4,706.26 – 6,275.00 | $6,275.01 + |
| 6 | $0 – 3,595.83 | $3,595.84 – 4,494.79 | $4,494.80 – 5,393.75 | $5,393.76 – 7,191.67 | $7,191.68 + |
| 7 | $0 – 4,054.17 | $4,054.18 – 5,067.71 | $5,067.72 – 6,081.25 | $6,081.26 – 8,108.33 | $8,108.34 + |
| 8 | $0 – 4,512.50 | $4,512.51 – 5,640.63 | $5,640.64 – 6,768.75 | $6,768.76 – 9,025.00 | $9,025.01 + |
Nominal Fee ($10) | Level 1 $20 Charge | Level 2 $30 Charge | Level 3 $40 Charge | No Discount |
*Based on 2025 Federal Poverty Guidelines published in the Federal Register on January 15, 2025
For families/households with more than 8 persons, add $458.33 for each additional person.
Discounted charge includes all services performed by the center during the visit (i.e. in-house labs, x-rays, injections, labs performed by Lab Corp and any non-face to face visits associated f/u instructions initiated during the face to face visit.)
2025 Dental Sliding Fees
| Categories & Subcategories | Nominal Fee | Level 1 | Level 2 | Level 3 | Over 200% FPG |
| Diagnostic & Preventive | $10 | $20 | $30 | $40 | No Discount |
| Phase 1 (Basic Restorative) | $20 | $40 | $60 | $80 | No Discount |
| Root Canal Therapy: Anterior/Premolar Root Canal Therapy | $50 | 60% of Fees | 65% of Fees | 70% of Fees | No Discount |
| Root Canal Therapy: Molar Root Canal Therapy | $100 | 60% of Fees | 65% of Fees | 70% of Fees | No Discount |
| Phase 2* (Prosthodontics) | |||||
| Dentures | $500 | 60% of Fees | 65% of Fees | 70% of Fees | No Discount |
| Crowns & Bridges | $300 | 60% of Fees | 65% of Fees | 70% of Fees | No Discount |
| Interim (Temporary) Dentures | $400 | 60% of Fees | 65% of Fees | 70% of Fees | No Discount |
| Interim Partial Dentures (Flippers) | $200 | 60% of Fees | 65% of Fees | 70% of Fees | No Discount |
| Denture Relines | $200 | 60% of Fees | 65% of Fees | 70% of Fees | No Discount |
| Occlusal Guards | $95 | 60% of Fees | 65% of Fees | 70% of Fees | No Discount |
| Whitening | $75 | 60% of Fees | 65% of Fees | 70% of Fees | No Discount |
Nominal | Level 1 | Level 2 | Level 3 | No Discount |
Qualification for Sliding Fee Discounts is outlined in Attachment H of SFDP and are based on Income and Family Size.
Subcategories are defined in the Dental Categories and Fee Workbook.
Nominal Fee: If dental services are provided from multiple categories on same date of service, the guarantor will be responsible to pay the highest categorical or sub-categorical nominal fee.
Levels 1-3: If dental services are provided from Diagnostic & Preventive and Phase 1 treatment categories on same date of service, the guarantor will be responsible to pay the Phase 1 flat fee only. If dental services are provided from a subcategory with percentage-based discount and a category with flat fee on same date of service, the patient will be responsible to pay for services with percentage-based discount only and no flat fee will be charged.
*This category includes a portion of supply cost.
Women's Care Services Sliding Fees for OB/GYN Surgery, LEEP, and Delivery
|
Fed. Poverty Guideline |
At or Below 100% |
101-125% |
126%-150% |
151%-200% |
Over 200% |
|
Nominal Fee |
Level 1 |
Level 2 |
Level 3 |
No Discount |
|
|
OB/GYN Surgery, LEEP, and Delivery |
$40 |
10% of Fees |
15% of Fees |
20% of Fees |
No Discount |
Qualification for Sliding Fee Discounts is outlined in Attachment H of SFDP and are based on Income and Family Size.
*If the procedure is performed in the office setting, and an office visit charge is incurred, only the procedural sliding fee will be collected from the patient. The office visit will be adjusted, as well as supplies/medications.
** Follow up hospital visits and post-operative (global) visits will be adjusted when related to procedures performed in the hospital setting.
