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 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
- 1 unemployment stub
- Food Stamp Award Letter
- Copy of Social Security or Disability Check
- Letter from an employer that states your salary or wages.
Discount levels for patients who qualify are shown below.
2024 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- | $15,061 – | $18,826- $22,590 | $22,591- | $30,121 |
| 2 | $0- | $20,441 – | $25,551- | $30,661- | $40,881 |
| 3 | $0- | $25,821 – | $32,276- | $38,731- | $51,641 |
| 4 | $0- | $31,201- | $39,001- | $46,801- | $62,401 |
| 5 | $0- | $36,581- | $45,726- | $54,871- | $73,161 |
| 6 | $0- | $41,961- | $52,451- | $62,941- | $83,921 |
| 7 | $0- | $47,341- | $59,176- | $71,011- $94,680 | $94,681 |
| 8 | $0- | $52,721- | $65,901- | $79,081- | $105,441 |
Nominal Fee-$10 | Level 1 $20 Charge | Level 2 $30 Charge | Level 3 $40 Charge | NO Discount |
*Based on 2024 Federal Poverty Guidelines published in the Federal Register January 16, 2024
For families/households with more than 8 persons add $5,380 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.)
2024 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- | $1,256- | $1,570- $1,883 | $1,884- | >$2,511 |
| 2 | $0- | $1,704 | $2,130- | $2,556- | >$3,408 |
| 3 | $0- | $2,153- | $2,261- | $3,229- | >$4,304 |
| 4 | $0- | $2,601- | $3,251- | $3,901- | >$5,201 |
| 5 | $0- | $3,049- | $3,811- | $4,574- | >$6,098 |
| 6 | $0- | $3,498- | $4,372- | $5,246- | >$6,994 |
| 7 | $0- | $3,946- | $4,932- | $5,919- $7,890 | >$7,891 |
| 8 | $0- | $4,394- | $5,493- | $6,591- | >$8,788 |
Nominal Fee-$10 | Level 1 $20 Charge | Level 2 $30 Charge | Level 3 $40 Charge | NO Discount |
*Based on 2024 Federal Poverty Guidelines published in the Federal Register on Jan. 16, 2024
For families/households with more than 8 persons add $448 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.)
2024 Dental Sliding Fees
| Categories | Nominal Fee | Level 1 | Level 2 | Level 3 | Over 200% FPG |
| Diagnostic & Preventive* | $30 | $60 | $80 | $100 | No Discount |
| Phase 1 Tx* | $50 | $80 | $100 | $120 | No Discount |
| Phase 2 Tx* | |||||
| Crowns (per single unit) | $500 | 60% of Fees | 65% of Fees | 70% of Fees | No Discount |
| Interim Complete Dentures (per arch) | $430 | 60% of Fees | 65% of Fees | 70% of Fees | No Discount |
| Interim Partial Dentures (per arch) | $200 | 60% of Fees | 65% of Fees | 70% of Fees | No Discount |
| Molar Root Canal Therapy (per tooth) | $300 | 60% of Fees | 65% of Fees | 70% of Fees | No Discount |
| Mouthguards (Athletic/Occlusal) | $95 | 60% of Fees | 65% of Fees | 70% of Fees | No Discount |
| Bleaching Trays (per arch) | $75 | 60% of Fees | 65% of Fees | 70% of Fees | No Discount |
| Bleaching Gel | $50 | 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 are outlined in Attachment A of SFDP and are based on Income and Family Size
Fee Schedule based on Optum 360 Fee Analyzer-Region Specific
*Diagnostic & Preventive, Phase 1 and Phase 2 are defined in the Dental Categories and Fee Workbook
If dental services are provided from the Diag. & Preventive and Phase 1 category on the same date of service the patient will be responsible to pay the higher flat fee, not both.
30% Prompt Pay Discount- Fees for Dental Services will be required prior to treatment, unless the Dentist determines that the treatment is considered Urgent or Emergent, and the patient will be eligible for a 30% discount.
