Sliding Fee Discount Policy

Income-based medical discounts with set verification & payment policies.


To provide medical services to individuals based on their ability to pay. To ensure the continued financial viability of the health center. To continue the provision of affordable medical services to those in need, especially under-served populations.


It is the policy of MHC to make health care affordable by offering a sliding fee discount to patients who qualify based on family size and income level in accordance with the Federal Poverty Guidelines (see forms section) as published and updated annually in the Federal Register. Patients are responsible for the payment of the fee after the discount is applied. Patients at or below 100% of poverty will be asked to pay a “nominal charge”, however they will not be denied care and the amount will be adjusted off if they are unable to pay the nominal charge. Private vaccines and outside dental lab costs are excluded from the sliding fee program and will be the responsibility of the patient.


  • Patient completes an application form and provides documentation regarding family income and family size. If the patient is likely to qualify for Medicaid, they will be referred to the local DHHR office or to the Patient Eligibility Specialist if they choose to complete an application. Family size is determined by related persons living in the same household. Adult children living in the same household but responsible for their own living expenses may be excluded from family size and income. Proof of income includes tax returns, pay stubs, written statements or receipts or a self-declaration statement.
  • The patient will sign a Patient Statement of Financial Responsibility indicating that he/she understands and agrees to pay the patient portion of the discounted fee at the time of service. If unable to make payment at the time of service, patient will be asked to sign a Delayed Copay Notice. (see forms section). Maximum of two Delayed Copay’s per year.
  • The Eligibility Enrollment Specialist or Billing Department Staff shall review the sliding fee discount application and determine patient eligibility for level of discount. Level of discount and patient portion will be noted in the patient billing record and the patient will be advised of the outcome of the review.
  • Discounts are good for one year. At the end of the period of eligibility (12 months), the patient will be required to reapply for the Sliding Fee Discount which includes documentation of family size and income.
  • A patient may reapply for the Sliding Fee Discount at any time their financial circumstances change.
  • After the patient has been approved (or re-approved) for the Sliding Fee Discount, the Billing Department may discount services which occurred up to ninety (90 days) before the sliding fee approval date.
  • The patient or their provider can make a request for a review. The Billing Department staff will conduct the review for appropriateness.
  • A patient may complete a “Self-Declaration of Income” as a last resort if no documentation can be provided. (see forms section)
  • Patients unwilling to provide necessary income information will not be eligible for the Sliding Fee Discount.
  • Courtesy write-offs may be provided to those individuals currently experiencing a hardship such as loss of home, loss of job, homelessness, no income or other such situations. The CEO or designee may make the determination of what constitutes hardship.
  • Reference MHC Collection Policy (see forms section) for procedures on collection of past-due accounts.
  • Reference MHC Willingness-to-Pay Policy (see forms section) for procedures regarding “Refusal to Pay”.


The CFO, Billing Supervisor and Front Office Coordinators – are responsible for the oversight and implementation of the Sliding Fee Discount Policy. Each year, a sliding fee scale in accordance with Federal poverty guidelines will be submitted to the Board of Directors by the CFO for approval.

Click here to access the Sliding Scale Application:

MHC Sliding Fee Application

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