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Grace Health

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.

2019 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-

$12,490

$12,491-

$15,613

$15,614-$18,735 $18,736-

$24,980

$24,981+
2 $0-

$16,910

$16,911

$21,138

$21,139-

$25,365

$25,366-

$33,820

$33,821+
3 $0-

$21,330

$21,331-

$26,663

$26,664-

$31,995

$31,996-

$42,660

$42,661+
4 $0-

$25,750

$25,751-

$32,188

$31,189-

$38,625

$38,626-

$51,500

$51,501+
5 $0-

$30,170

$30,171-

$37,713

$37,714-

$45,255

$45,256-

$60,340

$60,341+
6 $0-

$34,590

$34,591-

$43,238

$43,239-

$51,885

$51,886-

$69,180

$69,181+
7 $0-

$39,010

$39,011-

$48,763

$48,764-

$58,515

$58,516-$78,020 $78,021+
8 $0-

$43,430

$43,431-

$54,288

$54,289-

$65,145

$65,146-

$86,860

$86,861+
Nominal

Fee-$10

 

Level 1

$20 Charge

 

Level 2

$30 Charge

 

Level 3

$40 Charge

 

NO Discount

*Based on 2019 Federal Poverty Guidelines published in the Federal Register February 1, 2019

For families/households with more than 8 persons add $4,420 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.)