Many people with limited income do not have health insurance, making obtaining healthcare a challenge. However, many community health organizations offer a sliding fee scale, meaning that the cost of care is adjusted based on a patient’s income and family size. This allows people without insurance and a low income to receive care at reduced costs. If you are uninsured and need healthcare, it’s important to understand how these sliding fee scales work.
What Is a Sliding Fee Scale?
A sliding fee scale is a pricing system that adjusts the cost of medical services based on a patient’s income and household size, making care more affordable for people and families with limited income and resources. A sliding fee scale is commonly used by community clinics and Federally Qualified Health Centers (FQHCs) that receive support from the Health Resources and Services Administration.
Sliding fee scales are important for uninsured people who might otherwise not seek care due to cost concerns. By lowering costs, these programs allow patients to seek preventive care, routine checkups, and early treatment for health issues. Many clinics that offer sliding fee scales also help patients apply for programs such as Medi-Cal or Medicare.
It’s important to note that federal regulations require health centers funded through HRSA to offer services regardless of a patient’s ability to pay. While patients are expected to pay what they can based on the sliding fee scale, they generally cannot be denied care if they cannot afford the cost.
How Does a Sliding Fee Scale Work?
Under a sliding fee scale, clinics calculate the amount the person pays by comparing their household income to the Federal Poverty Level, which is determined each year by the federal government. This means that patients whose income falls below a certain percentage of the Federal Poverty level may qualify for significantly reduced fees. For example, a patient whose income is below 100% of the federal poverty level may pay only a small fee for services, while someone at 200% of the poverty level may pay a slightly higher amount.
To qualify for the sliding fee scale, patients usually need to provide documentation verifying their financial situation. Documents required may be pay stubs, tax returns, or proof of public benefits. They also have to disclose household size because the federal poverty level is adjusted based on how many people live in the household. Once the information is reviewed, the clinic assigns the patient to a fee category on the sliding scale. This determines how much the patient will pay for services.
Medi-Cal
If you are a resident of California and have a low household income, you may qualify for Medi-Cal. Medi-Cal is the state of California’s version of Medicaid and is overseen by the Department of Health Care Services (DHCS). It is for low-income residents of California and their families and makes no-to low-cost health care coverage accessible to many people who cannot afford private health insurance.
In 2026, Medi-Cal income limits are as follows:
- For one person, the limit is 138% of the FPL, which is $21,597 annually. For each additional family member, $7,500 is added to the limit. That means that for a family of two the limit is $29,187, and for a family of four, it is $44,367.
- For children 19 and under, the family income limit is 266% of FPL for a family of one, which is $41,629 per year. For a family of four, the limit is $85,519 per year.
- For pregnant women, income limits may be higher (213% FPL) for pregnancy-related coverage.
Other eligibility requirements include asset limits in some cases, and immigration status.
As of January 1. 2026, the Medi-Cal asset limits are $130,000 for persons enrolled in specific programs that require an asset test, with an additional $65,000 added for each individual in the household. Most modified adjusted gross income (MAGI)-based Medi-Cal programs, which include coverage for adults ages 19–64, children, and pregnant women, are not subject to asset limits. Eligibility for these groups is based strictly on income and household size.
Immigration status rules for Medi-Cal eligibility have changed in 2026. Beginning January 1, 2026, California implemented an enrollment freeze for certain immigrants:
- Adults age 19+ without “satisfactory immigration status” (such as undocumented adults or some recent legal residents) can no longer newly enroll in full-scope Medi-Cal.
- If they apply after that date, they can generally only get restricted-scope coverage, which includes:
- Emergency services
- Pregnancy-related care
- Some nursing home care
In Closing
Sliding fee scales make healthcare affordable for everyone and are offered by many community healthcare organizations. If you or someone you know needs care and is worried about cost, call our Euclid Community Health Center at 840-237-3344. The center is located at 600 N Euclid Ave. Ste. 202 Upland, CA 91786. At Health Service Alliance, we are dedicated to providing compassionate, personalized, and accessible care regardless of your ability to pay.
