2026 Sliding Fee Scale
Medical & Behavioral Health Services
| Family Size | Class 1 0–100% Nominal Fee $15 |
Class 2 101–125% 30% Payment |
Class 3 126–150% 40% Payment |
Class 4 151–175% 50% Payment |
Class 5 176–200% 60% Payment |
|---|---|---|---|---|---|
| 1 | Up to $15,960 | $15,961–$19,950 | $19,951–$23,940 | $23,941–$27,930 | $27,931–$31,920 |
| 2 | Up to $21,640 | $21,641–$27,050 | $27,051–$32,460 | $32,461–$37,870 | $37,871–$43,280 |
| 3 | Up to $27,320 | $27,321–$34,150 | $34,151–$40,980 | $40,981–$47,810 | $47,811–$54,640 |
| 4 | Up to $33,000 | $33,001–$41,250 | $41,251–$49,500 | $49,501–$57,750 | $57,751–$66,000 |
| 5 | Up to $38,680 | $38,681–$48,350 | $48,351–$58,020 | $58,021–$67,690 | $67,691–$77,360 |
| 6 | Up to $44,360 | $44,361–$55,450 | $55,451–$66,540 | $66,541–$77,630 | $77,631–$88,720 |
| 7 | Up to $50,040 | $50,041–$62,550 | $62,551–$75,060 | $75,061–$87,570 | $87,571–$100,080 |
| 8 | Up to $55,720 | $55,721–$69,650 | $69,651–$83,580 | $83,581–$97,510 | $97,511–$111,440 |
| 9 | Up to $61,400 | $61,401–$76,750 | $76,751–$92,100 | $92,101–$107,450 | $107,451–$122,800 |
| 10 | Up to $67,080 | $67,081–$83,850 | $83,851–$100,620 | $100,621–$117,390 | $117,391–$134,160 |
Notes:
- Add $5,680 for each family member over eight.
- No discount available for income exceeding 200% of federal poverty level.
- Sliding fee does not apply to hospital physician charges or immunizations (except flu and DTaP).
- Does not apply to implantable birth control supply costs.
Dental Services
| Family Size | Class 1 0–100% Nominal Fee $40 |
Class 2 101–125% 80% Payment |
Class 3 126–150% 85% Payment |
Class 4 151–175% 90% Payment |
Class 5 176–200% 95% Payment |
|---|---|---|---|---|---|
| 1 | Up to $15,960 | $15,961–$19,950 | $19,951–$23,940 | $23,941–$27,930 | $27,931–$31,920 |
| 2 | Up to $21,640 | $21,641–$27,050 | $27,051–$32,460 | $32,461–$37,870 | $37,871–$43,280 |
| 3 | Up to $27,320 | $27,321–$34,150 | $34,151–$40,980 | $40,981–$47,810 | $47,811–$54,640 |
| 4 | Up to $33,000 | $33,001–$41,250 | $41,251–$49,500 | $49,501–$57,750 | $57,751–$66,000 |
| 5 | Up to $38,680 | $38,681–$48,350 | $48,351–$58,020 | $58,021–$67,690 | $67,691–$77,360 |
| 6 | Up to $44,360 | $44,361–$55,450 | $55,451–$66,540 | $66,541–$77,630 | $77,631–$88,720 |
| 7 | Up to $50,040 | $50,041–$62,550 | $62,551–$75,060 | $75,061–$87,570 | $87,571–$100,080 |
| 8 | Up to $55,720 | $55,721–$69,650 | $69,651–$83,580 | $83,581–$97,510 | $97,511–$111,440 |
Dental Notes:
- Nominal fee covers oral exam, adult and child prophylaxis, and fluoride application.
- Radiology and additional services are optional with 20% discount.
Hospital Services
| Family Size | Class 1 50% Payment |
Class 2 55% Payment |
Class 3 60% Payment |
Class 4 70% Payment |
Class 5 80% Payment |
|---|---|---|---|---|---|
| 1 | Up to $15,960 | $12,881–$16,100 | $16,101–$19,320 | $19,321–$22,540 | $22,541–$25,760 |
| 2 | Up to $21,640 | $21,641–$27,050 | $27,051–$32,460 | $32,461–$37,870 | $37,871–$43,280 |
| 3 | Up to $27,320 | $27,321–$34,150 | $34,151–$40,980 | $40,981–$47,810 | $47,811–$54,640 |
| 4 | Up to $33,000 | $33,001–$41,250 | $41,251–$49,500 | $49,501–$57,750 | $57,751–$66,000 |
| 5 | Up to $38,680 | $38,681–$48,350 | $48,351–$58,020 | $58,021–$67,690 | $67,691–$77,360 |
| 6 | Up to $44,360 | $44,361–$55,450 | $55,451–$66,540 | $66,541–$77,630 | $77,631–$88,720 |
| 7 | Up to $50,040 | $50,041–$62,550 | $62,551–$75,060 | $75,061–$87,570 | $87,571–$100,080 |
| 8 | Up to $55,720 | $55,721–$69,650 | $69,651–$83,580 | $83,581–$97,510 | $97,511–$111,440 |
