Sliding Fee Schedule
In order to ensure that primary health care is made reasonably available to the people of this area without regard of ability to pay, a Sliding Fee Program, based on family size and income, is offered to established SCRFHC patients and their families. All Sliding Fee Program participants must apply annually with current proof of income.
- Using the 2024 Table below, find your family size down the left column
- Next, find your annual income range on that same line
- Last, follow the income range column upward to the point that tells you whether you might pay a nominal fee or a designated percentage of the charges.
Note: This is primarily an estimate that should provide enough information to determine whether you want to submit an application or not. Individuals and families must complete the initial application for approval. The application and all required supporting documents will be reviewed and a decision made regarding the level of adjustment to be assigned. In addition, all participants in the Sliding Fee program must re-apply annually with current proof of income.
What will I need to submit my application?
- Current Proof of Income: Last year’s Tax return, pay stubs x 4 weeks, unemployment benefit statement or Social Security 1099 or benefit notice.
- Fully completed Application, including family size and all information required.
If you are interested in applying for the Sliding Fee program, please email DeeDee Lozier at [email protected]
If you would like to download the application, please click here.
Outside labs may also offer a sliding fee option but the tests would most likely need to be collected here at SCRFHC to be considered for eligibility.
Sliding Fee Chart
The Sliding Fee schedule changes annually in accordance with the Department of Health and Human Services poverty guidelines. The St. Croix Regional Family Health Center Board of Directors may also amend it. Sliding Fee cannot be applied to the cost of birth control measures.
Revised 1/17/2024 Federal Register Vol. 89, No. 11 pp. 2961-2963
For Families with more than 11 members, add $5,140.00 for each additional person.
The Sliding Fee Schedule changes annually in accordance with the Department of Health and Human Services poverty guidelines. The St. Croix Regional Family Health Center Board of Directors may also amend it. * The Sliding Fee cannot be applied to the cost of birth control measures. The St. Croix Regional Family Health Center provides for fees to be reduced or waived under special circumstances. Please request to speak to a Patient Assistance Representative if you meet at least one of the following criteria: Have no income, meet the definition of homelessness, are staying in a shelter or on the street, are seeking political asylum, or are unable to work due to immigration status.