Applying for the Sliding Fee Discount

What is a Sliding Fee Discount?

As a Federally Qualified Community Health Center, White House Clinics receive federal funding to provide a discount to uninsured or indigent patients.  The federal government provides specific instruction as to the use of this money so White House Clinics must follow very standardized procedures for enrollment.

How do I apply for the Sliding Fee Discount?

Patients interested in signing up for the discount may complete the Sliding Fee Form and bring it, along with proof of income, to their appointment. The patient should give the form to the receptionist so that the patient can meet with the financial counselor before their visit with the provider.

Spanish Forms

The discount program is based on family income, not necessarily household income. To receive the discount, the patient will need to provide verification of income. White House Clinics accept the following documents as proof of income:

  • 2 – 3 Paycheck Stubs
  • Letter from Social Security/Disability
  • Long Form from Food Stamp Office
  • Copy of Check/Bank Statement to Verify Child Support Payments
  • Other documents may work, but please ask your Financial Counselor about specific requirements.

What kind of discount would I receive?

The discount level is based on the income and number of family members in the household. Patients on the highest level of discount pay a $20 nominal fee for medical and behavioral health services, and $30 nominal fee for dental services. Medications purchased from the White House Clinics pharmacy are also discounted.

Does the Sliding Fee Discount mean that I can receive free visits?

Although we do provide a discount for services, White House Clinics are NOT free clinics. We do expect and require payment at the time of service in both our medical behavioral health, and dental clinics, as well as our pharmacy.

For your convenience, we accept cash, checks, and debit/credit cards.