Sliding Fee Discount Program Policy

Minis Walk-In Clinic

Minis Walk-In Clinic is committed to ensuring access to care regardless of a patient’s ability to pay.

No one will be denied access to services due to inability to pay. A sliding fee schedule is available based on family size and income.

Purpose

This policy establishes a Sliding Fee Discount Program and corresponding Sliding Fee Discount Schedule in alignment with HRSA/NHSC site readiness requirements.

Scope of Services

The Sliding Fee Discount Program applies to eligible services provided by Minis Walk-In Clinic.

The program may apply to:

Uninsured patients
Self-pay encounters
Non-covered services

The program does not apply to:

Services billed to Medicaid or Medicaid Managed Care plans
Services billed to other third-party payers where contractual obligations prohibit discounting

Eligibility

Eligibility is based on family size and gross household income. Family size includes all dependents supported by household income. Eligibility is determined using the current Federal Poverty Guidelines.

Acceptable verification methods may include:

Recent pay stubs
Tax returns
Employer letter
Bank statements
Unemployment benefit statements
Proof of public assistance
Self-declaration if no documentation is available, with justification

No Social Security Number is required. No credit checks are performed.

Sliding Fee Discount Schedule

Federal Poverty Guidelines are updated annually, and the Sliding Fee Discount Schedule will be revised accordingly.

Fixed Fee Structure

For patients at or below 100% of the Federal Poverty Guidelines, the $10 office visit fee applies per visit or encounter.

The $10 office visit fee applies to:

Sick visits
Follow-up visits
Telehealth visits
Other standard office encounters

Included services:

Provider evaluation
Basic exam

Additional services are billed separately and discounted according to the Sliding Fee Discount Schedule, including but not limited to:

Laboratory testing
Procedures
Medications or supplies

Application Process

Patients may apply for the Sliding Fee Discount Program at any time.

1. Patient completes the Sliding Fee Discount Program application.
2. Authorized staff verifies income and family size documentation.
3. Eligibility level is assigned according to the Sliding Fee Discount Schedule.
4. Determination is documented in the medical record.
5. Discount is applied at the time of service.

Renewal and Re-Evaluation

Eligibility must be re-evaluated every 12 months, or when the patient reports a change in income or household size.

Patients are responsible for notifying the clinic of material changes in household income or family size.

Expired eligibility may result in reclassification to full-pay status until updated documentation is received.

Billing Safeguards

Discounts are applied only to self-pay balances.

Discounts are not applied to insurance claims.

Medicaid billed charges may not be altered.

Insurance billing and Sliding Fee Discount Program adjustments must remain separate.

Sliding Fee Discount Program adjustments are applied only after insurance adjudication, when applicable.

Documentation

Minis Walk-In Clinic maintains documentation related to the Sliding Fee Discount Program, including completed applications, income verification or self-declaration forms, eligibility determinations, current discount schedule documentation, and policy documentation.

Records are retained in accordance with applicable regulatory requirements and made available during HRSA/NHSC audits or compliance reviews upon request.

Notice to Patients

No one will be denied access to services due to inability to pay. A sliding fee schedule is available based on family size and income.

Approved By: Dr. Ayman Rawda
Last Reviewed Date: 05/13/2026
Next Review Date: 05/13/2027