SLIDING FEE PROGRAM
All Polk County Residents seeking services at Polk County Behavioral Health (PCBH) are assured that they will be served regardless of ability to pay. No one is refused service because of lack of financial means to pay. This program is designed to provide free or discounted care to those who have no means, or limited means, to pay for their medical services (uninsured or underinsured).
PCBH offers a Sliding Fee Discount Program to all who are unable to pay for their services. PCBH will base program eligibility on a person’s ability to pay and will not discriminate on the basis of an individual’s race, color, sex, national origin, disability, religion, age, sexual orientation, or gender identity. The Federal Poverty Guidelines are used in creating and annually updating the sliding fee schedule (SFS) to determine eligibility.
Sliding Fee Schedule
| Poverty Level | <=100% | 110% | 120% | 130% | 140% | 150% | 160% | 170% | 180% | 190% | 200% | >200% |
| Family Size | Discount 100% | Discount 90% | Discount 80% | Discount 70% | Discount 60% | Discount 50% | Discount 40% | Discount 30% | Discount 20% | Discount 15% | Discount 10% | Discount 0% |
| 1 | $15,060 | 16,566 | 18,072 | 19,578 | 21,084 | 22,590 | 24,096 | 25,602 | 27,108 | 27,861 | 28,614 | 30,120+ |
| 2 | $20,440 | 22,484 | 24,528 | 26,572 | 28,616 | 30,660 | 32,704 | 34,748 | 36,792 | 37,814 | 38,836 | 40,880+ |
| 3 | $25,820 | 28,402 | 30,984 | 33,566 | 36,148 | 38,730 | 41,312 | 43,894 | 46,476 | 47,767 | 49,058 | 51,640+ |
| 4 | $31,200 | 34,320 | 37,440 | 40,560 | 43,680 | 46,800 | 49,920 | 53,040 | 56,160 | 57,720 | 59,280 | 62,400+ |
| 5 | $36,580 | 40,238 | 43,896 | 47,554 | 51,212 | 54,870 | 58,528 | 62,186 | 65,844 | 67,673 | 69,502 | 73,160+ |
| 6 | $41,960 | 46,156 | 50,352 | 54,548 | 58,744 | 62,940 | 67,136 | 71,332 | 75,528 | 77,626 | 79,724 | 83,920+ |
| 7 | $47,340 | 52,074 | 56,808 | 61,542 | 66,276 | 71,010 | 75,744 | 80,478 | 85,212 | 87,579 | 89,946 | 94,680+ |
| 8 | $52,720 | 57,992 | 63,264 | 68,536 | 73,808 | 79,080 | 84,352 | 89,624 | 94,896 | 97,532 | 100,168 | 105,440+ |
| For each additional person (9+) , add | $5,380 | 5,918 | 6,456 | 6,994 | 7,532 | 8,070 | 8,608 | 9,146 | 9,684 | 9,953 | 10,222 | 10,760+ |
Want to apply for sliding fee?
Complete the application and bring required documents to one of our office locations.
Download Sliding Fee Application by scrolling to bottom of page to Supporting Documents.
Descargue la Solicitud de Tarifa Rebajada desplazándose hasta la parte inferior de la página hasta Documentos de respaldo.
Have questions about the sliding fee program?
To learn more call 503-623-9289 and ask to speak with the Financial Assistance Team.
Or, you can click here and one of our members of the Financial Assistance Team will call you within 2 business days to answer your questions.
Supporting Documents
Solicitud de Tarifa Rebajada 2024 (234 KB) 