Based Upon Income Guidelines as Published in the Federal Register on January 15, 2025
The Sliding Fee Discount Program
The Sliding Fee Discount Program at Brownsville Multi-Service Family Health Center (BMS) offers reduced medical costs for patients with incomes at or below 200% of the Federal Poverty Guidelines. Those who qualify based on income and family size can receive significant discounts, while patients above the income limit are responsible for the full cost of services. No patient is denied care due to insurance status, immigration status, or inability to pay.
FAQ
- What are the benefits of enrolling in the program?
- You may be eligible to receive medical, dental, and mental health services at discounted rates.
- How do you enroll?
- Complete the Sliding Fee Enrollment Form.
- Give the complete form to the Patient Service Representative, who will determine if you qualify.
- If eligible, you will be asked to bring documentation of your income and complete the Income Verification Form. BMS will extend one visit at a sliding fee price without obtaining a copy of both income and family documentation.
- After completing the Income Verification Form, you will be enrolled for a period of six months. You must notify the Patient Service Representative of any changes in family income or size when you return for services.
- Who qualifies?
- Eligibility is based on:
- Income Level: Most programs require household income to be at or below 200% of the Federal Poverty Level (FPL).
- Family Size: The number of people in your household affects income thresholds.
- Insurance Status: Some programs are available to uninsured or underinsured patients.
- For example, Brownsville Community Development Corp’s sliding fee scale is available to uninsured patients meeting specific income requirements based on household size.
- Eligibility is based on:
- What are the required documents?
- Proof of Income: Recent pay stubs, tax returns, or other income documentation.
- Identification: A valid photo ID (e.g., Driver's License, Birth Certificate, Immigration Papers).
- Family Size Information: Details about the number of people in your household.
- For how long is the duration and renewal of the sliding fee?
- Duration: Sliding fee scales are typically valid for 6 months.
2025 SLIDING FEE DISCOUNT - AFFORDABLE MEDICAL and DENTAL SERVICES
| % of Income Poverty | A (0-100%) |
B 101% - 133% |
C 134% - 150% |
D 151% - 170% |
E 171% - 185% |
F 186% - 200% |
G (201%+) |
|---|---|---|---|---|---|---|---|
| FAMILY SIZE | |||||||
| 1 | $0 - $15,650 | $15,651 - $20,815 | $20,816 - $23,475 | $23,476 - $26,605 | $26,606 - $28,953 | $28,954 - $31,300 | $31,301 - OVER |
| 2 | $0 - $21,150 | $21,151 - $28,130 | $28,131 - $31,725 | $31,726 - $35,955 | $35,956 - $39,128 | $39,129 - $42,300 | $42,301 - OVER |
| 3 | $0 - $26,650 | $26,651 - $35,445 | $35,446 - $39,975 | $39,976 - $45,305 | $45,306 - $49,303 | $49,304 - $53,300 | $53,301 - OVER |
| 4 | $0 - $32,150 | $32,151 - $42,760 | $42,761 - $48,225 | $48,226 - $54,655 | $54,656 - $59,478 | $59,479 - $64,300 | $64,301 - OVER |
| 5 | $0 - $37,650 | $37,651 - $50,075 | $50,076 - $56,475 | $56,476 - $64,005 | $64,006 - $69,653 | $69,654 - $75,300 | $75,301 - OVER |
| 6 | $0 - $43,150 | $43,151 - $57,390 | $57,391 - $64,725 | $64,726 - $73,355 | $73,356 - $79,828 | $79,829 - $86,300 | $86,301 - OVER |
| 7 | $0 - $48,650 | $48,651 - $64,705 | $64,706 - $72,975 | $72,976 - $82,705 | $82,706 - $90,003 | $90,004 - $97,300 | $97,301 - OVER |
| 8 | $0 - $54,150 | $54,151 - $72,020 | $72,021 - $81,225 | $81,226 - $92,055 | $92,056 - $100,178 | $100,179 - $108,300 | $108,301 - OVER |
| Discount | 100% | 73% | 66% | 49% | 29% | 14% | 0% |
2025 SLIDING FEE DISCOUNT - URGENT CARE SERVICES
| Service Type | A | B | C | D | E | F | G |
|---|---|---|---|---|---|---|---|
| Office Visit | $0 | $65 | $82 | $123 | $172 | $208 | $242 |
| Nutrition Visit | $0 | $49 | $61 | $92 | $128 | $155 | $180 |
| Limited Oral Evaluation(D0140) | $0 | $15 | $19 | $29 | $40 | $49 | $57 |
| Detailed Oral Evaluation(D0120) | $0 | $21 | $27 | $40 | $55 | $67 | $78 |
| Detailed and extensive oral evaluation (D0160) | $0 | $37 | $47 | $70 | $98 | $119 | $138 |
| Comprehensive Periodontal Evaluation(D0180) | $0 | $17 | $21 | $32 | $45 | $54 | $63 |
| Prophylaxis - Adult (D1110) | $0 | $18 | $22 | $34 | $47 | $57 | $66 |
| Prophylaxis - Child (D1120) | $0 | $14 | $17 | $26 | $36 | $44 | $51 |
| Topical Fluoride (D1206) | $0 | $12 | $15 | $23 | $32 | $39 | $45 |
| Sealant - per tooth (D1351) | $0 | $11 | $13 | $20 | $28 | $34 | $39 |
* Extensive Dental procedures will require deposits over and above the Sliding Fee Scale on an individual basis.
- For family units with more than 8 members, add $5,500 for each additional member pursuant to the scale.
- All persons must show valid ID (example: Driver license, Passport, NY Resident ID, Valid Employment Card, etc.)
- All persons must show proof of income (examples are: Most recent tax returns, Pay stubs (3 most recent), Letter from employer stating annual income).
- Patients without valid proof of income will be assessed and billed for the full fee until income is verified.
- Persons with income above 200% of the Federal poverty level will be assessed and charged the full fee.
- It is the policy of B.M.S. Family Health & Wellness Center to provide medically necessary services regardless of the patient's ability to pay.
- The above scale does not include laboratory and other ancillary charges.
- Dental visits may cover more than one service.
