Sliding scale therapy
A sliding scale is a fee that goes down with your income. Some places are required to offer one; for most private therapists it is a choice. Here is how to tell the difference and how to ask.
Last reviewed against the public health sources linked on this page on .
Where a sliding fee is required
HRSA-funded community health centers, and FQHC Look-Alikes, must offer a sliding fee discount based on income and family size, with a full discount at or below 100% of the federal poverty guidelines (a nominal charge is allowed) and partial discounts up to 200% (HRSA Compliance Manual, Chapter 9 (opens in a new tab)). Some health centers provide mental health care; use HRSA’s Find a Health Center (opens in a new tab) and ask.
Private therapists
For private practices, a sliding scale is voluntary. NIMH suggests asking any prospective therapist whether they have a sliding scale for fees according to income. Ask what income information they need, what the lowest fee is, and whether a reduced fee is limited to a number of sessions.
How to ask
- “Do you offer a sliding scale, and what is the range?”
- “What do you need from me to qualify?”
- “Is the reduced fee reviewed or time-limited?”
- “If you are full, can you recommend a training clinic or community health center?”
Common questions
- Do I have to prove my income for a sliding scale?
- Often, yes, but policies vary. Health centers set their own documentation rules within HRSA’s program; private therapists set their own.
- Is sliding scale therapy lower quality?
- The fee does not change the clinician’s licence or training. Ask about credentials and approach the same way you would at any price.
Sources
- Health Center Program Compliance Manual, Chapter 9: Sliding Fee Discount Program (opens in a new tab) — HRSA Bureau of Primary Health Care
- Find a Health Center (opens in a new tab) — Health Resources and Services Administration (HRSA)
- Psychotherapies (opens in a new tab) — National Institute of Mental Health (NIMH)
Questions about this page
Tell us if something here is unclear or a source has changed. This form cannot match you with a therapist or answer questions about your own care. In crisis? Call or text 988 (Suicide & Crisis Lifeline), or text HOME to 741741.
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Last reviewed against the public health sources linked on this page on .
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